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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THE LARGEST PHARMACY CONFERENCE IN CANADA • LE PLUS GRAND CONGRÈS EN PHARMACIE AU CANADA<br />
January 30-February 3, 2010<br />
30 janvier - 3 février 2010<br />
The Sheraton Centre Toronto Hotel<br />
123 Queen Street West<br />
Toronto, ON<br />
ANNUAL PROFESSIONAL PRACTICE CONFERENCE<br />
CONFÉRENCE ANNUELLE SUR LA PRATIQUE PROFESSIONNELLE<br />
<strong>Final</strong> <strong>Program</strong><br />
<strong>Program</strong>me final
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 2011 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 which include measurable targets to establish baseline<br />
and monitor progress, and can be reviewed & revised as practice goals<br />
and guidelines change<br />
● Baseline data and progress will be obtained – the <strong>Hospital</strong> Pharmacy in<br />
Canada 2007/2008 report (www.lillyhospitalsurvey.ca) will include a<br />
special CSHP 2015 section in the next edition<br />
CSHP<br />
Targeting Excellence in Pharmacy Practice<br />
Goals<br />
1Increase the extent to which pharmacists help individual hospital<br />
inpatients achieve the best use <strong>of</strong> medications<br />
2Increase the extent to which pharmacists help individual<br />
non-hospitalized patients achieve the best use <strong>of</strong> medications<br />
3Increase 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 />
4Increase 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 />
5Increase the extent to which hospitals and related healthcare settings<br />
apply technology effectively to improve the safety <strong>of</strong> medication use<br />
6Increase 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 />
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 2011 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 />
● Les données de référence et d’état d’avancement seront collectées; en<br />
effet, la prochaine édition du rapport découlant du sondage sur les<br />
pharmacies hospitalières canadiennes (www.lillyhospitalsurvey.ca)<br />
comprendra une section spéciale sur le projet SCPH 2015<br />
SCPH<br />
Point de mire sur l’excellence en pratique pharmaceutique<br />
Buts<br />
1Élever le degré auquel les pharmaciens aident les patients<br />
hospitalisés à bénéficier d’une meilleure utilisation des médicaments<br />
2Élever le degré auquel les pharmaciens aident les patients non<br />
hospitalisés à bénéficier d’une meilleure utilisation des médicaments<br />
3Élever le degré auquel les pharmaciens des établissements de santé<br />
mettent activement en application les méthodes fondées sur des<br />
données probantes en vue d’améliorer la pharmacothérapie<br />
4Élever le degré auquel les services de pharmacie des établissements<br />
de santé jouent un rôle prépondérant dans l’amélioration de<br />
l’utilisation sécuritaire des médicaments<br />
5Élever le degré auquel les établissements de santé emploient<br />
efficacement la technologie en vue d’améliorer l’utilisation sécuritaire<br />
des médicaments<br />
6Élever le degré auquel les services de pharmacie des établissements<br />
de santé collaborent aux interventions de santé publique pour leurs<br />
communautés<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> <strong>Hospital</strong><br />
<strong>Pharmacists</strong> (CSHP), it is our pleasure to welcome you to CSHP’s 41st Annual<br />
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 <strong>of</strong><br />
specialties, management issues and pharmacy practice-related challenges. This<br />
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 2010<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 a few<br />
minutes and stop by the CSHP booth during the exhibits program and say hello.<br />
We look forward to welcoming each <strong>of</strong> you to another spectacular conference.<br />
Thank you for your ongoing support <strong>of</strong> CSHP!<br />
Jason Howorko<br />
BSc, BSP, ACPR<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 des<br />
pharmaciens d’hôpitaux (SCPH), nous avons le plaisir de vous souhaiter la<br />
bienvenue à la 41e 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 s’est<br />
affairé à rassembler un groupe impressionnant de conférenciers spécialisés en<br />
pharmacie et à vous préparer un programme d’une valeur éducative<br />
exceptionnelle avec des sujets touchant un large éventail de spécialités, de<br />
questions relatives à la gestion et de défis posés à la pratique pharmaceutique.<br />
Ce congrès est destiné à maximiser les possibilités de perfectionnement<br />
pr<strong>of</strong>essionnel, de réseautage et de rencontre avec d’autres praticiens de toutes<br />
les régions du pays. Nous espérons que vous pourrez tirer pleinement pr<strong>of</strong>it de<br />
ce que nous vous <strong>of</strong>frons en 2010 – tout en vous divertissant.<br />
Nous vous rappelons qu’au cours du congrès, la Direction et le personnel de la<br />
SCPH seront à votre entière disposition. Nous ferons tout en notre pouvoir pour<br />
répondre à vos questions, discuter des sujets qui vous préoccupent et vous aider<br />
au besoin de quelques manières que ce soit. Pendant le salon des exposants,<br />
assurez-vous d’effectuer un arrêt au stand de la SCPH afin de nous saluer!<br />
Nous sommes impatients de vous accueillir à cet autre congrès exceptionnel et<br />
vous remercions de votre appui soutenu à la SCPH.<br />
Jason Howorko<br />
BSc, BSP, ACPR<br />
Président de la SCPH<br />
Myrella Roy<br />
B. Sc. Phm., Pharm. D., FCCP<br />
Directrice générale
6<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 2009 Commanditaires de la SCPH en 2009 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 />
2009/2010 Awards Committee Comité des prix 2009-2010 11<br />
2009/2010 Awards <strong>Program</strong> <strong>Program</strong>me des prix 2009-2010 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 14<br />
<strong>Program</strong><br />
<strong>Program</strong>me<br />
<strong>Program</strong> <strong>of</strong> Events <strong>Program</strong>me des événements 15<br />
Speakers Abstracts Résumés des conférenciers 23<br />
SES 2010 Call for Abstracts Demande de résumés pour les SÉÉ 2010 45<br />
Poster Abstracts Résumés des affiches 48<br />
Poster Abstract Reviewers Réviseurs des présentations par affiches 62<br />
CSHP Fellows Associés de la SCPH 63<br />
Faculty Conférenciers 65<br />
Exhibitor List Liste des exposants 67
Executive Committee • Bureau de direction<br />
President<br />
Président<br />
Jason Howorko<br />
Alberta Health Services<br />
Pharmacy Services –<br />
Central Zone (West)<br />
Red Deer Regional<br />
<strong>Hospital</strong> Centre<br />
Red Deer, AB<br />
President Elect<br />
Président désigné<br />
Neil MacKinnon<br />
Dalhousie University<br />
Halifax, NS<br />
Past President<br />
Président sortant<br />
Richard Jones<br />
London Health Sciences<br />
Centre<br />
London, ON<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 />
7<br />
Council • Conseil<br />
British Columbia<br />
Colombie-Britannique<br />
Janice Munroe<br />
Fraser Health Authority<br />
Langley, BC<br />
Alberta<br />
Sheri Koshman<br />
University <strong>of</strong> Alberta<br />
Calgary, AB<br />
Saskatchewan<br />
Donald Kuntz<br />
Regina Qu’Appelle Health<br />
Region<br />
Regina, SK<br />
Manitoba<br />
Albert Eros<br />
Winnipeg Regional Health<br />
Authority<br />
Winnipeg, MB<br />
Ontario –<br />
Senior/Principale<br />
Carolee Awde-Sadler<br />
Peterborough Regional<br />
Health Centre<br />
Peterborough, ON<br />
Ontario –<br />
Junior/Débutante<br />
Rita Dhami<br />
London Health Sciences<br />
Centre<br />
London, ON<br />
Quebec<br />
Québec<br />
Martin Franco<br />
Hôpital<br />
Maisonneuve-Rosemont<br />
Montréal, QC<br />
New Brunswick<br />
Nouveau-Brunswick<br />
Leslie Manuel<br />
The Moncton <strong>Hospital</strong><br />
Saint John, NB<br />
Nova Scotia<br />
Nouvelle-Écosse<br />
Rosemary Hayter<br />
Pictou County Health<br />
Authority<br />
New Glasgow, NS<br />
Prince Edward Island<br />
Île-du-Prince-Édouard<br />
Iain Smith<br />
Queen Elizabeth <strong>Hospital</strong><br />
Charlottetown, PE<br />
Newfoundland and<br />
Labrador<br />
Terre-Neuve-et-Labrador<br />
Tiffany Fahey<br />
General <strong>Hospital</strong>, Health<br />
Sciences Centre<br />
St. John’s, NL<br />
Student Delegate<br />
Déléguée des étudiants<br />
Anna Huisman<br />
University <strong>of</strong> Toronto<br />
Toronto, ON<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 />
Janet Lett<br />
Conference Administrator<br />
Agente des congrès<br />
Desarae Davidson<br />
Awards/PSN Administrator<br />
Agente des prix et des RSP<br />
Colleen Drake<br />
Membership Administrator<br />
Agente du service aux<br />
membres<br />
Robyn Rockwell<br />
CHPRB Administrator<br />
Agente du CCRPH<br />
Gloria Day<br />
Finance Administrator<br />
Agente des finances<br />
Anna Dudek<br />
Publications Administrator<br />
Agente des publications<br />
Sonya Long<br />
Web Administrator<br />
Agente du Web<br />
Olga Chrzanowska<br />
Ontario Branch and Board<br />
<strong>of</strong> Fellows Administrator<br />
Agente de la section de<br />
l’Ontario et du Conseil des<br />
associés<br />
Susan Korporal<br />
Office Clerk<br />
Commis de bureau<br />
Julie Maillet<br />
CSHP 2015 Project<br />
Coordinator (Casual)<br />
Coordonnatrice du projet<br />
SCPH 2015 (occasionnelle)<br />
Barbara Wells
8<br />
CORPORATE MEMBERS • ENTREPRISES MEMBRES<br />
2009-2010 CSHP Industry Corporate<br />
Members<br />
(At time <strong>of</strong> printing)<br />
2009-2010 Entreprises membres du<br />
secteur de l’industrie<br />
(au moment de l’impression)<br />
Amerisource Bergen Canada<br />
Amgen Canada Inc.<br />
AstraZeneca Canada Inc.<br />
Baxter Corporation (Canada)<br />
Bayer Inc.<br />
<strong>Canadian</strong> Pharmaceutical Distribution Network<br />
Cardinal Health Canada<br />
Eli Lilly Canada Inc.<br />
Galenova Inc.<br />
Healthmark Ltd.<br />
Hospira Healthcare Corporation<br />
LEO Pharma Inc.<br />
McKesson Canada Corporation<br />
Novartis Pharma Canada Inc.<br />
Omega Laboratories Limited<br />
Pfizer Canada Inc.<br />
Pharmaceutical Partners <strong>of</strong> Canada Inc.<br />
Pharmascience Inc.<br />
Sandoz Canada Inc.<br />
San<strong>of</strong>i-aventis Canada Inc.<br />
Shoppers Drug Mart Specialty Health Network<br />
Stragen Inc.<br />
Teva Novopharm<br />
2009-2010 CSHP <strong>Hospital</strong> Corporate<br />
Members<br />
(At time <strong>of</strong> printing)<br />
2009-2010 Entreprises membres du<br />
secteur hospitalier<br />
(au moment de l’impression)<br />
Children’s <strong>Hospital</strong> <strong>of</strong> Eastern Ontario (CHEO)<br />
Horizon Health Network<br />
Lakeridge Health<br />
London Health Sciences Centre<br />
St. Michael’s <strong>Hospital</strong><br />
The Royal Victoria <strong>Hospital</strong> <strong>of</strong> Barrie<br />
University Health Network<br />
Vancouver Coastal Health/Providence Health Care Pharmacy<br />
Services<br />
Vancouver Island Health Authority
CSHP Sponsors 2009<br />
The following list reflects all CSHP<br />
Sponsorship received from January 1 to<br />
December 31, 2009.<br />
Platinum Sponsor<br />
Commanditaires platine<br />
$20,000 - $39,999<br />
• Abbott Laboratories Ltd.<br />
Bronze Sponsor<br />
Commanditaires bronze<br />
$1,000 - $4,999<br />
• GlaxoSmithKline Canada Inc.<br />
9<br />
Commanditaires de la<br />
SCPH en 2009<br />
La liste suivante reflète toutes les<br />
commandites reçues du premier janvier<br />
au 31 décembre 2009.<br />
• Baxter Corporation<br />
• Boehringer-Ingelheim Canada Ltd.<br />
• Merck Frosst Canada Ltd.<br />
• Novartis Pharma Canada<br />
• san<strong>of</strong>i-Aventis Canada Inc.<br />
• HealthPro<br />
• H<strong>of</strong>fmann-La Roche Limited<br />
• McKesson Canada<br />
• Ontario College <strong>of</strong> <strong>Pharmacists</strong><br />
• Omega Laboratories Limited<br />
• Shoppers Drug Mart Specialty Health<br />
Diamond Sponsor<br />
Commanditaires diamant<br />
$40,000 or greater<br />
40 000 $ et plus<br />
Gold Sponsor<br />
Commanditaires or<br />
$10,000 - $19,999<br />
• Bayer Inc.<br />
Donor Sponsor<br />
Commanditaires donateurs<br />
$100 - $999<br />
• <strong>Canadian</strong> Patient Safety Institute<br />
• Calea Ltd.<br />
CANADA’S PHARMACEUTICAL COMPANY<br />
• Hospira Healthcare Corporation<br />
• Pharmascience<br />
• <strong>Canadian</strong> Agency for Drug<br />
Technologies in Health<br />
• Cardinal Health<br />
Silver Sponsor<br />
Commanditaires argent<br />
$5,000 - $9,999<br />
• Amgen Canada Inc<br />
• Astellas Canada<br />
• Eli Lilly Canada Inc.<br />
• LEO Pharma Inc.<br />
• Mylan Pharmaceuticals<br />
• <strong>Canadian</strong> Forces Pharmacy<br />
• Galenova<br />
• Healthmark<br />
• Health Match BC<br />
• Lexicomp<br />
• Sepracor<br />
• Uman<br />
• Servier Canada Inc.<br />
• Schering-Plough Canada Inc.<br />
• Wyeth Pharmaceuticals
10<br />
Distinguished Service<br />
Award<br />
Prix pour service distingué<br />
Sponsored by Ortho Biotech Division <strong>of</strong><br />
Janssen-Ortho Inc.<br />
$1,500<br />
This award recognizes outstanding<br />
achievement in hospital pharmacy<br />
practice.<br />
Individuals are nominated by their<br />
peers.<br />
2010 Winner<br />
Emily Musing<br />
Past Winners<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 />
Isabel E. Stauffer<br />
Meritorious Service Award<br />
Prix Isabel E. Stauffer<br />
pour service méritoire<br />
Sponsored by Pharmaceutical Partners<br />
<strong>of</strong> Canada Inc.<br />
$1,500<br />
This award recognizes prolonged<br />
service and involvement in CSHP,<br />
primarily at the branch or chapter level.<br />
Individuals are nominated by their<br />
peers.<br />
2010 Winner<br />
Victoria Sills<br />
Past Winners<br />
2009 Lynda Chilbeck<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 praticien<br />
en pharmacie hospitalière<br />
Sponsored by Sandoz Canada Inc.<br />
$1,500 x 2<br />
This award acknowledges new hospital<br />
pharmacy practitioners, who through<br />
their service to patient care, to<br />
education or research, to the pr<strong>of</strong>ession<br />
and to the society, are worthy <strong>of</strong><br />
recognition. The individuals exhibit<br />
promising leadership, dedication and<br />
commitment to practice excellence and<br />
pr<strong>of</strong>essional growth.<br />
2010 Winners<br />
Erin Cashin & Rochelle Gellatly<br />
Past Winners<br />
2009 Eva Cho & Lynette Kolodziejak<br />
2008 Yvonne Kwan &<br />
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 <strong>Canadian</strong><br />
Association <strong>of</strong> Pharmacy Students<br />
and Interns<br />
$500<br />
This award recognizes pharmacy<br />
students who show promise as future<br />
hospital pharmacy practitioners through<br />
their student activities or their<br />
experiential training in direct patient<br />
care, research or education. The<br />
winners exhibit eagerness, dedication<br />
and a positive attitude toward the<br />
academic learning, the practice, and the<br />
pr<strong>of</strong>ession <strong>of</strong> hospital pharmacy.<br />
2010 Winner<br />
Christine Leong<br />
Past Winners<br />
2009 Amy Grossberndt<br />
2008 Omolayo O. Famuyide<br />
2007 Cathryn Sibbald<br />
2006 Justin Lee
2009-2010 Awards Committee<br />
Comité des prix 2009-2010<br />
Sincere appreciation is extended to the CSHP National Awards<br />
Committee.<br />
Chairperson<br />
Présidente<br />
Rosemary Zvonar<br />
Members<br />
Membres<br />
Mario Bédard<br />
Caroline Cheng<br />
Geneviève Goulet<br />
Alexander Kuo<br />
Kurt Schroeder<br />
2009-2010 Awards <strong>Program</strong><br />
<strong>Program</strong>me des prix 2009-2010<br />
The CSHP general awards program will be presented under six<br />
categories with eleven sponsors as listed below. The redesign<br />
was implemented last year. This was a recommendation by the<br />
Members Rewards and Recognition Task Force in order to<br />
update the program, increase accessibility and foster innovative<br />
pharmacy practice.<br />
Management and<br />
Leadership Best Practices<br />
Award<br />
Sponsored by:<br />
Apotex Inc...................$1,500<br />
Hospira Healthcare<br />
Corporation ................$1,500<br />
Patient Care<br />
Enhancement Award<br />
Sponsored by:<br />
AstraZeneca Canada Inc.<br />
$1,500<br />
TEVA Novopharm ........$1,500<br />
Pharmacotherapy Best<br />
Practices Award<br />
Sponsored by:<br />
Merck Frosst Canada Ltd.<br />
$1,500<br />
Pfizer Canada Inc. .......$1,500<br />
Safe Medication<br />
Practices Award<br />
Sponsored by:<br />
Baxter Corporation .....$1,500<br />
Hospira Healthcare<br />
Corporation ................$1,500<br />
Specialties in Pharmacy<br />
Practice Award<br />
Sponsored by:<br />
Bristol-Myers Squibb Canada<br />
$1,500<br />
Hospira Healthcare<br />
Corporation ................$1,500<br />
Teaching, Learning, and<br />
Education Award<br />
Sponsored by:<br />
Eli Lilly Canada Inc. ....$1,500<br />
2009-2010 Tribute to CSHP National Award<br />
Appraisers<br />
Hommage aux évaluateurs<br />
Award appraisers are an integral part <strong>of</strong> the CSHP National<br />
Awards program. We would like to extend our sincere thanks to<br />
the individuals listed below who volunteered their time to<br />
review this year’s award submissions. We are very grateful to<br />
you for sharing your time and expertise in support <strong>of</strong> the CSHP<br />
Awards <strong>Program</strong>. Without your dedicated efforts on the<br />
<strong>Society</strong>’s behalf, the program would not exist.<br />
Shirin Abadi<br />
Alison Alleyne<br />
Mayce Al-Sukhni<br />
Tejinder Bains<br />
Céline Corman<br />
Lisa Dolovich<br />
Anar Dossa<br />
Douglas Doucette<br />
Rehana Durocher<br />
Dinie Engels<br />
Barb Evans<br />
Olavo Fernandes<br />
Michelle Foisy<br />
Susan Halasi<br />
Kathryn Hollis<br />
Nicholas Honcharik<br />
Christine Hughes<br />
Fong Huynh<br />
Cynthia Jackevicius<br />
Christopher Judd<br />
Jean-Yves Julien<br />
Zahra Kanji<br />
Sheri Koshman<br />
Cecilia Laskoski<br />
Jaclyn LeBlanc<br />
Larry Legare<br />
Adrienne Lindblad<br />
Anita Lo<br />
Peter Loewen<br />
Barry Lyons<br />
Janice Ma<br />
Mark Makowsky<br />
Swasti Mathur<br />
Lisa McCarthy<br />
Karen McDermaid<br />
Kevin McDonald<br />
Tania Mysak<br />
Carmine Nieuwstraten<br />
Harjinder Parwana<br />
Glen Pearson<br />
Co. Q.D. Pham<br />
Patti Pracsovics<br />
Cheryl Sadowski<br />
Roy Steeves<br />
Sana Rikabi Sukkari<br />
Daniel Thirion<br />
Joyce Totton<br />
Bertha (Mary) White<br />
Kerry Wilbur<br />
Sharon Yamashita<br />
Peter Zed<br />
If you are interested in acting as an appraiser for the 2010-2011<br />
Awards <strong>Program</strong>, please contact Colleen Drake at the National<br />
<strong>of</strong>fice by phone at 613-736-9733, ext. 224, or by e-mail at<br />
cdrake@cshp.ca.<br />
11
12<br />
Upcoming Events<br />
Événements à venir<br />
Pr<strong>of</strong>essional Practice Conference<br />
(PPC):<br />
January 29 – February 2, 2011<br />
Sheraton Centre Toronto Hotel<br />
January 30 – February 3, 2012<br />
Sheraton Centre Toronto Hotel<br />
January 29 – February 2, 2013<br />
Sheraton Centre Toronto Hotel<br />
February 4 – 8, 2014<br />
Sheraton Centre Toronto Hotel<br />
Summer Educational Sessions (SES):<br />
August 7 – 10, 2010<br />
Marriott Halifax Harbourfront<br />
Halifax, Nova Scotia<br />
August 6 – 9, 2011<br />
Sheraton Wall Centre<br />
Vancouver, British Columbia<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 5 – 12, 2014<br />
Delta Newfoundland Hotel<br />
St. John’s, Newfoundland & Labrador<br />
Attendance at CSHP conferences, PPC<br />
and SES, are approximately 650 and<br />
250 respectively, excluding exhibitors.<br />
Please note we <strong>of</strong>fer an exhibit program<br />
at both events.<br />
For further information,<br />
please contact Desarae Davidson,<br />
Conference Administrator at the<br />
CSHP National Office.<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<br />
their participation in conjunction with<br />
the PPC 2010.<br />
Sunday January 31 (12:30-14:00)<br />
• Boehringer-Ingelheim Canada Inc.<br />
• Abbott Laboratories<br />
• Merck Frosst Canada Inc.<br />
Monday February 1 (17:30-19:30)<br />
• LEO Pharma Inc.<br />
• Pfizer Canada<br />
Tuesday February 2 (06:30-08:00)<br />
• Pfizer Canada<br />
Tuesday February 2 (17:30-19:30)<br />
• AstraZeneca Canada Inc.<br />
• Pfizer Canada<br />
Wednesday February 3 (12:40-14:10)<br />
• AstraZeneca Canada Inc.<br />
• San<strong>of</strong>i-aventis Canada Inc.<br />
See the program section for more<br />
details.<br />
Satellite<br />
Symposium<br />
SPONSORSHIP<br />
OPPORTUNITY<br />
63rd Summer Educational Sessions<br />
Marriott Halifax<br />
Harbourfront<br />
August 7 to 10, 2010<br />
Breakfast and<br />
Luncheon Availability<br />
For more information please contact<br />
Desarae Davidson<br />
Conference Administrator<br />
(613) 736-9733, ext. 229 or<br />
ddavidson@cshp.ca
August, 2010<br />
Hello from SES!<br />
Having a great time<br />
in Halifax. The food<br />
has been excellent<br />
(especially the<br />
lobster)! Tonight, for<br />
Fun Night, we are<br />
headed out on the<br />
harbour. It should be<br />
a blast.<br />
P.S. The CEs are<br />
great too :-)<br />
Pharmacy Manager<br />
c/o Pharmacy Dept.<br />
Somewhere in Canada<br />
www.destinationhalifax.com/CSHP2010<br />
Photo credit:<br />
Destination Halifax
14<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, Alberta<br />
Members • Membres<br />
Trudy Arbo, PharmD<br />
Alberta Health Services – Cancer Care<br />
Calgary, AB<br />
Toni Bailie, BScPhm<br />
Mount Sinai <strong>Hospital</strong><br />
Toronto, ON<br />
Carolyn Bubbar, PharmD<br />
Surrey, BC<br />
Claudia Bucci, PharmD<br />
Sunnybrook Health Sciences Centre<br />
Toronto, ON<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 />
Rochelle Gellatly, PharmD<br />
Providence Health Care<br />
Vancouver, BC<br />
Alfred Gin, PharmD, FCSHP<br />
Health Sciences Centre<br />
Winnipeg, MB<br />
Brenda Kisic, BScPhm<br />
University Health Network<br />
Toronto, ON<br />
Jeff Nagge, PharmD<br />
Centre for Family Medicine<br />
Kitchener, ON<br />
Payal Patel, PharmD<br />
Thames Valley Family Health Team<br />
London, ON<br />
Co Pham, PharmD<br />
Health Canada<br />
Ottawa, ON<br />
Kat Timberlake, PharmD<br />
The <strong>Hospital</strong> for Sick Children<br />
Toronto, ON<br />
The Educational Services Committee<br />
(ESC) <strong>of</strong> CSHP has been working for<br />
approximately 10 months on the content<br />
and format <strong>of</strong> PPC 2010. The committee<br />
also works on the Summer Educational<br />
Sessions, in conjunction with the local<br />
host task force and the national <strong>of</strong>fice.<br />
The ESC is comprised <strong>of</strong> a core<br />
committee <strong>of</strong> 15 hospital pharmacists as<br />
well as 8 corresponding members from<br />
the CSHP branches.<br />
Goal and Objectives for the 2010<br />
PPC <strong>Program</strong><br />
Goal:<br />
• To provide registrants with quality<br />
educational sessions.<br />
Objectives:<br />
• To provide registrants with<br />
educational sessions which inform,<br />
educate and motivate clinical<br />
practitioners and managers.<br />
• To provide leadership in hospital<br />
pharmacy practice by presenting<br />
sessions on innovative pharmacists’<br />
roles, pharmacy practice and<br />
pharmacy 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, poster sessions and<br />
interactive facilitated discussions.<br />
• To promote excellence in pharmacy<br />
practice through oral and poster<br />
presentations on original work and<br />
award winning projects.<br />
• To provide an opportunity for<br />
Pharmacy Specialty Networks to meet.<br />
Le Comité des services éducatifs<br />
travaille depuis près de 10 mois à<br />
l’élaboration du contenu et de la<br />
forme de la CPP 2010. Le Comité<br />
prépare aussi les Séances éducatives<br />
d’été de la SCPH en collaboration avec<br />
le Groupe de travail hôte local et le<br />
personnel de la SCPH. Le Comité<br />
comprend 15 membres principaux et<br />
8 membres orrespondants des sections<br />
de la SCPH.<br />
But et objectifs du programme<br />
de la CPP 2010<br />
But :<br />
• Présenter des conférences éducatives<br />
de qualité aux participants.<br />
Objectifs :<br />
• Présenter aux personnes inscrites des<br />
conférences éducatives susceptibles<br />
d’informer, d’instruire et de motiver<br />
les cliniciens et les gestionnaires.<br />
• Orienter la pratique de la pharmacie<br />
hospitalière en présentant des<br />
conférences sur les nouveautés<br />
touchant le rôle du pharmacien, la<br />
pratique de la pharmacie et les<br />
programmes de 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<br />
pratique de la pharmacie par des<br />
présentations orales et des séances<br />
d’affichage sur des travaux originaux<br />
et des projets primés.<br />
• Donner l’occasion aux réseaux de<br />
spécialistes en pharmacie de se<br />
réunir.
<strong>Program</strong><br />
<strong>Program</strong>me<br />
Saturday, January 30 • Samedi 30 janvier<br />
15:00-17:00 Registration<br />
Inscription<br />
CONCOURSE COATCHECK<br />
Sunday, January 31 • Dimanche 31 janvier<br />
07:30-17:00 Registration<br />
Inscription<br />
CONCOURSE COATCHECK<br />
08:00-08:15 Opening Remarks<br />
Remarques préliminaires<br />
DOMINION BALLROOM<br />
08:15-09:45 Pharmacy Issues and Controversies Forum –<br />
Panel Discussion<br />
Forum sur des questions et controverses en<br />
pharmacie – Panel<br />
DOMINION BALLROOM<br />
Technology and Pharmacy: Threat or<br />
Opportunity?<br />
Olavo Fernandes, PharmD, FCSHP – Moderator<br />
University Health Network<br />
Toronto, ON<br />
Kori Leblanc, PharmD<br />
University Health Network<br />
Toronto, ON<br />
Dante Morra, MD, MBA, FRCP(C)<br />
University Health Network<br />
Toronto, ON<br />
Peter Loewen, PharmD, FCSHP<br />
Vancouver Coastal Health<br />
Vancouver, BC<br />
Thomas Paton, PharmD<br />
Sunnybrook Health Sciences Centre<br />
Toronto, ON<br />
10:00-10:30 Break, Posters<br />
Pause, Affiches<br />
DOMINION FOYER/CHURCHILL ROOM<br />
10:45-11:30 Concurrent Sessions<br />
Séances concomitantes<br />
1. Cardiology Guideline Pearls: Top 1o Points<br />
DOMINION BALLROOM SOUTH<br />
Patrick Robertson, PharmD<br />
Saskatoon Health Region<br />
Saskatoon, SK<br />
2. Recent Advances in the Management <strong>of</strong><br />
Multiple Myeloma<br />
SIMCOE/DUFFERIN<br />
Tom Kouroukis, MD, MSc, FRCPC<br />
Juravinski Cancer Centre<br />
Hamilton, ON<br />
3. The Impact <strong>of</strong> Pharmacy Technician<br />
Regulations on <strong>Hospital</strong> Pharmacy<br />
CITY HALL<br />
Marita Tonkin, PharmD<br />
Hamilton Health Sciences Centre<br />
Hamilton, ON<br />
4. H1N1 Update: After the Wave<br />
CONFERENCE B/C<br />
Alfred Gin, PharmD<br />
Health Sciences Centre<br />
Winnipeg, MB<br />
11:40-12:25 Concurrent Sessions<br />
Séances concomitantes<br />
1. Update on Clinical Practice Guidelines for<br />
the Management <strong>of</strong> Catheter-Related<br />
Infections<br />
CITY HALL<br />
Linda Dresser, PharmD<br />
University Health Network<br />
Toronto, ON<br />
Update on Clinical Practice Guidelines for<br />
Candidiasis<br />
Alfred Gin, PharmD<br />
Health Sciences Centre Winnipeg<br />
Winnipeg, MB<br />
2. Accreditation: How Can it Impact Your<br />
Practice and Patient Safety Results?<br />
SIMCOE/DUFFERIN<br />
Janice Munroe, BScPhm<br />
Fraser Health Authority<br />
Langley, BC<br />
Julie Langlois<br />
Accreditation Canada<br />
Ottawa, ON<br />
3. Prioritizing Clinical Pharmacy Services<br />
DOMINION BALLROOM SOUTH<br />
Stephen Shalansky, PharmD, FCSHP<br />
Providence Healthcare<br />
Vancouver, BC<br />
4. Reversing Anticoagulation: Implications<br />
for <strong>Pharmacists</strong><br />
CONFERENCE B/C<br />
Natalie Crown, PharmD<br />
London Health Sciences Centre<br />
London, ON<br />
12:30-14:00 Satellite Symposiums<br />
(luncheon included)<br />
Symposiums satellites<br />
(déjeuner inclus)<br />
15
16<br />
1. The Light at the End <strong>of</strong> the Tunnel:<br />
Emerging Alternatives to Warfarin<br />
ESSEX BALLROOM<br />
Tammy Bungard, BSP, PharmD<br />
University <strong>of</strong> Alberta<br />
Edmonton, AB<br />
Hosted by Boehringer-Ingelheim Canada Ltd.<br />
2. <strong>Hospital</strong>ization in Inflammatory Bowel<br />
Disease: Past, Present and Future<br />
CIVIC BALLROOM SOUTH<br />
Anti-TNF Agents in IBD:<br />
A <strong>Hospital</strong> Pharmacy Perspective<br />
Eva Cohen, BPharm, DPH<br />
Jewish General <strong>Hospital</strong><br />
Montréal, QC<br />
<strong>Hospital</strong>ization in IBD:<br />
Focus on Anti-TNF Agents<br />
John K. Marshall, MD, MSc, FRCPC, AGAF<br />
McMaster University<br />
Hamilton, ON<br />
Hosted by Abbott Laboratories<br />
3. Helping You to Help Your Patients with<br />
Type 2 Diabetes<br />
DOMINION BALLROOM NORTH<br />
Robert Roscoe, BScPhm<br />
Saint John Regional <strong>Hospital</strong><br />
Saint John, NB<br />
Karen McDermaid, BSc, BSP<br />
Regina Qu’Appelle Health Region<br />
Regina, SK<br />
Hosted by Merck Frosst Canada Ltd.<br />
14:10-16:10 Workshops & PSN Sessions<br />
Ateliers et séances des RSP<br />
1. Evidence-Based Medicine for the Busy<br />
Clinician<br />
CONFERENCE B/C<br />
Trudy Arbo, PharmD<br />
Alberta Health Services - Cancer Care<br />
Calgary, AB<br />
2. Be All That You Can Be: Start Your Own<br />
Residency <strong>Program</strong><br />
CITY HALL<br />
Allan Mills, PharmD, FCSHP<br />
Trillium Health Centre<br />
Mississauga, ON<br />
Anjana Sengar, BScPhm<br />
Trillium Health Centre<br />
Mississauga, ON<br />
Anna Chiu, BScPhm<br />
Trillium Health Centre<br />
Mississauga, ON<br />
3. Cardiology PSN<br />
RSP en cardiologie<br />
DOMINION BALLROOM SOUTH<br />
Drug Interaction Between Clopidogrel and<br />
Proton Pump Inhibitors: Fact!<br />
Uchenwa Genus, BScPhm<br />
York Central <strong>Hospital</strong><br />
Richmond Hill, ON<br />
Clopidogrel and Proton Pump Inhibitor<br />
Drug Interaction: Fact or Fiction? Fiction:<br />
What Drug Interaction?<br />
Doson Chua, PharmD, BCPS(AQ)<br />
St. Paul’s <strong>Hospital</strong>, Providence Healthcare<br />
Vancouver, BC<br />
Update on Antiplatelets and<br />
Anticoagulants for Atrial Fibrillation<br />
Jin-Hyeun Huh, BScPhm<br />
Toronto Western <strong>Hospital</strong><br />
Toronto, ON<br />
4. Neuroscience PSN<br />
RSP en neurosciences<br />
WINDSOR<br />
Review <strong>of</strong> Myasthenia Gravis: Moving<br />
Beyond “That's All Greek (and Latin)<br />
to Me”<br />
Karen Tulloch, PharmD<br />
Vancouver Coastal Health<br />
Vancouver, BC<br />
Discussion Forum on the Management <strong>of</strong><br />
Chronic Daily Headache and Intractable<br />
Migraine in <strong>Hospital</strong><br />
Linda Methot, BScPhm<br />
Kingston General <strong>Hospital</strong><br />
Kingston, ON<br />
5. <strong>Pharmacists</strong>-in-Training PSN/OPRA<br />
RSP des pharmaciens en<br />
apprentissage/OPRA<br />
SIMCOE/DUFFERIN<br />
Where Can Pharmacy Take Me? Exploring<br />
Unique Pharmacy Career Opportunities –<br />
Panel Discussion<br />
Christine Mitry, BScPhm – Moderator<br />
University Health Network<br />
Toronto, ON<br />
Diana Spizzirri, RPh, BScPhm<br />
Ontario College <strong>of</strong> <strong>Pharmacists</strong><br />
Toronto, ON<br />
Heather Kertland, PharmD<br />
St. Michael’s <strong>Hospital</strong><br />
Toronto, ON<br />
Cynthia Jackevicius, PharmD, FCSHP<br />
Western University <strong>of</strong> Health Sciences<br />
Los Angeles, CA<br />
16:15-17:45 Awards Ceremony<br />
Cérémonie de remise des prix<br />
ESSEX BALLROOM<br />
Everyone welcome<br />
Bienvenue à tous
18:00-19:30 Career Opportunities Evening<br />
Soirée de perspectives d’emploi<br />
GRAND BALLROOM EAST<br />
Monday, February 1 • Lundi 1 er février<br />
07:30-17:00 Registration<br />
Inscription<br />
CONCOURSE COATCHECK<br />
08:00-08:15 Opening Remarks<br />
Remarques préliminaires<br />
DOMINION BALLROOM<br />
08:15-09:45 Pharmaceutical Care: Practice Change and<br />
Reaching a Unified Practice<br />
DOMINION BALLROOM<br />
Linda Strand, PharmD, PhD, DSc(Hon)<br />
Medication Management Systems Inc.<br />
Minneapolis, MN<br />
New Fellows Presentation<br />
Présentation des nouveaux membres<br />
associés<br />
09:45-10:15 Break, Exhibits, Posters<br />
Pause, Kiosques, Affiches<br />
SHERATON/OSGOODE HALLS<br />
10:30 – 12:10 Workshop (note length <strong>of</strong> session)<br />
Atelier (à noter : durée de la séance)<br />
Motivating Patients through Effective<br />
Communication: Motivational Interviewing<br />
ESSEX BALLROOM<br />
Christiane Mayer, BPharm<br />
Certificate in Psychology<br />
Université de Montréal<br />
Montréal, QC<br />
10:30-11:15 Concurrent Sessions<br />
Séances concomitantes<br />
1. Aspirin for Primary Prevention: A Sober<br />
Second Look<br />
DOMINION BALLROOM SOUTH<br />
Danette Beechinor, PharmD<br />
Centre for Family Medicine, Family Health<br />
Team<br />
Kitchener, ON<br />
2. Leadership Pearls<br />
CITY HALL<br />
Peter Zed, PharmD, FCSHP<br />
Capital Health<br />
Halifax, NS<br />
Jason Howorko, BSP<br />
Alberta Health Services<br />
Red Deer, AB<br />
3. Oral Presentations <strong>of</strong> Award-Winning<br />
Research and Pharmacy Practice Projects<br />
Présentations orales des projets de<br />
recherche et de pratique pharmaceutique<br />
primés<br />
SIMCOE/DUFFERIN<br />
4. The Marketed Health Products<br />
Directorate: Regulatory Oversight <strong>of</strong><br />
Health Product Advertising in Canada<br />
CONFERENCE B/C<br />
Ann Sztuke-Fournier, BPharm<br />
Health Canada<br />
Ottawa, ON<br />
11:25-12:10 Concurrent Sessions<br />
Séances concomitantes<br />
1. Managing Diabetes in a Cardiovascular<br />
Patient: Separating the “STICKY” from<br />
the “SWEET”<br />
CITY HALL<br />
Kori Leblanc, PharmD<br />
University Health Network<br />
Toronto, ON<br />
2. Reversing Anticoagulation: Implications<br />
for <strong>Pharmacists</strong> (encore)<br />
CONFERENCE B/C<br />
Natalie Crown, PharmD<br />
London Health Sciences Centre<br />
London, ON<br />
3. Oral Presentations <strong>of</strong> Award-Winning<br />
Research and Pharmacy Practice Projects<br />
Présentations orales des projets de<br />
recherche et de pratique pharmaceutique<br />
primés<br />
SIMCOE/DUFFERIN<br />
4. Hypertension: Guidelines, Updates,<br />
Outcomes, and What it All Means for<br />
<strong>Pharmacists</strong><br />
DOMINION BALLROOM SOUTH<br />
Ross Tsuyuki, PharmD, FCSHP<br />
University <strong>of</strong> Alberta<br />
Edmonton, AB<br />
5. Research and Education Foundation<br />
Research Grant Pearls<br />
Fondation pour la recherche et l’éducation<br />
Trésors des bourses de recherche<br />
WINDSOR<br />
Measurement <strong>of</strong> the Effect <strong>of</strong><br />
Discontinuing Bacl<strong>of</strong>en and Dantrolene<br />
Therapy in Long-Term Institutionalized<br />
Patients with Spasticity<br />
Barbara Farrell, PharmD, FCSHP<br />
Bruyère Continuing Care<br />
Ottawa, ON<br />
17
18<br />
Physical Compatibility <strong>of</strong> Drug Infusions<br />
used in <strong>Canadian</strong> Intensive Care Units<br />
Salmaan Kanji, PharmD<br />
Ottawa <strong>Hospital</strong> Research Institute<br />
Ottawa, ON<br />
12:15-13:50 Lunch, Exhibits, Posters<br />
Déjeuner, Kiosques, Affiches<br />
SHERATON/OSGOODE HALLS<br />
14:00-15:00 Here’s your Script ..... You’ll be fine: Barriers<br />
to Medication Adherence<br />
DOMINION BALLROOM<br />
Cynthia Jackevicius, PharmD, FCSHP<br />
Western University <strong>of</strong> Health Sciences<br />
Los Angeles, CA<br />
15:10-17:10 Workshops & PSN Sessions<br />
Ateliers et séances des RSP<br />
1. Pharmaceutical Care: How to Conduct an<br />
Assessment Care Plan and Follow-up<br />
Evaluation<br />
CONFERENCE B/C<br />
Linda Strand, PharmD, PhD, DSc(Hon)<br />
Medication Management Systems Inc.<br />
Minneapolis, MN<br />
2. Motivating Patients through Effective<br />
Communication: Motivational Interviewing<br />
(encore)<br />
CITY HALL<br />
Christiane Mayer, BPharm<br />
Certificate in Psychology<br />
Université de Montréal<br />
Montréal, QC<br />
3. Evidence-Based Medicine for the Busy<br />
Clinician (encore)<br />
SIMCOE/DUFFERIN<br />
Trudy Arbo, PharmD<br />
Alberta Health Services – Cancer Care<br />
Calgary, AB<br />
4. Primary Care PSN<br />
RSP en soins de santé primaires<br />
Business meeting to follow session<br />
WINDSOR<br />
Scanning the Horizon: The Evolving<br />
Provincial Approaches to <strong>Pharmacists</strong><br />
Working in Primary Care<br />
Lisa Dolovich, PharmD, MSc<br />
St. Joseph’s Healthcare<br />
Hamilton, ON<br />
Derek Jorgenson, PharmD<br />
University <strong>of</strong> Saskatchewan<br />
Saskatoon, SK<br />
5. Anticoagulation PSN<br />
RSP en anticoagulation<br />
DOMINION BALLROOM SOUTH<br />
Dabigatran and Rivaroxaban: Is it Time for<br />
a Warfarin-Ban?<br />
Jeff Nagge, PharmD<br />
University <strong>of</strong> Waterloo<br />
Kitchener, ON<br />
DVT Treatment Duration: Who to Treat for<br />
How Long<br />
Bill Bartle, PharmD, FCSHP<br />
Sunnybrook Health Sciences Centre<br />
Toronto, ON<br />
17:30-19:30 Satellite Symposiums<br />
(dinner included)<br />
Symposiums satellites<br />
(dîner inclus)<br />
1. Emerging Trends in Anticoagulation<br />
ESSEX BALLROOM<br />
Cyndy Brocklebank, PharmD<br />
Alberta Health Services<br />
Calgary, AB<br />
Hosted by LEO Pharma Inc.<br />
2. Break Free: Model for Pharmacist<br />
Intervention in Smoking Cessation<br />
DOMINION BALLROOM NORTH<br />
Ron Pohar, BScPhm<br />
Myros Pharmacy<br />
Edmonton, AB<br />
Hosted by Pfizer Canada Inc.<br />
Tuesday, February 2 • Mardi 2 février<br />
06:30-8:00 Satellite Symposium<br />
(breakfast included)<br />
Symposium satellite<br />
(petit déjeuner inclus)<br />
ESSEX BALLROOM<br />
07:30-17:00 Registration<br />
Inscription<br />
Antipsychotics: Metabolic Effects and<br />
the Use <strong>of</strong> Atypicals in Schizophrenia and<br />
Bipolar Disorder<br />
Joel Lamoure, BScPhm, FASCP<br />
London Health Sciences Centre<br />
London, ON<br />
Hosted by Pfizer Canada Inc.<br />
CONCOURSE COATCHECK<br />
08:00-08:15 Opening Remarks<br />
Remarques préliminaires<br />
DOMINION BALLROOM<br />
08:15-09:45 Going for Gold<br />
DOMINION BALLROOM<br />
Catriona Le May Doan<br />
Olympic Champion Speed Skater & CBC<br />
Broadcaster
Sponsored by Sandoz Canada Inc. through an<br />
unrestricted educational grant<br />
Commandité par Sandoz Canada Inc. grâce à<br />
une subvention sans restriction<br />
Presentation <strong>of</strong> the Distinguished Service Award<br />
Winner<br />
Présentation de la lauréate du Prix pour service<br />
distingué<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. Practical Approach to Non-Cancer Pain<br />
Management<br />
CONFERENCE B/C<br />
Amita Woods, PharmD<br />
University Health Network<br />
Toronto, ON<br />
2. Hypertension: Guidelines, Updates,<br />
Outcomes, and What it All Means for<br />
<strong>Pharmacists</strong> (encore)<br />
DOMINION BALLROOM SOUTH<br />
Ross Tsuyuki, PharmD, FCSHP<br />
University <strong>of</strong> Alberta<br />
Edmonton, AB<br />
3. Ten Things You Really Need to Know About<br />
CSHP 2015<br />
CITY HALL<br />
Neil MacKinnon, PhD, FCSHP<br />
Dalhousie University<br />
Halifax, NS<br />
4. Oral Presentations <strong>of</strong> Award-Winning<br />
Research and Pharmacy Practice Projects<br />
Présentations orales des projets de<br />
recherche et de pratique pharmaceutique<br />
primés<br />
SIMCOE/DUFFERIN<br />
11:25-12:10 Concurrent Sessions<br />
Séances concomitantes<br />
1. Clinical Pearls: Hot Topics in GI<br />
DOMINION BALLROOM SOUTH<br />
Peter Thomson, PharmD<br />
Winnipeg Regional Health Authority<br />
Winnipeg, MB<br />
2. Update on Intensive Care Unit Sedation<br />
CITY HALL<br />
Lisa Burry, PharmD<br />
Mount Sinai <strong>Hospital</strong><br />
Toronto, ON<br />
3. Improving Patient Safety through Bar<br />
Coded Medication Administration (BCMA)<br />
CONFERENCE B/C<br />
Jimmy Fung, BScPhm<br />
Credit Valley <strong>Hospital</strong><br />
Mississauga, ON<br />
4. Oral Presentations <strong>of</strong> Award-Winning<br />
Research and Pharmacy Practice Projects<br />
Présentations orales des projets de<br />
recherche et de pratique pharmaceutique<br />
primés<br />
SIMCOE/DUFFERIN<br />
12:15-13:50 Lunch, Exhibits, Posters<br />
Déjeuner, Kiosques, Affiches<br />
SHERATON/OSGOODE HALLS<br />
14:00-15:00 Pharmacy Practice Research and the<br />
“Meaning <strong>of</strong> (Pharmacist) Life”<br />
DOMINION BALLROOM<br />
Ross Tsuyuki, PharmD, FCSHP<br />
University <strong>of</strong> Alberta<br />
Edmonton, AB<br />
15:10-17:10 Workshops & PSN Sessions<br />
Ateliers et séances des RSP<br />
1. Pharmaceutical Care: The Importance <strong>of</strong><br />
Documentation and Reimbursement<br />
CONFERENCE B/C<br />
Linda Strand, PharmD, PhD, DSc(Hon)<br />
Medication Management Systems Inc.<br />
Minneapolis, MN<br />
2. Critical Care PSN<br />
RSP en soins intensifs<br />
Business meeting to follow session<br />
DOMINION BALLROOM SOUTH<br />
Management <strong>of</strong> Intravascular<br />
Catheter-Related Infections: Focus on<br />
Critical Care 2009 IDSA Guidelines Update<br />
Julie Pellerin, BScPhm<br />
University <strong>of</strong> Alberta<br />
Edmonton, AB<br />
Drug Dosing in Continuous Renal<br />
Replacement Therapy<br />
Clarence Chant, PharmD, FCSHP<br />
St. Michael’s <strong>Hospital</strong><br />
Toronto, ON<br />
3. Pediatrics PSN<br />
RSP en pédiatrie<br />
WINDSOR<br />
Evidence-Based Morphine Monitoring<br />
Régis Vaillancourt, PharmD, FCSHP<br />
Children’s <strong>Hospital</strong> <strong>of</strong> Eastern Ontario<br />
Ottawa, ON<br />
Pediatric Anticoagulation<br />
Kat Timberlake, PharmD<br />
The <strong>Hospital</strong> for Sick Children<br />
Toronto, ON<br />
19
20<br />
4. Medication Safety PSN<br />
RSP en sécurité des médicaments<br />
SIMCOE/DUFFERIN<br />
Tracking Required Organizational<br />
Practices: If You Don't Know Where You<br />
Are, How Will You Get There?<br />
Janice Munroe, BScPhm<br />
Fraser Health Authority<br />
Langley, BC<br />
Mits Miyata, BScPhm<br />
Fraser Health Authority<br />
Langley, BC<br />
5. Key Performance Indicators for Pharmacy<br />
Practice<br />
CITY HALL<br />
Bruce Millin, BScPhm<br />
Fraser Health Authority<br />
Langley, BC<br />
17:30-19:30 Satellite Symposiums<br />
(dinner included)<br />
Symposiums satellites<br />
(dîner inclus)<br />
1. Feeling the Burn: A Team Approach to<br />
GERD and Safety <strong>of</strong> Long-Term PPI Use<br />
ESSEX BALLROOM<br />
Peter Thomson, PharmD<br />
Winnipeg Regional Health Authority<br />
Winnipeg, MB<br />
Hosted by AstraZeneca Canada Inc.<br />
2. Management <strong>of</strong> Gram Positive Infections:<br />
What’s the Standard?<br />
DOMINION BALLROOM NORTH<br />
Shariq Haider, MD, FRCPC<br />
McMaster University Medical Centre<br />
Hamilton, ON<br />
Daniel Thirion, PharmD, FCSHP<br />
Université de Montréal<br />
Montréal, QC<br />
Hosted by Pfizer Canada Inc.<br />
Wednesday, February 3 • Mercredi 3 février<br />
07:30-15:00 Registration<br />
Inscription<br />
CONCOURSE COATCHECK<br />
08:00-08:15 Opening Remarks<br />
Remarques préliminaires<br />
DOMINION BALLROOM<br />
08:15-09:15 CPSI Patient Safety Lecture<br />
Conférence de l'ICSP sur la sécurité des<br />
patients<br />
DOMINION BALLROOM<br />
Sponsored by the <strong>Canadian</strong> Patient Safety<br />
Institute through an unrestricted grant<br />
Commandité par l'Institut canadien sur la<br />
sécurité des patients grâce à une subvention<br />
sans restriction<br />
Medication Safety: A Vision for Pharmacy<br />
Practice in the Future<br />
Michael Cohen, RPh, MS, ScD<br />
Institute for Safe Medication Practices<br />
Horsham, PA<br />
09:15-10:15 H1N1 2009 Update: The Public Health<br />
Perspective<br />
DOMINION BALLROOM<br />
Brian Schwartz, MD<br />
Ontario Agency for Health Protection and<br />
Promotion<br />
Toronto, ON<br />
10:15-10:45 Break, Posters<br />
Pause, Affiches<br />
DOMINION FOYER/CHURCHILL ROOM<br />
10:55-11:40 Concurrent Sessions<br />
Séances concomitantes<br />
1. Recent Trials That May Change Your<br />
Practice in Acute Care<br />
DOMINION BALLROOM SOUTH<br />
Vincent Teo, PharmD<br />
Sunnybrook Health Sciences Centre<br />
Toronto, ON<br />
2. Antimicrobial Stewardship: The Current<br />
Frontier<br />
SIMCOE/DUFFERIN<br />
Sandra Howie, PharmD<br />
Mount Sinai <strong>Hospital</strong><br />
Toronto, ON<br />
3. The Ethics Behind the Stats: What Every<br />
Clinician Needs to Know to Talk to Patients<br />
CITY HALL<br />
Timothy Christie, MHSc, PhD<br />
Saint John Regional <strong>Hospital</strong><br />
Saint John, NB<br />
11:50-12:35 Concurrent Session<br />
Séances concomitantes<br />
1. MRSA in 2010: Trends in Epidemiology &<br />
Pharmacotherapy<br />
CITY HALL<br />
Rosemary Zvonar, BScPhm<br />
The Ottawa <strong>Hospital</strong><br />
Ottawa, ON<br />
2. Recent Evidence in COPD Management<br />
DOMINION BALLROOM SOUTH<br />
Marie-France Beauchesne, PharmD<br />
Université de Montréal<br />
Montréal, QC
3. Career Strategic Planning: If You Don't Know<br />
Where You Are Going, Any Road Will Do<br />
CONFERENCE B/C<br />
Robin Ensom, PharmD, FCSHP<br />
Vancouver Coastal Health, Providence<br />
Health Care<br />
Vancouver, BC<br />
12:40-14:10 Satellite Symposiums<br />
(luncheon included)<br />
Symposiums satellites<br />
(déjeuner inclus)<br />
1. The Role <strong>of</strong> Atypical Antipsychotics for the<br />
Treatment <strong>of</strong> Mood Disorders<br />
ESSEX BALLROOM<br />
Alexander (Dooley) Goumeniouk MD, FRCP<br />
University <strong>of</strong> British Columbia<br />
Vancouver, BC<br />
Hosted by AstraZeneca Canada Inc.<br />
2. Themes in Thromboembolism<br />
DOMINION BALLROOM NORTH<br />
Are Patients Adherent to Injectables for<br />
VTE Prophylaxis? Findings from the<br />
COMPLETE Registry<br />
Allan Mills, PharmD, FCSHP<br />
Trillium Health Centre<br />
Mississauga, ON<br />
Proton Pump Inhibitors Controversy:<br />
What Are the Facts?<br />
Hosted by San<strong>of</strong>i-aventis Canada Inc. &<br />
Bristol-Myers Squibb<br />
3. Getting a G.R.I.P. on CV Risk (Guidelines<br />
Rolled into Practice)<br />
CIVIC BALLROOM SOUTH<br />
Patrick Robertson, PharmD<br />
Saskatoon Health Region<br />
Saskatoon, SK<br />
Hosted by AstraZeneca Canada Inc.<br />
14:15-15:00 Cultural Competence for Health Care<br />
Providers<br />
DOMINION BALLROOM<br />
Mitra Assemi, PharmD<br />
University <strong>of</strong> California at San Francisco<br />
Fresno, CA<br />
15:10-17:10 Workshops & PSN Sessions<br />
Ateliers et séances des RSP<br />
1. Workshop – Infectious Diseases PSN<br />
Atelier – RSP en infectiologie<br />
CONFERENCE B/C<br />
THOMAS CHIN LECTURE<br />
Short Course Therapy for Infectious<br />
Diseases: Fact or Fiction?<br />
Linda Dresser, PharmD<br />
University Health Network<br />
Toronto, ON<br />
Antimicrobial Dosing in Obesity:<br />
A Growing Problem<br />
Margaret Gray, BSP<br />
Alberta Health Services<br />
Edmonton, AB<br />
2. Emergency Medicine PSN<br />
RSP en urgentologie<br />
SIMCOE/DUFFERIN<br />
Hot Topics in Emergency Medicine<br />
Peter Zed, PharmD, FCSHP<br />
Capital Health<br />
Halifax, NS<br />
3. Geriatrics PSN<br />
RSP en gériatrie<br />
Business meeting to follow session<br />
DOMINION BALLROOM SOUTH<br />
The Challenges <strong>of</strong> Implementing Drug<br />
Changes in the Frail Elderly<br />
Pam Howell, BScPhm<br />
Bruyère Continuing Care<br />
Ottawa, ON<br />
Cheryl Sadowski, PharmD<br />
University <strong>of</strong> Alberta<br />
Edmonton, AB<br />
4. Key Performance Indicators for Pharmacy<br />
Practice (encore)<br />
CITY HALL<br />
Bruce Millin, BScPhm<br />
Fraser Health Authority<br />
Langley, BC<br />
17:10 Close <strong>of</strong> the 41st Annual Pr<strong>of</strong>essional<br />
Practice Conference<br />
Clôture de la 41 e Conférence annuelle sur la<br />
pratique pr<strong>of</strong>essionnelle<br />
21
R&E Foundation<br />
Silent Auction<br />
This year’s Research & Education Foundation<br />
Fundraiser at the PPC 2010 will once again<br />
be the popular silent auction. Items will be<br />
on display Sunday, January 31 outside the Career<br />
Opportunities Evening (Grand Ballroom East,<br />
Lower Concourse) and on Monday and Tuesday<br />
during the exhibitor lunches (12:15 - 1:50 p.m.)<br />
in the Exhibit Hall.<br />
<strong>Final</strong> bids will be tallied at 1:00 p.m. on Tuesday.<br />
Winners will be announced at the end <strong>of</strong> the<br />
exhibits program. We request your presence in<br />
order to pick up your item(s). All payments must<br />
be made on-site.<br />
Money raised on behalf <strong>of</strong> the R&E Foundation<br />
means you are helping to support the<br />
development <strong>of</strong> research skills among practicing<br />
hospital pharmacists as well as research projects<br />
and targeted pharmacy education programs<br />
undertaken by CSHP members.<br />
Awards Ceremony<br />
Please join us for our CSHP’s National<br />
Awards Ceremony and Cocktail Reception!<br />
It is an opportunity to congratulate your<br />
colleagues, network, and socialize with members.<br />
This event is open to the public (you do not have<br />
to be registered for the PPC to attend).<br />
Sunday, January 31, 2010 • 4:15 - 5:45 p.m.<br />
Essex Ballroom<br />
Cocktails to follow<br />
Career Opportunities<br />
Evening<br />
This annual networking and recruitment event<br />
will take place after the Awards Ceremony on<br />
Sunday, January 31, 2010. Join us in the Grand<br />
Ballroom East (new location!) from 6:00 - 7:30 p.m.<br />
and chat with hospitals and other organizations<br />
from across the country.<br />
This event is open to the public (you do not have to<br />
be registered for the PPC to attend). Refreshments<br />
will be provided.
Speaker Abstracts<br />
Résumés des conférenciers<br />
23<br />
Sunday, January 31 • Dimanche 31 janvier<br />
Pharmacy Issues and Controversies Forum:<br />
Technology and Pharmacy: Threat or Opportunity?<br />
Olavo Fernandes, PharmD, FCSHP, University Health Network,<br />
Toronto, ON – Moderator<br />
Panelists: Kori Leblanc, PharmD, University Health Network,<br />
Toronto, ON, Dante Morra, MD, MBA, FRCP(C), University<br />
Health Network, Toronto, ON, Peter Loewen, PharmD, FCSHP,<br />
Vancouver Coastal Health, Vancouver BC, Thomas Paton,<br />
PharmD, Sunnybrook Health Sciences Centre, Toronto ON<br />
This Issues and Controversies Forum is an exciting opportunity<br />
for leaders in our pr<strong>of</strong>ession to debate, as well as facilitate<br />
discussion with conference participants, about current issues<br />
facing the pr<strong>of</strong>ession <strong>of</strong> Pharmacy. This conference’s topic will<br />
colourfully examine the opportunities and threats that<br />
technology poses to the pr<strong>of</strong>ession <strong>of</strong> pharmacy. In this day<br />
and age, pharmacists are facing various pr<strong>of</strong>essional practice<br />
advances and issues linked to topical subjects such as CPOE,<br />
robotic dispensing, electronic health records and<br />
documentation, remote dispensing technology and PDA/<br />
blackberry interpr<strong>of</strong>essional communication. Each issue has<br />
distinct practical advantages and challenges. This session is<br />
aimed to educate and enrich your thinking. We welcome you to<br />
share ideas, opinions and input during the panel discussion.<br />
Come to this session to expand your thinking! Each panelist will<br />
have the opportunity to present their thoughts and experiences<br />
linked to these technological innovations. We invite you to<br />
express your opinions, ask questions, and share ideas and<br />
experiences.<br />
Goals and Objectives<br />
1. To facilitate open discussion with conference participants on<br />
the advantages and limitations <strong>of</strong> technologic advances that<br />
affect the pr<strong>of</strong>ession <strong>of</strong> pharmacy.<br />
2. To provide conference participants with an opportunity to<br />
share their ideas, concerns and experiences with respect to<br />
opportunities and threats <strong>of</strong> technology available today and<br />
on the horizon.<br />
Cardiology Guideline Pearls: Top 10 Points<br />
Patrick Robertson, PharmD, Saskatoon Health Region,<br />
Saskatoon, SK<br />
Practice guidelines are intended to assist health care providers<br />
in clinical decision making by describing a range <strong>of</strong> generally<br />
acceptable approaches for the diagnosis, management, and<br />
prevention <strong>of</strong> specific diseases or conditions. These guidelines<br />
attempt to define practices that meet the needs <strong>of</strong> most<br />
patients in most circumstances. Guideline recommendations<br />
should reflect a consensus <strong>of</strong> expert opinion after a thorough<br />
review <strong>of</strong> the available, current scientific evidence and are<br />
intended to improve patient care.<br />
However, it is a very involved process for guideline committees<br />
to produce the recommendations. As such, unless there are<br />
annual updates to guidelines, they may become dated as new<br />
evidence is published.<br />
The goal <strong>of</strong> this session is to provide pharmacists with a brief<br />
summary <strong>of</strong> guideline recommendations for the care <strong>of</strong> their<br />
patients with cardiovascular disease and the strength <strong>of</strong> the<br />
evidence supporting their treatment. The presentation will also<br />
cover some recent trials that have not yet been included in the<br />
summary <strong>of</strong> evidence for current guidelines. The focus will be<br />
on the management <strong>of</strong> acute coronary syndromes (ACS),<br />
dyslipidemia, and heart failure.<br />
Goals and Objectives<br />
1. To provide pharmacists with a brief summary <strong>of</strong> 10 guideline<br />
recommendations for the care <strong>of</strong> their patients with<br />
cardiovascular disease and the strength <strong>of</strong> the evidence<br />
supporting their treatment.<br />
2. To discuss recent major trial evidence that has not yet been<br />
reviewed in guidelines to help pharmacists understand their<br />
potential impact and changes in the care <strong>of</strong> patients with<br />
cardiovascular disease.<br />
Self-Assessment Questions<br />
1. What are the current recommendations for the duration <strong>of</strong><br />
triple antithrombotic therapy.<br />
2. What are the current antithrombotic therapy<br />
recommendations patients with high-risk ACS?<br />
3. What is impact <strong>of</strong> new antiplatelet agent and the supporting<br />
evidence on the care <strong>of</strong> ACS patients?<br />
4. Should high-sensitivity c-reactive protein be performed on all<br />
dyslipidemic patients?<br />
Recent Advances in the Management <strong>of</strong> Multiple<br />
Myeloma<br />
C. Tom Kouroukis, MD, MSc FRCPC, Juravinski Cancer Centre,<br />
McMaster University, Hamilton, ON<br />
The goal <strong>of</strong> this session is to review recent advances in the<br />
management <strong>of</strong> patients with multiple myeloma.<br />
Multiple myeloma remains in incurable plasma cell malignancy.<br />
Although there have been improvements in outcomes over the<br />
past several years as a result <strong>of</strong> new treatment approaches,<br />
such improvements until recently have been mostly limited to<br />
younger patients. In younger patients, there have been benefits<br />
from high dose chemotherapy and autologous stem cell<br />
transplantation and this has remained a routine treatment<br />
option. The outcome for older patients has only recently
24<br />
improved as a result <strong>of</strong> combination chemotherapy regimens<br />
incorporating newer agents, as either first line therapy or at the<br />
time <strong>of</strong> relapse. Bortezomib is a first in class proteosome<br />
inhibitor that has shown activity in both the upfront and<br />
relapsed treatment setting. The immunomodulatory agents,<br />
such as thalidomide and lenalidomide have also seen<br />
expanded use in both the upfront and relapsed setting. When<br />
combined with melphalan and prednisone in the upfront<br />
treatment <strong>of</strong> older patients, bortezomib or thalidomide have<br />
shown improvement in disease control and overall survival.<br />
Thalidomide in combination with dexamethasone has become<br />
the preferred induction regimen for younger patients intending<br />
to be treated with high dose chemotherapy and stem cell<br />
transplantation. At the time <strong>of</strong> relapse, options now include a<br />
second autologous stem cell transplant, the<br />
immunomodulatory agents (thalidomide, lenalidomide) and<br />
bortezomib, typically in combination with corticosteroids.<br />
Newer combinations for treatment in both the upfront and<br />
relapsed setting are also being tested with encouraging results.<br />
Goals and Objectives<br />
1. To understand how newer treatment regimens have<br />
impacted the outcome <strong>of</strong> patients with multiple myeloma.<br />
2. To illustrate some <strong>of</strong> the practical issues related to<br />
administering these novel combinations.<br />
Self-Assessment Questions<br />
1. How are decisions made as to what the best treatment<br />
option is for patients with newly diagnosed multiple<br />
myeloma?<br />
2. What are the options for treating multiple myeloma in the<br />
relapsed setting, and what are the advantages and<br />
disadvantages <strong>of</strong> the common approaches?<br />
3. What may be the expected toxicities <strong>of</strong> the newer agents<br />
(bortezomib, lenalidomide, thalidomide) when used in<br />
patients with multiple myeloma?<br />
H1N1 Update: After the Wave<br />
Alfred Gin, BScPhm, PharmD, Health Sciences Centre Winnipeg,<br />
Winnipeg, MB<br />
This presentation will review the current knowledge regarding<br />
the pandemic H1N1 (pH1N1) with regards to the epidemiology<br />
and management. <strong>Pharmacists</strong> had an active and important<br />
role in pandemic planning and clinical management.<br />
Since the declaration <strong>of</strong> a global pandemic on June 11, 2009,<br />
two pandemic waves have occurred in the northern<br />
hemisphere. At this time <strong>of</strong> writing, the second pandemic wave<br />
in Canada has peaked. The epidemiology observed in the first<br />
wave led to considerable planning for the second wave. In<br />
contrast to previous influenza strains, pH1N1 affected younger<br />
patients. Risk factors for severe disease were identified.<br />
Knowledge gaps with respect to antiviral treatment generated<br />
discussion with respect to the dose and duration and specific<br />
populations. The level <strong>of</strong> awareness, identification <strong>of</strong> risk<br />
groups, use <strong>of</strong> antivirals and mass pH1N1 vaccination programs<br />
was historic.<br />
Goals and Objectives<br />
1. To provide pharmacists with an overview <strong>of</strong> the current<br />
knowledge regarding pH1N1.<br />
2. To provide pharmacists with an appreciation <strong>of</strong> issues for<br />
future pandemic planning.<br />
Self-Assessment Questions<br />
1. What are the treatment options for pH1N1?<br />
2. Are there gaps with oseltamivir dosing?<br />
3. What alternatives were used for compounding oseltamivir<br />
emergency suspension?<br />
Update on Clinical Practice Guidelines for the<br />
Management <strong>of</strong> Catheter-Related Infections<br />
Linda Dresser PharmD, University Health Network, Toronto, ON<br />
The goal <strong>of</strong> this presentation is to provide pharmacists involved<br />
in the care <strong>of</strong> patients with intravascular devices an update on<br />
the recently published guidelines for managing infections <strong>of</strong><br />
these catheters.<br />
Catheter-related bloodstream infections (CRBSI) are a<br />
significant source <strong>of</strong> morbidity and mortality among<br />
hospitalized patients. In the US ~ 80,000 central-venous<br />
catheter related bloodstream infections occur in the intensive<br />
care each year. This does not include the infections associated<br />
with short-term peripheral catheters occurring on other<br />
inpatient units. In addition hospital length <strong>of</strong> stay and hospitals<br />
costs are independently increased by the occurrence <strong>of</strong> a<br />
nosocomially-acquired CRBSI.<br />
The majority <strong>of</strong> CRBSI’s originate from either the insertion site,<br />
the hub or both while the 4 groups <strong>of</strong> organisms most<br />
commonly associated with CRBSI’s are coagluase-negative<br />
staphylococcus, S. aureus, Candida species, and enter<br />
gram-negative bacilli.<br />
The Infectious Diseases <strong>Society</strong> <strong>of</strong> America published updated<br />
clinical practice guidelines on the diagnosis and management<br />
<strong>of</strong> intravascular catheter-related infection in 2009. This<br />
presentation will briefly review the areas <strong>of</strong> change from<br />
previous guidelines (published in 2001) and discuss the areas<br />
<strong>of</strong> emphasis; diagnosis, general management, unique aspects<br />
<strong>of</strong> short-term peripheral catheter -, non-tunnelled<br />
central-venous catheter-, arterial catheter-, and long-term or<br />
implanted catheter-associated infections.<br />
Goals and Objectives<br />
1. To identify relevant changes to the management <strong>of</strong><br />
catheter-related infection guidelines since the previous<br />
version.<br />
2. To discuss the ongoing areas <strong>of</strong> controversy specifically with<br />
respect to duration <strong>of</strong> therapy.
3. To highlight the pharmacists role in optimizing antimicrobial<br />
use in catheter-related infections<br />
Self-Assessment Questions<br />
1. What is the most common organism associated with CRBSI’s<br />
involving peripherally inserted short-term catheters?<br />
2. What are the most appropriate antimicrobial choice and<br />
duration <strong>of</strong> therapy for the management <strong>of</strong> a<br />
methicillin-susceptible S. aureus peripheral short-term<br />
catheter-related blood stream infection at your institution?<br />
Update on Clinical Practice Guidelines for<br />
Candidiasis<br />
Alfred Gin, BScPhm, PharmD, Health Sciences Centre Winnipeg,<br />
Winnipeg, MB<br />
Candida infections are an increasing concern with a significant<br />
morbidity and mortality associated with invasive disease. Risk<br />
factors such a central venous catheters, broad spectrum<br />
antibiotics, immunosuppression and parenteral nutrition have<br />
been associated with invasive candidiasis. Candidemia is<br />
considered the fourth most common cause <strong>of</strong><br />
institution-related blood stream infections. Antifungal agents<br />
include the polyenes, azoles and the echinocandins. The<br />
Infectious Diseases <strong>Society</strong> <strong>of</strong> America in early 2009 updated<br />
their clinical practice guidelines previously published in 2004<br />
on the management <strong>of</strong> candidiasis. This presentation will<br />
briefly review the 2009 guidelines and highlight changes from<br />
the previous guidelines.<br />
Goals and Objectives<br />
1. To become familiar with the recommendations for managing<br />
candidiasis in different patient populations.<br />
2. To become familiar with the role(s) <strong>of</strong> different antifungals<br />
for the treatment <strong>of</strong> candidiasis.<br />
Self-Assessment Questions<br />
1. What is the most common antifungal used for candidemia in<br />
your institution?<br />
2. What is the recommended treatment for treating Candida<br />
albicans bacteremia?<br />
Accreditation: How Can It Impact Your Practice and<br />
Patient Safety Results?<br />
Julie Langlois, Accreditation Specialist, Ontario Market,<br />
Accreditation Canada, Janice Munroe, BScPhm, Fraser Health<br />
Authority, Langley, BC<br />
With the introduction <strong>of</strong> “Qmentum”, Accreditation Canada’s<br />
most recent accreditation program, organizations have shifted<br />
their focus on to patient safety and this has significantly<br />
changed the culture. Qmentum has resulted in organizations<br />
actively involved in ongoing Quality Improvement activities that<br />
have embedded patient safety into daily practice.The<br />
importance <strong>of</strong> medication management was brought to the<br />
forefront with Qmentum. This set <strong>of</strong> standards was developed<br />
to assist organizations with their medication management<br />
program.<br />
This session will provide participants with the latest updates on<br />
the Qmentum Accreditation <strong>Program</strong> and an overview <strong>of</strong> how<br />
the program impacts pharmacy practice. The session will also<br />
provide examples <strong>of</strong> how Qmentum has changed the culture <strong>of</strong><br />
one organization, Fraser Health in British Columbia.<br />
Participants will be able to ask questions <strong>of</strong> an Accreditation<br />
Canada representative as well as hear from both a surveyor and<br />
pharmacist who has “survived” the Qmentum accreditation<br />
process and thrived!<br />
Goals and Objectives<br />
1. To provide pharmacists with the latest updates on the<br />
Qmentum Accreditation program.<br />
2. To enable pharmacists to reflect on how they can address<br />
accreditation requirements to benefit their practices.<br />
Self-Assessment Questions<br />
1. What are the Required Operational Practices (ROPs) that<br />
impact pharmacists?<br />
2. How do those ROPs benefit my practice and my<br />
organization?<br />
3. How has the medication management standards helped with<br />
your current practice?<br />
Prioritizing Clinical Pharmacy Services<br />
Stephen Shalansky, PharmD, ACPR, FCSHP, Providence<br />
Healthcare, Vancouver, BC<br />
This session will provide pharmacists and pharmacy<br />
administrators with an understanding <strong>of</strong> the supporting<br />
evidence and common strategies for prioritizing clinical<br />
pharmacy services.<br />
There is now a wealth <strong>of</strong> evidence supporting the benefit <strong>of</strong><br />
clinical pharmacy services, both in terms <strong>of</strong> positively<br />
influencing patient outcomes and cost-effectiveness. Although<br />
not all studies have demonstrated a conclusive benefit, the<br />
supporting evidence relative to other allied health disciplines is<br />
impressive. As a result, there is now specific focus in<br />
pr<strong>of</strong>essional and hospital accreditation standards regarding the<br />
provision <strong>of</strong> clinical pharmacy services. However, health care<br />
labour budgets are perpetually limited, and the recent<br />
economic downturn has further constrained or reduced funding<br />
available for clinical pharmacy programs. It has become<br />
increasingly important for administrators to ensure that clinical<br />
pharmacy services are focused on activities that are effective<br />
and efficient. While there are recommendations regarding<br />
clinical pharmacist staffing levels per hospital bed, clinical<br />
staffing levels vary widely across Canada.<br />
Strategies for allocating clinical pharmacy services must<br />
consider current staffing levels, services provided, evidence<br />
supporting specific clinical pharmacy services and<br />
accreditation standards. In addition, pharmacist shortages<br />
have increased focus on recruitment and retention, thus job<br />
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satisfaction must also be a prominent consideration. Examples<br />
<strong>of</strong> commonly encountered decisions around clinical service<br />
allocation will be reviewed by using case studies presented<br />
from the perspective <strong>of</strong> both pharmacy administrators and<br />
front-line clinical pharmacists.<br />
Goals and Objectives<br />
1. To provide an overview <strong>of</strong> the published evidence supporting<br />
the benefits <strong>of</strong> clinical pharmacy, and specific services<br />
provided by clinical pharmacy programs. These benefits<br />
include both patient care outcomes and cost-effectiveness.<br />
2. To review what is expected from clinical pharmacy services<br />
based on published CSHP position statements and<br />
Accreditation Canada’s Required Organizational Practices.<br />
3. To provide basic strategies for allocating clinical pharmacy<br />
services within a limited labour budget considering<br />
evidence, standards, and intangibles including job<br />
satisfaction.<br />
4. To provide examples and provoke discussion using case<br />
studies based on practical experience.<br />
Self-Assessment Questions<br />
1. Name the seven clinical pharmacy services associated with<br />
reduced mortality rates according to the data published by<br />
C.A. Bond for the American College <strong>of</strong> Clinical Pharmacy.<br />
2. Describe two pros and two cons associated with equally<br />
distributing clinical pharmacy service across an entire<br />
institution versus providing more comprehensive service to<br />
specific wards or patients.<br />
Reversing Anticoagulation: Implications for<br />
<strong>Pharmacists</strong><br />
Natalie Crown, PharmD, London Health Sciences Centre,<br />
London, ON<br />
Anticoagulation therapy is associated with a significant<br />
reduction in thrombotic events in a variety <strong>of</strong> clinical settings<br />
including atrial fibrillation, venous thromboembolism, and<br />
acute coronary syndromes. The most important and feared<br />
complication with these therapies is the risk <strong>of</strong> bleeding.<br />
Bleeding requiring medical intervention occurs at a rate <strong>of</strong><br />
approximately 1-3% per year while on vitamin K antagonist<br />
therapy, although the risk varies depending on a variety <strong>of</strong><br />
patient characteristics. Bleeding events have important<br />
implications to both the clinician and patient. Fear <strong>of</strong> bleeding<br />
complications is a commonly cited reason for failure to<br />
prescribe vitamin K antagonists for stroke prevention in atrial<br />
fibrillation.<br />
Traditional anticoagulants such as warfarin and heparin have<br />
specific antidotes such as vitamin K and protamine sulfate for<br />
reversal <strong>of</strong> bleeding complications. However, many <strong>of</strong> the<br />
emerging anticoagulants lack specific antidotes and as such,<br />
reversal strategies have not been fully elucidated.<br />
The goal <strong>of</strong> this session is provide pharmacists with a practical<br />
overview <strong>of</strong> anticoagulation reversal strategies, as well as<br />
considerations for managing bleeding complications<br />
associated with various anticoagulation therapies. This will<br />
include identifying important risk factors for bleeding, the<br />
management <strong>of</strong> patients who are over-anticoagulated but<br />
asymptomatic, and the management <strong>of</strong> bleeding complications<br />
associated with anticoagulants. We will also discuss future<br />
considerations for anticoagulation reversal with the emerging<br />
novel anticoagulants.<br />
Goals and Objectives<br />
1. Discuss current anticoagulation reversal strategies and<br />
describe the management <strong>of</strong> bleeding complications for both<br />
traditional and emerging novel anticoagulants.<br />
2. Discuss current clinical practice guideline recommendations<br />
and evaluate recent evidence examining the role <strong>of</strong> vitamin K<br />
for management <strong>of</strong> supratherapeutic INRs for patients on<br />
warfarin therapy.<br />
3. Describe the use role <strong>of</strong> blood transfusion products including<br />
prothrombin complex concentrates (PCC) for the reversal or<br />
warfarin anticoagulation.<br />
Self-Assessment Questions<br />
1. What are the important risk factors for bleeding for patients<br />
on anticoagulation therapy?<br />
2. Who should receive vitamin K for anticoagulation reversal<br />
while on warfarin therapy (and by what route)?<br />
3. What are the advantages <strong>of</strong> prothrombin complex<br />
concentrates compared to fresh frozen plasma for<br />
management <strong>of</strong> bleeding associated with vitamin K<br />
antagonists?<br />
Evidence Based Medicine for the Busy Clinician<br />
Trudy Arbo, PharmD, ACPR, BCPS, Alberta Health Services,<br />
Calgary, AB<br />
The goal <strong>of</strong> this workshop is to provide participants with<br />
effective and practical skills to evaluate and implement EBM<br />
into your current clinical practice. Throughout this workshop,<br />
we will discuss the importance <strong>of</strong> developing a clear and<br />
concise clinical question (using the PICO method) before<br />
attempting to search for a topic or clinical problem and learn<br />
how to formulate this type <strong>of</strong> question. We will also discuss the<br />
best places to search for quality summaries <strong>of</strong> the evidence<br />
(secondary resources) as well as learn (or re-learn) the<br />
important aspects <strong>of</strong> critically reviewing available evidence.<br />
This is an interactive workshop.<br />
Goals and Objectives<br />
1. To enable participants to develop clear and concise clinical<br />
questions in order to effectively and efficiently search for<br />
target clinical information.<br />
2. Understand the hierarchy <strong>of</strong> evidence and the advantages<br />
and disadvantages <strong>of</strong> each level.<br />
3. Provide participants with a list <strong>of</strong> 5 useful websites available<br />
to facilitate EBM implementation into clinical practice
4. Provide a number <strong>of</strong> resources to allow the participant to<br />
further knowledge in the realm <strong>of</strong> EBM.<br />
5. Feel confident with current critical appraisal skills and be<br />
able to apply them to the evidence<br />
Self-Assessment Questions<br />
1. List two useful EBM websites and their main target audience.<br />
Also describe how this website could be useful to you in your<br />
current practice<br />
2. Describe the aspects <strong>of</strong> PICO and why it is important when<br />
searching for a clinical question.<br />
3. Outline the value <strong>of</strong> a systematic review and meta-analysis<br />
and describe how to identify a good quality systematic<br />
review and meta-analysis.<br />
Be All That You Can Be: Start Your Own Residency<br />
<strong>Program</strong><br />
Allan Mills, PharmD, FCSHP, Anjana Sengar, BScPhm, Anna<br />
Chiu, BScPhm, Trillium Health Centre, Mississauga, ON<br />
In this interactive session, participants will gain insight into<br />
overcoming barriers in establishing and implementing a new<br />
residency program. Participants will also have the opportunity<br />
to work together to design a sample <strong>of</strong> an internal medicine<br />
rotation outline using outcome based measures as per the new<br />
2015 CSHP residency accreditation standards. You will emerge<br />
with ideas and tools on topics such as preceptor development,<br />
organizational engagement and helpful resources for setting up<br />
your program.<br />
Goals and Objectives<br />
1. To highlight the predevelopment Stages <strong>of</strong> a New Residency<br />
<strong>Program</strong><br />
• Participants will discuss barriers to setting up a new<br />
residency program and discuss methods to overcome these<br />
barriers<br />
• Participant will become familiar with resources available<br />
for designing and implementing a residency program<br />
• Participants will learn techniques on engaging and<br />
developing new preceptors and mentors<br />
• Participants will gain insight into engaging institutional<br />
leaders to support program development<br />
2. To design learning objectives and goals for outcomes-based<br />
performance<br />
• Participants will be able to discuss the rationale for<br />
outcome based measures<br />
• Participants will be able to define observational based<br />
outcomes<br />
• Attendees will discuss/participate in groups to develop a<br />
set <strong>of</strong> outcome based objectives and goals for an Internal<br />
Medicine Rotation with guidance from the facilitators<br />
Drug Interaction between Clopidogrel and Proton<br />
Pump Inhibitors: Fact!<br />
Uchenwa Genus, BScPhm, ACPR, York Central <strong>Hospital</strong>,<br />
Richmond Hill, ON<br />
The interaction <strong>of</strong> proton pump inhibitors (PPIs) with<br />
clopidogrel leading to an increased risk <strong>of</strong> adverse cardiac<br />
outcomes has sparked significant debate in the cardiology<br />
community. This session will provide insight into the<br />
authenticity <strong>of</strong> the interaction and implications to patient care.<br />
The bioactivation <strong>of</strong> clopidogrel is mediated by the cytochrome<br />
P450 2C19 enzyme. PPIs that inhibit the enzyme alter<br />
clopidogrel pharmacokinetics resulting in a reduction in<br />
antiplatelet action. Relevant platelet reactivity and<br />
observational studies show concerning data <strong>of</strong> a decreased<br />
platelet response to clopidogrel leading to a significant<br />
increased risk <strong>of</strong> adverse cardiac outcomes such as myocardial<br />
infarction (MI), death or rehospitalization for acute coronary<br />
syndromes. Studies highlighting the interaction have<br />
limitations inherent to the study design; however, the<br />
randomized evidence countering the argument have several<br />
limitations that are uncharacteristic to their reputation for<br />
design rigor and strong conclusions.<br />
Contradicting evidence does not debate the presence <strong>of</strong> an<br />
interaction but strives to quantify its clinical relevance.<br />
Arguably, the paramount importance <strong>of</strong> clopidogrel to reduce<br />
major coronary events cannot be overstated. Studies suggest<br />
that delays in initiating and maintaining clopidogrel therapy are<br />
associated with significant adverse outcomes. Clinicians also<br />
face the dilemma <strong>of</strong> clopidogrel nonadherence and resistance.<br />
Federal regulatory agencies recognize the interaction and<br />
advise against indiscriminate use. A clear conclusion on<br />
optimal medication use is elusive and pharmacists should<br />
place patient safety first, erring on the side <strong>of</strong> caution.<br />
Goals and Objectives<br />
1. To provide pharmacists with some insight into the<br />
pharmacokinetics behind the interaction <strong>of</strong> proton pump<br />
inhibitors and clopidogrel.<br />
2. To provide pharmacists with a greater understanding <strong>of</strong> the<br />
evidence supporting the interaction.<br />
3. To enable pharmacists to use an informed approach when<br />
managing potential patients on this drug combination.<br />
Self-Assessment Questions<br />
1. What is the clinical relevance <strong>of</strong> the interaction between<br />
clopidogrel and proton pump inhibitors?<br />
2. Should my patients on clopidogrel avoid proton pump<br />
inhibitor use?<br />
3. How do I identify which patients are most at risk?<br />
Clopidogrel and Proton Pump Inhibitors Drug<br />
Interaction: Fact or Fiction? Fiction: What Drug<br />
Interaction?<br />
Doson Chua, BScPhm, PharmD, St. Paul’s <strong>Hospital</strong>, Providence<br />
Health Care, Vancouver, BC<br />
The goal <strong>of</strong> this session is to provide pharmacists with an<br />
understanding <strong>of</strong> the evidence behind the controversy<br />
surrounding the drug interaction between clopidogrel and<br />
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proton pump inhibitors (PPI) and the most recent evidence<br />
which disputes this purported drug interaction.<br />
A clopidogrel – PPI drug interaction has been recently<br />
highlighted in the literature and media. Previous studies that<br />
have suggested a drug interaction between clopidogrel and PPI<br />
were in vitro studies using laboratory endpoints. This clinical<br />
drug interaction is based on 2 recent, large, retrospective<br />
cohort studies which demonstrated an increased cardiac risk<br />
with concomitant use <strong>of</strong> clopidogrel and PPI as compared to<br />
clopidogrel alone. However, these cohort studies are subject to<br />
many flaws due to its observational and retrospective nature<br />
and only establishes an association, not a casual relationship,<br />
between increased cardiac adverse outcomes with clopidogrel<br />
and PPI use. Other studies conflict with the results <strong>of</strong> these 2<br />
retrospective studies.<br />
More recent, high quality evidence has become available which<br />
refutes the clopidogrel – PPI drug interaction. A subgroup<br />
analysis <strong>of</strong> the large, randomized controlled clinical trial<br />
TRITON-TIMI 38, showed no difference in cardiac events in<br />
patients on clopidogrel alone or clopidogrel in combination<br />
with PPI. The recently presented landmark, randomized,<br />
controlled COGENT trial clearly demonstrated no risk <strong>of</strong><br />
increase cardiac events with concomitant clopidogrel and PPI<br />
use.<br />
Therefore, while previous laboratory and retrospective cohort<br />
studies suggest a drug interaction with clopidogrel and PPI,<br />
more recent, robust randomized trials clearly demonstrate no<br />
clinical drug interaction.<br />
Goals and Objectives<br />
1. To provide pharmacists with an understanding <strong>of</strong> the<br />
weaknesses <strong>of</strong> and arguments against the evidence<br />
suggesting a drug interaction between clopidogrel and PPI<br />
1. To update pharmacists with recent, emerging evidence that<br />
demonstrates there is no clinically significant drug<br />
interaction between clopidogrel and PPI<br />
Self-Assessment Questions<br />
1. What are the weaknesses <strong>of</strong> the evidence that suggests a<br />
clinically significant drug interaction between clopidogrel<br />
and PPI?<br />
2. What is the most recent, emerging evidence surrounding this<br />
clopidogrel and PPI drug interaction?<br />
Review <strong>of</strong> Myasthenia Gravis: Moving Beyond<br />
“That’s All Greek (and Latin) to Me”<br />
Karen Tulloch, BScPhm, PharmD, Vancouver Coastal Health,<br />
Vancouver, BC.<br />
Once considered a relatively obscure condition, myasthenia<br />
gravis is now the best characterized and understood<br />
autoimmune disorder. Knowledge <strong>of</strong> the mechanisms behind<br />
the disease pathogenesis has resulted in the emergence <strong>of</strong> new<br />
pharmacologic therapies as well as the identification <strong>of</strong> specific<br />
precipitants, including medications, which may adversely affect<br />
the disease. <strong>Pharmacists</strong>, across many clinical specialties play<br />
an important role in the management, safety, and education <strong>of</strong><br />
the myasthenic patient.<br />
This session will highlight the early history <strong>of</strong> myasthenia<br />
gravis and provide the pharmacist with a description <strong>of</strong> the<br />
clinical features associated with the disease, an explanation <strong>of</strong><br />
its pathophysiology, and a basic overview <strong>of</strong> how a diagnosis <strong>of</strong><br />
myasthenia is made. The major focus <strong>of</strong> this session will be on<br />
discussion <strong>of</strong> the fundamental treatment options that are<br />
available, including symptomatic treatment<br />
(acetylcholinesterase inhibitors), long-term immunomodulating<br />
therapy (corticosteroids and immunosuppressives), acute crisis<br />
management (plasma exchange, intravenous immunoglobulin),<br />
and surgical treatment options.<br />
Patients with myasthenia gravis may have worsening <strong>of</strong><br />
symptoms upon exposure to a number <strong>of</strong> medications. While<br />
the majority <strong>of</strong> the literature reporting adverse drug events is<br />
anecdotal, the major categories <strong>of</strong> potentially problematic<br />
medications will be discussed and strategies to minimize the<br />
risk <strong>of</strong> adverse events will be introduced.<br />
Goals and Objectives<br />
1. To provide pharmacists with a basic understanding <strong>of</strong> the<br />
clinical features, pathogenesis, diagnosis, and therapeutic<br />
management strategies for myasthenia gravis.<br />
2. To enable pharmacists to identify potentially dangerous<br />
medications and/or medication classes that may worsen<br />
myasthenia gravis.<br />
Self-Assessment Questions<br />
1. How do acetylcholinesterase inhibitors work to improve<br />
symptoms in myasthenia gravis?<br />
2. How should an immunosuppressive regimen with<br />
corticosteroids and azathioprine be prescribed and<br />
monitored?<br />
3. What medications should be avoided in patients with<br />
myasthenia gravis?<br />
Discussion Forum on the Management <strong>of</strong> Chronic<br />
Daily Headache and Intractable Migraine in<br />
<strong>Hospital</strong><br />
Linda Methot, BScPhm, Kingston General <strong>Hospital</strong>, Kingston,<br />
ON<br />
The goal <strong>of</strong> this session is for pharmacists to share experiences<br />
from their practice sites in the management <strong>of</strong> chronic daily<br />
headache and intractable migraine.<br />
Chronic daily headache is defined as headache occurring on<br />
more than 15 days per month, for at least 3 months. There are<br />
many etiologies <strong>of</strong> chronic daily headache. One etiology <strong>of</strong><br />
particular interest to pharmacists is medication overuse.<br />
Patients with severe intractable chronic daily headache due to<br />
medication overuse may be hospitalized for detoxification and<br />
treatment.
Patients with intractable migraine frequently present to<br />
emergency departments and occasionally require<br />
hospitalization for treatment.<br />
These patients present opportunities for hospital pharmacists<br />
to be involved in drug therapy management. Some examples<br />
include identifying significant drug interactions with DHE<br />
(dihydroergotamine), identifying patients who would benefit<br />
from prophylactic therapy and educating patients about<br />
medication overuse.<br />
Goals and Objectives<br />
1. To provide a forum for pharmacists to share experiences<br />
from their practice sites in the management <strong>of</strong> chronic daily<br />
headache and intractable migraine<br />
2. To discuss opportunities for pharmacists to get involved at<br />
their practice site in drug therapy management for chronic<br />
daily headache and intractable migraine<br />
Self-Assessment Questions<br />
1. What medications used in the treatment <strong>of</strong> headaches<br />
and/or migraines put the patient at risk for medication<br />
overuse headaches?<br />
2. What medications interact with dihydroergotamine?<br />
3. What are the treatment options for chronic daily<br />
headache/intractable migraine?<br />
Where Can Pharmacy Take Me? Exploring Unique<br />
Pharmacy Career Opportunities<br />
Panel: Cynthia Jackevicius, BScPhm, ACPR, PharmD, FCSHP,<br />
Western University <strong>of</strong> Health Sciences, Los Angeles, CA;<br />
Heather Kertland, PharmD, St. Michael’s <strong>Hospital</strong>/University <strong>of</strong><br />
Toronto, Toronto, ON; Diana Spizzirri, BScPhm, ACPR, MEd,<br />
Ontario College <strong>of</strong> <strong>Pharmacists</strong>, Toronto, ON<br />
Panel Moderator: Christine Mitry, BScPhm, University Health<br />
Network, Toronto, ON<br />
The pr<strong>of</strong>ession <strong>of</strong> pharmacy <strong>of</strong>fers many unique practice<br />
opportunities, some less obvious than others. Whether you’re a<br />
student, recent grad, or would like to further explore the<br />
pr<strong>of</strong>ession, it is valuable to talk to other colleagues and learn<br />
from their experiences.<br />
These three speakers will be sharing details <strong>of</strong> their education<br />
and career paths; highlighting the extent <strong>of</strong> their involvement in<br />
various endeavors and providing insight into the challenges<br />
faced and awaiting them at the next step <strong>of</strong> their careers. Their<br />
varied backgrounds will provide the audience with information<br />
on a broad spectrum <strong>of</strong> environments including leadership,<br />
education, government roles, and international contributions.<br />
This will be a great opportunity for you to ask questions<br />
relevant to your situation. The free forum style <strong>of</strong> this session<br />
will also allow for plenty <strong>of</strong> discussion, and provide some food<br />
for thought.<br />
Goals and Objectives<br />
1. Provide students, residents and pharmacists with<br />
information on unique pharmacy career options, novel<br />
practice environments, postgraduate educational<br />
opportunities and pharmacy leadership roles.<br />
Self-Assessment Questions<br />
1. Where do I see myself pr<strong>of</strong>essionally in five years?<br />
2. What can I do to pursue these pr<strong>of</strong>essional goals? Are there<br />
any career options discussed today that I would like to<br />
explore further?<br />
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Monday, February 1 • Lundi 1 er février<br />
Pharmaceutical Care: Practice Change and<br />
Reaching a Unified Practice<br />
Linda Strand, PharmD, PhD, DSc(Hon), Medication<br />
Management Systems, Minneapolis, MN<br />
This session will discuss the changes occurring in the health<br />
care system and the impact these changes will have on<br />
pharmacy. The evolution <strong>of</strong> the pharmacist from dispensing<br />
through clinical practice and finally into direct patient care will<br />
be discussed. The responsibility <strong>of</strong> direct patient care changes<br />
the rules, roles and expectations <strong>of</strong> the pharmacist. This<br />
presentation discusses this new set <strong>of</strong> rules and the behaviors<br />
that have to change in pharmacy to accommodate this new set<br />
<strong>of</strong> responsibilities.<br />
A new standard <strong>of</strong> care must be realized and all patients need<br />
to receive this same standard <strong>of</strong> care to be taken seriously by<br />
our medical colleagues. To accomplish this, all pharmacists<br />
around the world need to adopt the same pr<strong>of</strong>essional practice.<br />
This necessity and what it takes to realize it will be the content<br />
<strong>of</strong> this presentation.<br />
A focus <strong>of</strong> the presentation will be how pharmacists can<br />
prepare themselves for the changes occurring and on how<br />
pharmacists will know if they are being successful at achieving<br />
their goals.<br />
Data that depicts a successful practice will be presented.<br />
Practical means <strong>of</strong> achieving this goal will be presented<br />
throughout the presentation.<br />
<strong>Final</strong>ly, considerations for future progress in pharmacy will be<br />
discussed.<br />
Goals and Objectives<br />
1. To present the rules that will apply to pharmacists who<br />
provide direct patient care.<br />
2. To establish what it will take to be successful at providing<br />
pharmaceutical care practice.
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3. To provide pharmacists with the means to evaluate their<br />
progress toward a successful practice.<br />
Self-Assessment Questions<br />
1. What four rules, which are non-negotiable, apply to all direct<br />
patient care providers?<br />
2. Which standards <strong>of</strong> care must be met to be successful at<br />
pharmaceutical care practice?<br />
3. What three measures can a pharmacist use to determine if<br />
his/her practice is successful?<br />
Motivating Patients through Effective<br />
Communication: Motivational Interviewing<br />
Christiane Mayer, BPharm, Certificate in Psychology, University<br />
<strong>of</strong> Montréal, Montréal, QC<br />
The success <strong>of</strong> many therapeutic interventions depends to a<br />
large degree on the extent to which patients engage with their<br />
treatment and adhere to the changes that are recommended by<br />
their health pr<strong>of</strong>essionals. However, this usually requires, on<br />
the part <strong>of</strong> the patient, a high degree <strong>of</strong> continuous effort and<br />
strong motivation.<br />
While the health pr<strong>of</strong>essional may be the authority in<br />
diagnosing what the patient should change, the patient is the<br />
authority in deciding what is most important and possible in<br />
the context <strong>of</strong> his or her life.<br />
A key task for pharmacist is enhancing motivation for<br />
behaviour change. Motivational interviewing has been shown<br />
to be an effective and efficient method for building motivation<br />
in a number <strong>of</strong> problem areas, but not enough yet put forward<br />
as a preferred mode <strong>of</strong> intervention for everyday patient<br />
interactions.<br />
The goal <strong>of</strong> this workshop is to review spirit, principles and<br />
counselling tools <strong>of</strong> motivational interviewing in order to<br />
promote behaviour changes and results in positive health<br />
outcomes.<br />
Goals and Objectives<br />
Upon completion <strong>of</strong> this activity, participants will be able to:<br />
1. Describe the key concepts <strong>of</strong> motivational interviewing (MI).<br />
2. Perform rapid assessments <strong>of</strong> their patients’ readiness for<br />
change<br />
3. Use practical and efficient strategies, given the significant<br />
time constraints <strong>of</strong> clinical practice<br />
4. Apply and integrate some MI communications techniques<br />
into clinical encounters with patients.<br />
Self-Assessment Questions<br />
1. Describe the spirit <strong>of</strong> motivational interviewing<br />
2. What are the 5 principles <strong>of</strong> motivational interviewing?<br />
3. When should I consider using motivational interviewing<br />
communication tools?<br />
Aspirin for Primary Prevention: A Sober Second<br />
Look<br />
Danette Beechinor, BScPhm, PharmD, Centre for Family<br />
Medicine, Kitchener, ON<br />
The Goal <strong>of</strong> this session is to explore the data supporting the<br />
evidence for the use <strong>of</strong> aspirin in the primary prevention <strong>of</strong><br />
cardiovascular events, and define the areas <strong>of</strong> uncertainty<br />
where the balance <strong>of</strong> the evidence does not support the use <strong>of</strong><br />
aspirin.<br />
In the past year, several meta-analyses have been published<br />
which re-examine and question the utility <strong>of</strong> aspirin in primary<br />
prevention. This session will summarize and review the most<br />
recent findings, which are conflicting, and help participants<br />
come to an understanding <strong>of</strong> both the available evidence and<br />
the continued uncertainties. Evidence <strong>of</strong> risks and benefits <strong>of</strong><br />
aspirin for primary prevention in specific patient groups,<br />
including women, patients with peripheral arterial disease or<br />
diabetes without a prior history <strong>of</strong> a cardiovascular event will<br />
be examined.<br />
Goals and Objectives<br />
1. At the end <strong>of</strong> this session, participants will be able to<br />
quantify the risks and benefits <strong>of</strong> aspirin for primary<br />
prevention in cardiovascular disease in specific patients and<br />
assist patients in a model <strong>of</strong> informed shared decision<br />
making.<br />
Self-Assessment Questions<br />
1. When is it reasonable to use aspirin for primary prevention <strong>of</strong><br />
vascular events?<br />
2. What patient specific factors influence the balance <strong>of</strong> risk<br />
versus benefit?<br />
Leadership Pearls<br />
Peter J. Zed, BSc, BScPhm, ACPR, PharmD, FCSHP, Capital<br />
Health and Dalhousie University, Halifax, NS, Jason M.<br />
Howorko, BS., BSP, ACPR, Alberta Health Services, Red Deer, AB<br />
The goal <strong>of</strong> this session is to discuss leadership issues<br />
important to hospital pharmacy practice with particular<br />
attention to challenges, opportunities and barriers in<br />
leadership development.<br />
Leadership is defined as the “art <strong>of</strong> motivating a group <strong>of</strong><br />
people to act towards achieving a common goal”. <strong>Hospital</strong><br />
pharmacy practice is rapidly evolving in the context <strong>of</strong> the<br />
common goal to provide safe and effective medications to the<br />
patients under our care. Enabling pharmacists to maximize the<br />
full potential within our scope <strong>of</strong> practice requires leadership in<br />
clinical practice, education, research and administration.<br />
<strong>Pharmacists</strong> <strong>of</strong> today are being challenged more than ever<br />
before to improve the optimal delivery <strong>of</strong> health care but it is<br />
the responsibility <strong>of</strong> the leaders <strong>of</strong> our pr<strong>of</strong>ession to enable,<br />
support and motivate pharmacists and to foster an<br />
environment to allow leaders in reach their full potential to
achieve our common goal to optimize patient outcomes and<br />
improve overall health.<br />
The session will share personal perspective and experiences on<br />
leadership development in pharmacy practice, education,<br />
research and administration. Opportunities, challenges and<br />
barriers in leadership development will be discussed as well as<br />
critical factors that must be present to create an environment<br />
for leaders to emerge in today’s healthcare climate.<br />
Goals and Objectives<br />
1. To discuss leadership opportunities and challenges facing<br />
hospital pharmacists in today’s healthcare climate.<br />
2. To discuss barriers and potential solutions to leadership<br />
development in hospital pharmacy practice.<br />
3. To discuss factors that will enable pharmacists to develop to<br />
become future leaders in our pr<strong>of</strong>ession.<br />
Self-Assessment Questions<br />
1. What are the greatest challenges facing hospital pharmacy<br />
leaders today?<br />
2. What solutions can be utilized to minimize or avoid barriers<br />
to realizing full leadership potential?<br />
3. What can you do to take on the challenge <strong>of</strong> leadership in<br />
hospital pharmacy practice?<br />
The Marketed Health Products Directorate:<br />
Regulatory Oversight <strong>of</strong> Health Product Advertising<br />
in Canada<br />
Ann Sztuke-Fournier, BPharm, Marketed Health Products<br />
Directorate, Health Canada<br />
The purpose <strong>of</strong> this presentation is to give pharmacists a<br />
greater understanding <strong>of</strong> how health product advertising is<br />
regulated in Canada. The inter-related roles <strong>of</strong> Health Canada,<br />
Industry and the advertising preclearance agencies will be<br />
discussed, along with the federal legislation, policies and<br />
guidelines pertaining to pharmaceutical advertising.<br />
Health Canada is the national regulatory authority for health<br />
product advertising and bears the ultimate responsibility for<br />
enforcing the Food & Drugs Act and related Regulations. Within<br />
Health Canada, the Marketed Health Products Directorate<br />
(MHPD) provides policies to effectively regulate marketed<br />
health products. MHPD develops guidance documents for the<br />
interpretation <strong>of</strong> the regulatory framework, oversees regulated<br />
advertising activities, and intervenes in the resolution <strong>of</strong><br />
advertising complaints in specific situations. The<br />
pharmaceutical and natural health product industries are<br />
responsible to ensure that the advertising they produce is not<br />
false, misleading or deceptive, and meets all other legal<br />
requirements. Although voluntary, Health Canada strongly<br />
recommends that health product manufacturers have their<br />
advertising reviewed by one <strong>of</strong> the independent advertising<br />
preclearance agencies prior to launch, as an effective aid to<br />
meeting these requirements. Advertising preclearance agencies<br />
are also the first route for adjudication <strong>of</strong> most advertising<br />
complaints.<br />
Not all messages about health products constitute advertising.<br />
Since some messages are non-promotional, it is important to<br />
understand this distinction in order to determine whether a<br />
given message is acceptable within the meaning <strong>of</strong> the<br />
regulatory framework. The types <strong>of</strong> health product messages<br />
and criteria used to assess whether they constitute advertising<br />
will be discussed.<br />
Goals and Objectives<br />
1. To provide pharmacists with an overview <strong>of</strong> how advertising<br />
<strong>of</strong> marketed health products is regulated in Canada,<br />
particularly with respect to pharmaceuticals.<br />
2. To acquaint pharmacists with the federal legislation, policies<br />
and guidelines related to pharmaceutical advertising.<br />
3. To explain the distinction between advertising and other<br />
types <strong>of</strong> messages related to health products.<br />
Self-Assessment Questions<br />
1. In which situations does Health Canada intervene in order to<br />
resolve advertising complaints related to health products?<br />
2. Would it be acceptable for a pharmaceutical company to<br />
engage in an advertising campaign to consumers for a<br />
prescription drug which discusses the drug name along with<br />
its therapeutic indication? Why or why not?<br />
3. What is an important way pharmaceutical and natural health<br />
product manufacturers can help to ensure their advertising<br />
meets the requirements <strong>of</strong> the Food and Drugs Act and<br />
associated Regulations?<br />
Managing Diabetes in the Cardiovascular Patient:<br />
Separating the STICKY from the SWEET<br />
Kori Leblanc BScPhm, ACPR, PharmD, University Health<br />
Network, Toronto ON<br />
Type 2 diabetes mellitus (T2DM) is a significant health<br />
challenge affecting up to 5% <strong>of</strong> all people in the western world.<br />
Cardiovascular disease (CVD) accounts for up to 80% <strong>of</strong> the<br />
deaths among patients with T2DM. It is clear that diabetes is a<br />
potent cardiovascular risk factor, and once CVD becomes<br />
manifest, patients with diabetes have a poorer prognosis than<br />
patients without diabetes.<br />
The management <strong>of</strong> people with T2DM must focus on multiple<br />
risk factor intervention including hyperglycemia, hypertension,<br />
dyslipidemia, microalbuminuria and primary prevention with<br />
aspirin. Management <strong>of</strong> hyperglycemia in the patient with<br />
established CVD should take into consideration the global<br />
effects <strong>of</strong> the treatments on cardiovascular endpoints. Over the<br />
last several years, research has begun to focus more on the<br />
effects <strong>of</strong> antihyperglycemic agents on global cardiovascular<br />
outcomes in addition to glycemic outcomes such as fasting<br />
plasma glucose and A1c levels.<br />
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There are a number <strong>of</strong> challenges with the currently available<br />
blood glucose lowering medications in patients with CVD; risk<br />
<strong>of</strong> lactic acidosis with metformin in patients with CVD and CHF,<br />
edema and CHF in patients treated with thiazolidinediones, and<br />
concerns <strong>of</strong> ischemic preconditioning inhibition with certain<br />
sulfonylureas. In addition, recently developed agents for blood<br />
sugar management lack long term safety and efficacy outcome<br />
effects in patients with CVD.<br />
It is important to understand the available literature to enable<br />
clinicians to weigh the benefits and risks <strong>of</strong> these agents in<br />
primary care management <strong>of</strong> T2DM patients with CVD.<br />
Goals and Objectives<br />
1. To provide pharmacists with an understanding <strong>of</strong> the<br />
evidence behind the benefits and risk <strong>of</strong> oral agents for the<br />
management <strong>of</strong> diabetes in patients with cardiovascular<br />
disease<br />
2. To enable pharmacists to confidently meet the<br />
pharmacotherapeutic needs <strong>of</strong> these patients.<br />
Hypertension: Guidelines, Updates, Outcomes and<br />
What it All Means for <strong>Pharmacists</strong><br />
Ross T. Tsuyuki, BScPhm, PharmD, MSc, FCSHP, FACC, Pr<strong>of</strong>essor<br />
<strong>of</strong> Medicine (Cardiology), University <strong>of</strong> Alberta<br />
Hypertension remains one <strong>of</strong> the most important public health<br />
problems, causing more preventable deaths worldwide than<br />
any other condition. Yet, it remains poorly controlled. To<br />
address this issue, the <strong>Canadian</strong> Hypertension Education<br />
<strong>Program</strong> (CHEP) has been producing evidence-based guidelines<br />
for the past 10 years, with a recent focus on the role <strong>of</strong><br />
pharmacists.<br />
In this presentation, I will present the latest CHEP guidelines,<br />
as well as recently published evidence for the efficacy <strong>of</strong> the<br />
CHEP process. Since one <strong>of</strong> the major themes <strong>of</strong> the 2010<br />
guidelines will be interdisciplinary care, it is timely to review<br />
the evidence for the role <strong>of</strong> the pharmacist in hypertension<br />
management and discuss new initiatives further defining the<br />
role <strong>of</strong> pharmacists in the management <strong>of</strong> this major public<br />
health problem.<br />
Goals and Objectives<br />
1. To review the latest <strong>Canadian</strong> Hypertension Education<br />
<strong>Program</strong> (CHEP) guidelines for hypertension and the<br />
proposed 2010 updates<br />
2. To review the evidence for the efficacy <strong>of</strong> CHEP’s efforts<br />
3. To discuss the evidence for the pharmacist’s role in<br />
hypertension detection and management<br />
Self-Assessment Questions<br />
1. The proportion <strong>of</strong> patients with hypertension in Canada that<br />
are controlled to recommended targets is:<br />
(a) about 85%<br />
(b) about 66%<br />
(c) about 50%<br />
(d) about 15%<br />
2. The recommended target blood pressure for most patients<br />
is:<br />
(a) < 120/80 mmHg<br />
(b) < 130/80 mmHg<br />
(c) < 140/90 mmHg<br />
(d) < 160/90 mmHg<br />
Answers: 1 (d); 2 (c)<br />
Measurement <strong>of</strong> the Effect <strong>of</strong> Discontinuing<br />
Bacl<strong>of</strong>en and Dantrolene Therapy in Long-Term<br />
Institutionalized Patients with Spasticity<br />
Barbara Farrell, BScPhm, PharmD, Bruyère Continuing Care,<br />
Ottawa, ON<br />
Despite lack <strong>of</strong> valid trials documenting efficacy, bacl<strong>of</strong>en and<br />
dantrolene are widely used to treat spasticity.<br />
The purpose <strong>of</strong> this project was to evaluate the effects <strong>of</strong><br />
planned withdrawal <strong>of</strong> bacl<strong>of</strong>en and dantrolene in consenting<br />
patients who were receiving complex continuing care. We also<br />
surveyed physicians and patients (or substitute decision<br />
makers) for the reasons they considered when deciding to<br />
participate in the withdrawal program.<br />
In this descriptive study, data were collected before, during and<br />
after the withdrawal intervention. A withdrawal protocol was<br />
used in which the clinical team performed individualized<br />
monitoring as a basis for making withdrawal decisions.<br />
Of 69 patients taking either bacl<strong>of</strong>en or dantrolene, 29 were<br />
excluded from the withdrawal protocol primarily because <strong>of</strong><br />
physicians’ decisions. Of the 40 eligible patients, 26 (65%)<br />
participated in the tapering protocol. Of these 26, 15 (58%)<br />
were able to discontinue the drugs, 6 (23%) had their doses<br />
reduced, 4 (15%) had no change in dose and one patient died<br />
during tapering. Six (23%) had other changes made to their<br />
spasticity treatment, and 4 (15%) had improvements in other<br />
symptoms that could have been adverse effects <strong>of</strong> the<br />
antispasticity agents.<br />
More than half <strong>of</strong> the participating patients were able to have<br />
bacl<strong>of</strong>en or dantrolene discontinued or the dose lowered; some<br />
had adjustments in other medications. Targeted medication<br />
withdrawal programs can be used to reduce unnecessary<br />
medication in patients receiving long-term care in an<br />
institutional setting.<br />
Goals and Objectives<br />
1. To provide pharmacists with an example <strong>of</strong> a successful<br />
bacl<strong>of</strong>en/dantrolene targeted medication withdrawal<br />
program<br />
2. To raise awareness <strong>of</strong> the importance <strong>of</strong> routinely<br />
re-examining medication indications and effectiveness and<br />
the need to consider targeted tapering programs as a viable<br />
approach to minimizing the use <strong>of</strong> unnecessary medications<br />
Self-Assessment Questions<br />
1. What proportion <strong>of</strong> patients are successful in either stopping<br />
or lowering doses <strong>of</strong> antispasticity agents?
2. What reasons for being interested in withdrawing<br />
antispasticity agents do patients give?<br />
Here’s your Script... You’ll be fine: Barriers to<br />
Medication Adherence<br />
Cynthia Jackevicius, BScPhm, PharmD, MSc, FCSHP, BCPS (AQ<br />
Cardiology), Western University <strong>of</strong> Health Sciences, Los<br />
Angeles, CA<br />
The goal <strong>of</strong> this session is to describe the barriers to<br />
medication use in the outpatient setting related to adherence<br />
and medication policy. Primary and secondary nonadherence,<br />
and intentional vs. nonintentional adherence will be discussed<br />
using recent examples from the literature. Factors associated<br />
with filling discharge medications after hospitalization will be<br />
examined with a discussion on how the pharmacist can<br />
enhance medication adherence at this transition in care. In<br />
addition, this session will identify ongoing barriers to<br />
adherence and provide pharmacists with long term<br />
evidence-based strategies to improve patient nonadherence.<br />
Current literature and real-life examples will be used to discuss<br />
the barriers and solutions.<br />
Goals and Objectives<br />
1. To identify barriers to medication use in the outpatient<br />
setting related to adherence and medication policy.<br />
2. To inform pharmacists <strong>of</strong> strategies to improve medication<br />
adherence.<br />
Self-Assessment Questions<br />
1. What are the most common barriers to medication<br />
adherence?<br />
2. When are most medications filled by patients after discharge<br />
post-myocardial infarction?<br />
3. What are evidence-based strategies to improve<br />
nonadherence?<br />
Pharmaceutical Care: How to Conduct an<br />
Assessment, Care Plan and Follow-up Evaluation<br />
Linda M. Strand, PharmD, PhD, DSc(Hon), Medication<br />
Management Systems<br />
This workshop will review the key components <strong>of</strong> the patient<br />
care process. Each component will be discussed in detail. The<br />
assessment will be presented starting with the medication<br />
experience, working through the Pharmacotherapy Workup <strong>of</strong><br />
Drug Therapy and finishing with the identification <strong>of</strong> any drug<br />
therapy problems that are present. The care plan will be<br />
presented beginning with resolving drug therapy problems,<br />
establishing goals <strong>of</strong> therapy, and making personalized and<br />
individualized interventions to optimize the patient’s<br />
medication experience. The follow-up evaluation with be<br />
discussed including appropriate timing for follow-up<br />
evaluations, the definition <strong>of</strong> appropriate parameters for<br />
monitoring effectiveness and safety and the need to<br />
re-evaluate patients on an on-going basis.<br />
This workshop will provide participants with “hands-on”<br />
experience <strong>of</strong> conducting an assessment, care plan and<br />
follow-up evaluation. The focus will be on developing the<br />
thought processes necessary to be successful in practice.<br />
The care process will be discussed in the context <strong>of</strong><br />
establishing a practice and creating a financially viable practice<br />
while delivering these services.<br />
Goals and Objectives<br />
1. To provide pharmacists the basics <strong>of</strong> how to conduct each <strong>of</strong><br />
the principle elements <strong>of</strong> the patient care process; the<br />
assessment, the care plan, and the follow-up evaluation.<br />
2. To share experiences <strong>of</strong> pharmacists who have established<br />
practices and are caring for patients.<br />
3. To share data from practices <strong>of</strong> pharmaceutical care.<br />
Self-Assessment Questions<br />
1. What is the starting point <strong>of</strong> an assessment?<br />
2. What are the four major categories and seven different types<br />
<strong>of</strong> drug therapy problems?<br />
3. What are the three characteristics <strong>of</strong> a goal <strong>of</strong> therapy?<br />
Scanning the Horizon: The Evolving Provincial<br />
Approaches to Pharmacist Working in Primary Care<br />
Lisa Dolovich, BScPhm, PharmD, MSc, Department <strong>of</strong> Family<br />
Medicine, McMaster University, Hamilton, ON<br />
Team-based collaborative care is now being recognized as a<br />
strategy to best manage ever evolving complex drug therapy<br />
needs <strong>of</strong> many types <strong>of</strong> patient populations. <strong>Pharmacists</strong> are<br />
increasingly taking on roles as integral parts <strong>of</strong> family practice<br />
teams on site in family physician group practices all across<br />
Canada. A recent project, Integrating Family Medicine and<br />
Pharmacy to Advance Primary Care Therapeutics (IMPACT),<br />
demonstrated that pharmacists form an integral part <strong>of</strong> family<br />
physician group practice and can carry out many activities<br />
within that setting to improve drug prescribing and monitoring.<br />
Goals and Objectives<br />
The goal <strong>of</strong> this presentation is to discuss different initiatives<br />
underway across Canada to encourage pharmacist integration<br />
within primary care. The objectives <strong>of</strong> this presentation are to<br />
describe:<br />
1. The roles and activities taken on by pharmacists working in<br />
Ontario Family Health Teams<br />
2. Primary care pharmacy initiatives underway in various<br />
provinces<br />
3. Evolving challenges and opportunities for pharmacists in<br />
primary care<br />
Self-Assessment Questions<br />
1. Which provinces have formal initiatives incorporating<br />
pharmacists into primary care practice sites?<br />
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2. What are two more common services <strong>of</strong>fered by pharmacists<br />
working within primary care practice sites?<br />
Scanning the Horizon: The Evolving Provincial<br />
Approaches to Pharmacist Working in Primary Care<br />
Derek Jorgenson, BSP, PharmD<br />
The goal <strong>of</strong> this session is to provide an update on how<br />
pharmacists have been utilized differently in the primary health<br />
care system over the last 12-24 months in Canada. The focus <strong>of</strong><br />
the discussion will be on primary care roles that health system<br />
/ institutional pharmacists from the western provinces are<br />
becoming involved in, with a particular focus on recent<br />
advancements in the province <strong>of</strong> Saskatchewan.<br />
In recent years, the role <strong>of</strong> pharmacists as integrated members<br />
<strong>of</strong> interpr<strong>of</strong>essional family medicine teams has greatly<br />
expanded across Canada; however, the extent to which this<br />
model has been adopted and the approaches being used to<br />
integrate these pharmacists has varied greatly in each<br />
province. One consistent factor in most provinces has been the<br />
fact that health system / institutional pharmacists have been<br />
highly involved in both providing the clinical services and<br />
supporting the integration <strong>of</strong> this new pharmacist role on<br />
primary care teams. Therefore, it is important for CSHP<br />
members to be aware <strong>of</strong> the different approaches that have<br />
been taken in this area because as this patient care practice<br />
expands further across the country most hospital pharmacy<br />
departments will have staff members involved in these clinics.<br />
By understanding the challenges and successes that have been<br />
experienced by others, subsequent pharmacy departments will<br />
likely have a much easier time supporting this new services.<br />
Self-Assessment Questions<br />
1. List two barriers you might expect to experience in your<br />
pharmacy department if you were attempting to integrate a<br />
pharmacist onto a primary health care team?<br />
2. Describe what makes it more challenging to integrate<br />
pharmacists onto primary health care teams in the prairie<br />
provinces?<br />
Dabigatran and Rivaroxaban: Is it Time For a<br />
Warfarin-Ban?<br />
Jeff Nagge, PharmD, Centre for Family Medicine, Kitchener, ON<br />
The goal <strong>of</strong> this session is to provide a practical overview <strong>of</strong> two<br />
new oral antithrombotic agents that are poised to replace<br />
warfarin.<br />
There is no debate that warfarin is a challenging medication to<br />
manage. Warfarin: 1) has a delay in onset and <strong>of</strong>fset <strong>of</strong> effect;<br />
2) causes wide inter-individual variability in the response to a<br />
given dose; and, 3) requires vigilant monitoring as the<br />
antithrombotic effect can vary due to drug and food<br />
interactions, and changes to a patient’s lifestyle and health.<br />
Despite these complexities, warfarin is the reigning oral<br />
antithrombotic agent <strong>of</strong> choice for most thromboembolic<br />
disorders.<br />
After a false-start with ximelagatran, several new<br />
antithrombotic agents are positioned to possibly dethrone<br />
warfarin for many indications. Both rivaroxaban, a direct factor<br />
Xa inhibitor, and dabigatran, a direct thrombin inhibitor,<br />
possess a number <strong>of</strong> advantages over warfarin. Most <strong>of</strong> the<br />
clinical trial data involving these agents are from the setting <strong>of</strong><br />
thromboprophylaxis after orthopaedic surgery, but a large trial<br />
<strong>of</strong> dabigatran compared to warfarin in patients with atrial<br />
fibrillation was presented earlier this year. There are a number<br />
<strong>of</strong> issues to consider before either <strong>of</strong> these new agents can be<br />
crowned and we finally declare a warfarin-ban.<br />
Goals and Objectives<br />
After attending this session, participants will be able to:<br />
1. Explain the pharmacology, pharmacokinetics, and approved<br />
indications <strong>of</strong> rivaroxaban and dabigatran<br />
2. Discuss the potential benefits, harms and costs associated<br />
with the use <strong>of</strong> these agents<br />
Self-Assessment Questions<br />
1. What are the potential benefits <strong>of</strong> rivaroxaban and<br />
dabigatran compared to warfarin?<br />
2. What are the potential benefits <strong>of</strong> warfarin compared to<br />
rivaroxaban and dabigatran?<br />
Unprovoked VTE’s in Males and Females-Whom to<br />
Treat and For How Long?<br />
B. Bartle, PharmD, Sunnybrook Health Sciences Centre,<br />
University <strong>of</strong> Toronto, Toronto, ON<br />
This session will provide an evidence-based approach to<br />
anticoagulant duration in unprovoked VTE.<br />
It is now recognized that the clinical circumstances at the time<br />
<strong>of</strong> the first VTE event strongly influences the risk <strong>of</strong> a second<br />
event after stopping anticoagulant therapy.<br />
For patients with a minor reversible risk factor(e.g. estrogen<br />
therapy), the risk <strong>of</strong> recurrence is about 5% in the first yr after<br />
stopping anticoagulant therapy and this is considered low<br />
enough to justify stopping therapy after 3 months.<br />
Patients with active cancer and a first episode <strong>of</strong> VTE usually<br />
receive treatment indefinitely.<br />
Two placebo-controlled RCTs involving patients with<br />
unprovoked VTEhave shown clear benefit from<br />
extended-duration anticoagulant therapy with a target INR <strong>of</strong><br />
2.5 or 1.75, compared to stopping therapy at 3-6 mo. However,<br />
many non-thrombosis specialists are reluctant to extend<br />
therapy indefinitely, arguing that only 50% <strong>of</strong> patients will have<br />
a recurrence within 10 yrs.<br />
A <strong>Canadian</strong> study recently found that women with an<br />
unprovoked clot could discontinue warfarin(W) after 5-7mo if<br />
they 0 or 1 <strong>of</strong> the following risk factors for recurrence:<br />
post-thrombotic signs in legs, D-Dimer>250ug/L, BMI>30, or<br />
age >65. No low risk criteria could be established for men. For<br />
men, at least, considering a case-fatality rate for major
leeding <strong>of</strong> 8-9% while on W, and a case-fatality rate for<br />
recurrent <strong>of</strong> VTE <strong>of</strong> 4-9%.<br />
For many patients <strong>of</strong> these patients then, unprovoked VTE<br />
should be considered a chronic disorder, and many patients<br />
should remain on W indefinitely with yearly assessments for<br />
bleeding risk and patient preference.<br />
35<br />
Tuesday, February 2 • Mardi 2 février<br />
Practical Approach to Management <strong>of</strong><br />
Non-Cancer Pain<br />
Amita Woods, PharmD, BScPhm, University Health Network,<br />
Leslie Dan Faculty <strong>of</strong> Pharmacy, Toronto, ON<br />
The goal <strong>of</strong> this session is to provide pharmacists with a<br />
general approach to assist in the management <strong>of</strong> patients with<br />
chronic non-cancer pain, including the safe and effective use <strong>of</strong><br />
opioids<br />
Opioids are commonly used for severe acute pain, cancer<br />
related pain or end <strong>of</strong> life care. The use <strong>of</strong> opioids for chronic<br />
non cancer pain (CNCP) is more controversial. However<br />
prescriptions for opioids have increased in the past 20 years in<br />
part due to their use for CNCP. Prescription opioid misuse and<br />
mortality related to use is also an ongoing issue.<br />
A benefit to harm assessment should be conducted and<br />
documented prior to and during chronic opioid therapy (COT)<br />
for CNCP to identify those most likely to benefit from opioids<br />
while minimizing complications. Randomized controlled trials<br />
that demonstrate the benefits <strong>of</strong> COT are most applicable to<br />
patients with moderate or more severe pain who failed to<br />
respond to non opioids.<br />
<strong>Pharmacists</strong> can play a significant role in the management <strong>of</strong><br />
these patients – educating practitioners and patients about the<br />
use <strong>of</strong> opioids and in helping to monitor efficacy and safety <strong>of</strong><br />
those on opioids<br />
Goals and Objectives<br />
1. To provide pharmacists with an update on the emerging<br />
guidelines<br />
2. To provide pharmacists with an approach to the management<br />
<strong>of</strong> patients with Chronic Non-Cancer Pain<br />
3. To enable pharmacists to utilize available tools to promote<br />
the safe and effective use <strong>of</strong> opioids<br />
4. To provide pharmacists with a balanced approach to opioid<br />
use, acknowledging legitimate medical need, and<br />
recognizing the risks <strong>of</strong> abuse and diversion<br />
Self-Assessment Questions<br />
1. Which patients with CNCP might benefit from a trial <strong>of</strong><br />
opioids?<br />
2. What baseline assessments need to be completed and<br />
documented for patients being started on opioids for Chronic<br />
Non Cancer Pain?<br />
3. What type <strong>of</strong> tools are available to help identify those<br />
patients that might be at higher risk <strong>of</strong> dependence or<br />
diverting opioids? How are the tools meant to be used?<br />
Ten Things You Really Need to Know About<br />
CSHP 2015<br />
Neil J. MacKinnon, PhD, FCSHP, Dalhousie University, Halifax,<br />
NS<br />
The goal <strong>of</strong> this session is to provide pharmacists with an<br />
update <strong>of</strong> the activities <strong>of</strong> the CSHP 2015 initiative including<br />
practical take-home messages for hospital pharmacists and<br />
those in management positions.<br />
CSHP 2015 is a pharmacy practice excellence initiative, adopted<br />
from the ASHP 2015 initiative. It was first approved by CSHP’s<br />
Council in February 2007 and revised in May 2008. It is also<br />
included as a strategic objective <strong>of</strong> the CSHP Vision 2011.<br />
Overall, CSHP 2015 has six primary goals and 36 objectives, all<br />
with measurable targets. CSHP 2015 is applicable both in<br />
hospitals and in related healthcare settings.<br />
In the past 12 months, there has been considerable activity<br />
related to CSHP 2015. A Steering Committee has been formed<br />
and meets regularly and branch champions have been selected.<br />
A project manager has been hired by CSHP to help coordinate<br />
the initiative.<br />
Baseline data for the goals and objectives was collected as part<br />
<strong>of</strong> the 2008-2009 <strong>Hospital</strong> Pharmacy in Canada Survey and was<br />
released in 2009. Comparisons to the ASHP 2015 data were<br />
made which yielded interesting results. A CSHP 2015 Crosswalk<br />
was developed in late 2009. The Crosswalk contains the<br />
evidence in support <strong>of</strong> each <strong>of</strong> the 36 objectives and also links<br />
CSHP 2015 to many other national initiatives and organizations<br />
such as Safer Healthcare Now and Accreditation Canada. In fall<br />
2009, <strong>Canadian</strong> hospital pharmacy directors and managers<br />
were invited to complete an on-line self-assessment survey<br />
related to CSHP 2015. The results provide insight into the<br />
current use <strong>of</strong> CSHP 2015 and expected activities in the coming<br />
months.<br />
Goals and Objectives<br />
1. To provide pharmacists with the highlights <strong>of</strong> the CSHP 2015<br />
initiative and a clearer picture <strong>of</strong> progress made to date.
36<br />
2. To enable pharmacists to consider how best to apply the<br />
CSHP 2015 initiative to their own practice setting.<br />
Self-Assessment Questions<br />
1. How might the new CSHP 2015 Crosswalk be used?<br />
2. How do the baseline CSHP 2015 results compare to those <strong>of</strong><br />
the ASHP 2015 initiative?<br />
3. What are the main findings <strong>of</strong> the CSHP 2015<br />
self-assessment questionnaire completed by hospital<br />
pharmacy directors and managers in fall 2009?<br />
Clinical Pearls: Hot Topics in GI<br />
Peter Thomson BScPhm, PharmD, Winnipeg Regional Health<br />
Authority, Winnipeg, MB<br />
GI issues arise in almost any pharmacy practice site. This<br />
session will touch on recent literature regarding three topics:<br />
acute liver failure, hepatorenal syndrome and rebound<br />
hypersecretion with proton pump inhibitors.<br />
Goals and Objectives<br />
1. To familiarize pharmacists with hallmarks <strong>of</strong> fulminant acute<br />
liver failure<br />
2. Discuss the evolving role <strong>of</strong> N-Acetylcysteine in non<br />
acetaminophen induced acute liver failure.<br />
3. Discuss drug management issues with hepatorenal<br />
syndrome<br />
4. Review concept <strong>of</strong> rebound hypersecretion with intensive PPI<br />
therapy<br />
Self-Assessment Questions<br />
1. What drug therapies are commonly utilitized to improve<br />
outcomes in hepatorenal syndrome<br />
2. Is there evidence to support the use <strong>of</strong> N-Acetylcysteine in<br />
patients who have non acetaminophen related acute liver<br />
failure?<br />
3. What is the likelihood <strong>of</strong> healthy adults developing acid<br />
related symptoms after completing an 8 week course <strong>of</strong><br />
intensive acid suppressive therapy?<br />
Update on ICU Sedation<br />
Lisa Burry, BScPhm, PharmD, FCCP, Mount Sinai <strong>Hospital</strong>,<br />
Toronto, ON<br />
“Today we will be mixing…the Draught <strong>of</strong> Peace, a potion to<br />
calm anxiety and soothe agitation. Be warned: if you are too<br />
heavy-handed with the ingredients you will put the drinker into<br />
a heavy and sometimes irreversible sleep, so you will need to<br />
pay attention to what you are doing.” – Potions teacher<br />
Severus Snape. Harry Potter.<br />
Critically ill mechanically ventilated (MV) patients are at risk <strong>of</strong><br />
experiencing pain, stress, and anxiety. Sedative, analgesic, and<br />
anxiolytic pharmacotherapy, collectively referred to as<br />
‘sedation’, is fundamental in the ICU to facilitate life-supporting<br />
treatments and to ensure patient comfort, safety, and amnesia<br />
as needed. A recent international, multi-center database <strong>of</strong><br />
> 5000 patients highlighted the extent <strong>of</strong> sedative use during<br />
MV. In this database, two-thirds <strong>of</strong> patients received a sedative<br />
at some point during MV, and persistent use <strong>of</strong> sedation was<br />
associated with longer durations <strong>of</strong> ventilation and ICU stay.<br />
Additional new evidence also suggests that patient outcomes<br />
are negatively influenced by the presence <strong>of</strong> over-sedation, the<br />
choice <strong>of</strong> drug therapy, poor pain control, and the occurrence <strong>of</strong><br />
delirium.<br />
Despite ubiquity <strong>of</strong> sedative use in the ICU, achieving optimal<br />
sedation can be challenging, given shifting therapeutic targets<br />
based on clinical status, pre-morbid alcohol and drug use,<br />
unpredictable pharmacokinetics and dynamics associated with<br />
critical illness, and potential drug adverse effects. The objective<br />
<strong>of</strong> this review is to assist clinicians in selecting, assessing and<br />
titrating sedative and analgesic agents in critically ill adult<br />
patients by highlighting the literature published in the last<br />
decade and the findings for a recently completed <strong>Canadian</strong><br />
observational study conducted by hospital pharmacists. A<br />
case-based approach will be used illustrate the principles <strong>of</strong><br />
sedation in the ICU.<br />
Self-Assessment Questions<br />
1. What medications are available for sedation and analgesia in<br />
the ICU?<br />
2. What are the desired features <strong>of</strong> a sedation assessment tool?<br />
3. What strategies are available to adjust drug therapy and<br />
avoid the scenario <strong>of</strong> circling between over then<br />
under-sedation?<br />
Improving Patient Safety through Bar Coded<br />
Medication Administration (BCMA)<br />
Jimmy Fung, BScPhm, MBA, The Credit Valley <strong>Hospital</strong>,<br />
Mississauga, ON<br />
The Credit Valley <strong>Hospital</strong> (CVH) is a 381 bed community<br />
hospital located in Mississauga Ontario. Studies estimate that<br />
38% <strong>of</strong> medication errors occur at the point <strong>of</strong> administration.<br />
Virtually all <strong>of</strong> these errors will get through to the patient since<br />
there is no double check between the nurse and patient. A Bar<br />
Coded Medication Administration (BCMA) system will provide<br />
this check and warn the nurse <strong>of</strong> potential errors.<br />
CVH decided to implement the Meditech Bedside Medication<br />
Verification (BMV) module as the BCMA system. CVH is one <strong>of</strong><br />
the first hospitals in Canada to implement a BCMA system.<br />
Major benefits <strong>of</strong> a BCMA system include:<br />
• Ability to scan barcoded patient identification ensures<br />
adherence to Positive Patient Identification Policy.<br />
• Tracks point-<strong>of</strong>-care medication administration, confirming<br />
the 8 rights <strong>of</strong> medication administration.<br />
• Provides clinical decision support<br />
• Efficient – eMAR immediately available for use by health care<br />
team<br />
• Eliminate manipulation and scanning <strong>of</strong> paper MAR
This session will focus on our lessons learned when moving<br />
from a computerized paper medication administration record<br />
(MAR) to an electronic MAR as part <strong>of</strong> a BCMBA system.<br />
Result/Outcome: The Special Care Nursery was our pilot site<br />
and has been live since October 2008 with plans to implement<br />
in the rest <strong>of</strong> the hospital. Major warnings were found in 1.09%<br />
<strong>of</strong> medication administrations. If extrapolated to entire<br />
hospital, there would be approximately 57 warnings per day.<br />
This means approximately 20,000 potential medication<br />
administration errors would be prevented annually if the<br />
program were implemented hospital-wide!<br />
Goals and Objectives<br />
1. Describe the impact <strong>of</strong> Bar Coded Medication Administration<br />
in increasing patient safety.<br />
2. Identify strategies for successful transition from a<br />
paper-based MAR to an eMAR.<br />
3. Discuss the challenges <strong>of</strong> implementing a BCMA system.<br />
Self-Assessment Questions<br />
1. What are some key gaps in patient safety during medication<br />
administration and how can these be addresses through Bar<br />
Coded medication Administration (BCMA)?<br />
2. How can BCMA increase patient safety through improved<br />
clinical decision support?<br />
Pharmacy Practice Research and the “Meaning <strong>of</strong><br />
(Pharmacist) Life”<br />
Ross T. Tsuyuki, BScPhm, PharmD, MSc, FCSHP, FACC, Pr<strong>of</strong>essor<br />
<strong>of</strong> Medicine (Cardiology), University <strong>of</strong> Alberta, Edmonton, AB<br />
The Blueprint for Pharmacy articulates the vision for our<br />
pr<strong>of</strong>ession: “Optimal drug therapy outcomes for <strong>Canadian</strong>s<br />
through patient-centred care”.<br />
In order to achieve this vision, we must move our pr<strong>of</strong>ession<br />
forward – taking responsibility for patient outcomes. In our<br />
current healthcare environment, we also need evidence.<br />
Evidence that pharmacist care improves outcomes. This is why<br />
pharmacy practice research is so important to our pr<strong>of</strong>ession –<br />
it’s not a “nice to have”, it’s a “have to have”. We must invest<br />
in this research.<br />
In recognition <strong>of</strong> the importance <strong>of</strong> this research, I am<br />
honoured to give the inaugural presentation <strong>of</strong> a series on<br />
“What’s New in Pharmacy Practice Research”. To kick things <strong>of</strong>f,<br />
I will highlight some examples <strong>of</strong> seminal <strong>Canadian</strong> pharmacy<br />
practice research, e.g., SCRIP, IMPACT, AMS, COLLABORATE.<br />
In the (near) future, we need to continue to produce good<br />
evidence for the efficacy <strong>of</strong> pharmacist care, but also need to<br />
understand why so little <strong>of</strong> the evidence we have is<br />
disseminated and implemented by pharmacists and pharmacy<br />
organizations.<br />
Goals and Objectives<br />
1. To highlight the importance <strong>of</strong> pharmacy practice research in<br />
guiding the future <strong>of</strong> our pr<strong>of</strong>ession<br />
2. To review some <strong>of</strong> the pivotal trials in <strong>Canadian</strong> pharmacy<br />
practice research<br />
3. To discuss the future <strong>of</strong> pharmacy practice and the issues we<br />
must address in moving forward<br />
Self-Assessment Questions<br />
1. Reflection: Make <strong>of</strong> list <strong>of</strong> the main things you do in your job<br />
on a daily basis.<br />
a. Are they things that really need to be done by a<br />
pharmacist?<br />
b. How many are evidence-based? (i.e., have pro<strong>of</strong> that they<br />
improve outcomes).<br />
c. Why aren’t you incorporating some proven pharmacist<br />
interventions into your practice? Be honest with yourself.<br />
2. List 2 things you can change in your practice to be more<br />
patient-centred.<br />
Pharmaceutical Care: The Importance <strong>of</strong><br />
Documentation and Reimbursement<br />
Linda M. Strand, PharmD, PhD, DSc(Hon), Medication<br />
Management Systems, Minneapolis, MN<br />
This workshop will focus on the need to document the care<br />
delivered and to receive reimbursement for the service. There<br />
will be three major themes to this workshop: 1) the purpose <strong>of</strong><br />
documenting the patient care process, 2) understanding the<br />
information necessary to document in practice, 3) discuss the<br />
requirements <strong>of</strong> an effective method for reimbursement <strong>of</strong> the<br />
service.<br />
Caring for patients establishes a clinical, ethical and legal<br />
environment that requires extensive documentation when<br />
caring for a patient. Direct patient care requires an additional<br />
level <strong>of</strong> documentation as compared to consultant work and<br />
the requirements are nonnegotiable. We will discuss these<br />
requirements as well as the information required to achieve the<br />
purposes <strong>of</strong> documentation. Patient, disease, and drug<br />
information as well as clinical, economic and behavioral<br />
outcomes are all necessary to document.<br />
Reimbursement for patient care is not optional, as it is<br />
necessary to establish a financially viable practice in order to<br />
continue to deliver services. Different reimbursement<br />
approaches will be presented and experience with “selling” the<br />
service <strong>of</strong> pharmaceutical care will be shared.<br />
Extensive time will be devoted to sharing experiences, asking<br />
questions and evaluating electronic medical records as well as<br />
other s<strong>of</strong>tware programs being used for documentation.<br />
Goals and Objectives<br />
1. To discuss the information required for documentation<br />
purposes.<br />
2. To demonstrate the importance <strong>of</strong> documentation for clinical<br />
practice, legal and ethical purposes.<br />
3. To discuss the available approaches to reimbursement and<br />
the importance <strong>of</strong> selecting the correct method.<br />
37
38<br />
Self-Assessment Questions<br />
1. List five reasons why documenting patient care is necessary.<br />
2. Select the most appropriate approach to reimbursement for<br />
pharmaceutical care.<br />
3. List the 10 most important information elements for a<br />
documentation system in pharmaceutical care practice.<br />
Management <strong>of</strong> Intravascular Catheter-Related<br />
Infections: Focus on Critical Care<br />
2009 IDSA Guidelines Update<br />
Julie Pellerin, BScPhm, MSc, BCPS, University <strong>of</strong> Alberta<br />
<strong>Hospital</strong>, Edmonton, Edmonton, AB<br />
The majority <strong>of</strong> the patients admitted to an intensive care unit<br />
(ICU) will have at least one, and <strong>of</strong>ten multiple, central venous<br />
catheters (CVC) inserted during their stay. In Canada, 6.8% <strong>of</strong><br />
the ICU patients who have a CVC in place for more than 48<br />
hours will develop a CVC related bloodstream infection (BSI).<br />
An observational study published in 2006 by the <strong>Canadian</strong><br />
Nosocomial Infections Surveillance <strong>Program</strong> (CNISP) described<br />
the clinical situation <strong>of</strong> CVC-BSI in <strong>Canadian</strong> ICUs. It showed<br />
that both catheter removal and antimicrobials reduce mortality<br />
in patients that develop a CVC-BSI in the ICU.<br />
With the progression <strong>of</strong> microbial resistance and the better<br />
understanding <strong>of</strong> the relationship between risk factors and<br />
specific pathogens, IDSA revised its recommendations<br />
regarding the empiric treatment <strong>of</strong> CVC-BSI. Risk factors<br />
suggesting that gram negative and/or fungal coverage is<br />
required will be reviewed and discussed.<br />
Duration <strong>of</strong> antimicrobial therapy for CVC-BSI varies in practice,<br />
in part because <strong>of</strong> the lack <strong>of</strong> evidence in the literature.<br />
Individualization <strong>of</strong> patient therapy based on the clinical<br />
picture and pathogens is crucial to minimize complications<br />
associated with a CVC-BSI and the risks <strong>of</strong> resistance caused by<br />
prolonged exposure to antimicrobials.<br />
Goals and Objectives<br />
1. To give a general picture <strong>of</strong> the situation <strong>of</strong> CVC-BSI in<br />
<strong>Canadian</strong>s ICUs.<br />
2. To review IDSA guidelines recommendations for empiric<br />
therapy for CVC-BSI and the evidence supporting these<br />
guidelines.<br />
3. To discuss IDSA guidelines recommendations for the<br />
duration <strong>of</strong> antimicrobials therapy for CVC-BSI.<br />
Self-Assessment Questions<br />
1. What are the two therapeutic strategies that have proven to<br />
reduce mortality in patients with a CVC-BSI according to the<br />
CNISP study?<br />
2. Name four risk factors that warrant antifungal use as part <strong>of</strong><br />
the empiric therapy for a CVC-BSI.<br />
3. Name 3 factors that warrant a longer antimicrobial course<br />
Evidence-Based Morphine Monitoring<br />
Dr. Régis Vaillancourt, OMM, CD, BPharm, PharmD, FCSHP,<br />
Director <strong>of</strong> Pharmacy, Children’s <strong>Hospital</strong> <strong>of</strong> Eastern Ontario<br />
(CHEO), Ottawa, ON<br />
Morphine is a high alert drug that is associated with drug errors<br />
that have the potential to cause harm to the patient. There is a<br />
growing awareness <strong>of</strong> the importance <strong>of</strong> the design and<br />
implementation <strong>of</strong> medication administration systems that will<br />
reduce the risk and number <strong>of</strong> morphine errors.<br />
One initiative completed at our institution was to measure<br />
compliancy to practice change and to define the prevalence <strong>of</strong><br />
morphine adverse drug reactions (ADRs) within our paediatric<br />
population with the implementation <strong>of</strong> new monitoring<br />
guidelines for initial and subsequent morphine doses that<br />
target the pharmacokinetics for infants and children. The<br />
prevalence <strong>of</strong> ADR’s detected in this study was 59.3% for the<br />
first dose, and 77.8% over the complete course <strong>of</strong> morphine<br />
use.<br />
A human factors approach was adopted to understand the<br />
context and tasks associated with the administration <strong>of</strong> IV<br />
bolus morphine to pediatric patients. Four major categories <strong>of</strong><br />
influencing factors were identified in a total <strong>of</strong> 51 observations<br />
<strong>of</strong> morphine administration. In 36% <strong>of</strong> the observations, time<br />
between process initiation and actual morphine administration<br />
was twice as long as the average time. Error-likely points when<br />
morphine is used are related to both organizational and<br />
environmental/physical aspects.<br />
Additionally, 10 mg/ml vials have been removed as data shows<br />
that most doses are less than 4mg. Lastly, a failure mode effect<br />
analysis is currently underway to evaluate morphine<br />
prescribing practices. Thus, interventions to improve morphine<br />
administration must be targeted at the error-likely points to<br />
have the greatest impact on reducing the opportunities for<br />
failures and increasing patient safety.<br />
Goals and Objectives<br />
1. To provide pharmacists with an understanding <strong>of</strong> why we<br />
need morphine monitoring systems in place and<br />
evidence-based data that supports these practices.<br />
2. To share successes and barriers in implementation <strong>of</strong> revised<br />
morphine monitoring guidelines, and discuss results from<br />
the pilot study and long-term policy compliancy.<br />
3. To present an overview <strong>of</strong> various hospital initiatives<br />
regarding morphine safety.<br />
4. To discuss error preventing strategies at different points <strong>of</strong><br />
morphine administration (prescribing, administration,<br />
monitoring).<br />
Self-Assessment Questions<br />
1. What evidence-based practices should be implemented in<br />
hospital to prevent morphine errors?<br />
2. Is it reasonable to use similar safety methods for other<br />
high-alert medications?
Pediatric Anticoagulation<br />
Kat Timberlake, PharmD, The <strong>Hospital</strong> for Sick Children,<br />
Toronto, ON<br />
Pediatric thromboembolism differs from adults in many<br />
respects. The epidemiology <strong>of</strong> thrombosis in infants and<br />
children varies even among different development age groups.<br />
Pediatric patients have special considerations for the safety<br />
and efficacy <strong>of</strong> prophylaxis and treatment <strong>of</strong> thrombi as well.<br />
This session will focus on Unfractionated Heparin,<br />
Low-molecular weight heparin, Warfarin and the anti-platelet<br />
agents used most <strong>of</strong>ten in pediatric patients. A review <strong>of</strong><br />
reasons why pediatric patients develop thrombi, and<br />
prevention and treatment strategies <strong>of</strong> thromboembolism will<br />
be provided. Practical tips on administration <strong>of</strong> anticoagulants<br />
that are not formulated with pediatric patients in mind will be<br />
considered.<br />
Goal and Objectives<br />
By the end <strong>of</strong> this presentation, the attendees will be able to:<br />
1. Discuss origins <strong>of</strong> pediatric thromboembolism.<br />
2. Identify developmental differences in pediatric thrombosis.<br />
3. Understand the mechanism <strong>of</strong> action and reason for use <strong>of</strong><br />
each <strong>of</strong> the following anticoagulants/antiplatelets: Heparin,<br />
LMWH, Warfarin, Aspirin and clopidogrel.<br />
4. Design a therapeutic monitoring plan associated with each<br />
<strong>of</strong> the anticoagulants.<br />
dashboard-style overview.<br />
In addition, the session will demonstrate the ability for users to<br />
easily extract detailed information regarding ROP status in<br />
specific sites or in specific patient care units, highlight specific<br />
options utilized to achieve ROP compliance, identify areas in<br />
need <strong>of</strong> focused attention, and provide a mechanism to track<br />
progress on specific ROPs, at the level <strong>of</strong> the health authority,<br />
site, or specific patient care unit.<br />
Goals and Objectives<br />
1. To provide pharmacists, administrators, and coordinators<br />
with an interest in medication safety with an understanding<br />
<strong>of</strong> baseline concepts required to build a user-friendly but<br />
powerful data collection and analysis tool.<br />
2. To demonstrate the use <strong>of</strong> a spreadsheet-based tool, using<br />
actual data collected in a large health authority, to highlight<br />
the ability to track ROP status, identify areas requiring<br />
focused attention, and quantify the different options utilized<br />
to achieve ROP compliance.<br />
Self-Assessment Questions<br />
1. What are the baseline principles which need to be<br />
established before a data collection tool for ROPs can be<br />
designed?<br />
2. What are the different levels <strong>of</strong> analysis that can be achieved<br />
through use <strong>of</strong> a well-designed tool?<br />
3. How can the dashboard-style overview assist the pharmacy<br />
department in achieving ROP compliance?<br />
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Tracking Required Organizational Practices: If You<br />
Don’t Know Where You Are, How Are You Going to<br />
Get There?<br />
Mits Miyata, BScPhm, ACPR, Janice Munroe BScPhm, Fraser<br />
Health Authority, Langley, BC<br />
The number <strong>of</strong> medication-related Required Organizational<br />
Practices (ROPs) grows every year. Pharmacy is <strong>of</strong>ten seen as<br />
the leader <strong>of</strong> these medication-related improvement initiatives.<br />
Many regions/health authorities have established medication<br />
or patient safety positions within pharmacy programs. These<br />
individuals are challenged by the <strong>of</strong>ten significant practice<br />
changes that the ROPs require. Further compounding the<br />
challenge is the need to coordinate practice changes at more<br />
than one site. Add onto this the variability in practice<br />
environments between sites and you have a next to impossible<br />
mandate!<br />
Fraser Health has developed an Excel spreadsheet that is used<br />
to monitor progress on the ROPs at all 12 sites. The goal <strong>of</strong> this<br />
session is to provide pharmacy administrators and medication<br />
safety coordinators with a practical mechanism to track the<br />
status and progress <strong>of</strong> ROPs across large health authorities.<br />
Using examples <strong>of</strong> Accreditation Canada’s ROP standards as a<br />
guideline, the session will walk through the conceptual steps<br />
required to form the foundation for building a user-friendly data<br />
collection tool that can be used to obtain consistent and<br />
meaningful input <strong>of</strong> data from specific sites with a<br />
Key Performance Indicators for Pharmacy Practice<br />
Bruce Millin, BScPhm, ACPR, Fraser Health Authority, Langley, BC<br />
Key Performance Indicators (KPI) are quantifiable<br />
measurements that reflect the critical success factors <strong>of</strong> a<br />
department and can help Pharmacy Managers measure<br />
progress towards departmental and organizational goals. They<br />
provide a high – level snapshot <strong>of</strong> a department and are unique<br />
to a particular department and organization, dependent upon<br />
the mission and goals <strong>of</strong> a department.<br />
Through the use <strong>of</strong> real life examples, participants will walk<br />
through the steps required to identify, measure and record<br />
KPIs. In addition a process for recording, communicating and<br />
“telling the story” <strong>of</strong> the department through KPIs will also be<br />
discussed.<br />
Goals and Objectives<br />
1. To provide Pharmacy Managers and coordinators an<br />
overview <strong>of</strong> how Key Performance Indicators can be used to<br />
measure the progress <strong>of</strong> the department in reaching<br />
departmental goals and targets.<br />
2. To demonstrate the steps required to identify and monitor a<br />
KPI for distribution and clinical areas.<br />
3. To have smile and have fun!
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Self-Assessment Questions<br />
1. What are the differences between workload measurement<br />
indicators and Key Performance Indicators?<br />
2. What are the steps required in creating a Key Performance<br />
Indicator?<br />
3. What tools are used to communicate your story?<br />
Wednesday, February 3 • Mercredi 3 février<br />
H1N1 2009 Update: The Public Health Perspective<br />
Brian Schwartz, MD, Ontario Agency for Health Protection and<br />
Promotion, Toronto, ON<br />
How has the 2009 H1N1 pandemic differed from previous<br />
pandemics? What have we learned and how can we apply it in<br />
future?<br />
The goal <strong>of</strong> this session is to analyze recent H1N1 pandemic<br />
events from the perspective <strong>of</strong> what we had planned for, how<br />
this differed (and why), and what we have learned. The<br />
implications for management <strong>of</strong> future pandemics and other<br />
health emergencies are discussed from a perspective <strong>of</strong> public<br />
health; implications for frontline health care providers,<br />
including pharmacists, are addressed.<br />
Although the 2009 pandemic was felt globally, the level <strong>of</strong><br />
severity, as compared to previous pandemics, was quite low.<br />
The disease was mild in most people who contracted it, but<br />
severe in some, especially young people with co-morbidities<br />
such as diabetes, asthma and pregnancy. First Nations<br />
members were also affected disproportionately, likely due to<br />
medical and social factors. As <strong>of</strong> November 27 there were 1582<br />
hospitalizations and 97 deaths related to pH1N1 in Ontario<br />
since April 2009. It is unclear at this time whether the virus will<br />
come back intact or in a mutated state and if so, whether we<br />
will handle it any differently.<br />
Syndromic surveillance <strong>of</strong> health activities related to influenza<br />
like illness (ILI) may be helpful in mapping the spread <strong>of</strong><br />
infectious diseases during epidemics and pandemics; examples<br />
include 911 and Telehealth calls, primary care ILI consultation<br />
rates and purchases <strong>of</strong> both antivirals and symptomatic<br />
medications from pharmacies.<br />
The pandemic has been managed with a combination <strong>of</strong> public<br />
health and infection control measures (hand hygiene, social<br />
distancing), early antiviral treatment in people at risk, and<br />
aggressive management <strong>of</strong> hospitalized patients. Vaccine<br />
manufactures were able to produce a vaccine targeted to pH1N1<br />
within six months; however, this did not reduce the criticism for<br />
not coming up with it sooner. Conversely, the expectations for<br />
comprehensive testing and guaranteed safety were also high.<br />
Vaccine uptake remains a challenge both in terms <strong>of</strong> risk<br />
communication and logistics.<br />
We do not know when the next pandemic will come, but hope<br />
that the lessons learned from the 2009 pandemic will inform<br />
future pandemic planning.<br />
Goals and Objectives<br />
1. To provide pharmacists with an understanding <strong>of</strong> public<br />
health issues in communicable disease, specifically<br />
outbreaks and pandemics.<br />
2. To inform future discussion on pandemic influenza<br />
recognition and management.<br />
Recent Trials That May Change Your Practice in<br />
Acute Care<br />
Vincent Teo, PharmD, Sunnybrook Health Sciences Centre,<br />
Toronto, ON<br />
The goal <strong>of</strong> this session is to review a few key studies<br />
published in the past year that may impact your practice in<br />
acute care. A case based format will be utilized to facilitate<br />
discussion on how the new evidence should be incorporated<br />
into clinical practice.<br />
Due to the nature <strong>of</strong> this presentation, the exact publications to<br />
be discussed will be selected just prior to the presentation<br />
date. Publications discussed will be from a variety <strong>of</strong> practice<br />
areas, but applicable to a target audience <strong>of</strong> mostly generalists.<br />
The session will be practical in nature, and focus on helping<br />
pharmacists determine the bottom-line <strong>of</strong> these studies along<br />
with determining the potential implications to practice.<br />
Goals and Objectives<br />
1. To provide pharmacists with a review <strong>of</strong> recent key clinical<br />
trials that may result in changes to practice.<br />
2. To discuss how these new studies may have implications to<br />
practice and how the results can be incorporated to practice.<br />
Self-Assessment Questions<br />
1. Discuss two things that you may do differently in practice<br />
after attending this presentation.<br />
2. Discuss a limitation <strong>of</strong> one <strong>of</strong> the clinical trials presented.<br />
How does this limit its applicability to your practice?<br />
Antimicrobial Stewardship: The Current Frontier<br />
Sandra Howie, BSP, PharmD, Mount Sinai <strong>Hospital</strong>, Toronto, ON<br />
Antimicrobial stewardship programs have been functioning in<br />
other countries for several years. However, in Canada, these<br />
programs are quite new and thus, pose a unique and novel<br />
position for pharmacists to be involved in. The goal <strong>of</strong> this<br />
session is to provide pharmacists with an overview <strong>of</strong><br />
antimicrobial stewardship programs. With a drought in the<br />
development <strong>of</strong> new antimicrobials, combined with increasing<br />
rates <strong>of</strong> antimicrobial resistant organisms and the always
present potential for adverse effects <strong>of</strong> antimicrobials, the<br />
appropriate use <strong>of</strong> antimicrobials is extremely important. The<br />
first step is developing a program. The Infectious Diseases<br />
<strong>Society</strong> <strong>of</strong> America and the <strong>Society</strong> for Healthcare Epidemiology<br />
<strong>of</strong> America have developed guidelines on implementing an<br />
antimicrobial stewardship program which covers the members<br />
<strong>of</strong> a program as well as the types <strong>of</strong> initiatives that can be<br />
undertaken such as prospective audit and feedback and<br />
formulary restrictions. Some <strong>of</strong> these strategies have more<br />
robust evidence for their effect than others. In addition, some<br />
strategies have less barriers than others that may make them<br />
more easily implemented. The development and strategies <strong>of</strong> a<br />
current antimicrobial stewardship program in Canada will be<br />
discussed. Once a program has been developed, the impact will<br />
need to be assessed. This should involve an assessment <strong>of</strong><br />
baseline information, as well as ongoing assessment.<br />
Measurement can include antimicrobial consumption, costs,<br />
patient outcomes and undesirable effects.<br />
Goals and Objectives<br />
1. To identify goals and objectives <strong>of</strong> an antimicrobial<br />
stewardship program<br />
2. To describe various antimicrobial stewardship strategies<br />
3. To discuss the ways in which the impact <strong>of</strong> an antimicrobial<br />
stewardship program can be assessed<br />
Self-Assessment Questions<br />
1. Describe 4 types <strong>of</strong> antimicrobial stewardship activities and<br />
the pros and cons <strong>of</strong> each<br />
2. List 4 types <strong>of</strong> data that could be collected to assess the<br />
impact <strong>of</strong> an antimicrobial stewardship program and how<br />
they might be gathered<br />
The Ethics behind the Stats: What Every Clinician<br />
Needs to Know to Talk to Patients<br />
Timothy Christie, BA(Hon), MA, MHSc, PhD, Regional Director,<br />
Ethics Services, Horizon Health Network, Saint John, NB<br />
“In making predictions and judgments under uncertainty,<br />
people do not appear to follow the calculus <strong>of</strong> chance or the<br />
statistical theory <strong>of</strong> prediction. Instead, they rely on a limited<br />
number <strong>of</strong> heuristics which sometimes yield reasonable<br />
judgments and sometimes lead to severe and systematic<br />
errors.” (Kahnman and Tversky, On the Psychology <strong>of</strong><br />
Prediction, 1973)<br />
This session will explain the legal technicalities required to get<br />
a valid informed consent from patients. It will then explain that<br />
although the legal standard for disclosing information may be<br />
achieved, patients and families typically do not interpret<br />
information the way we, as health care providers, expect.<br />
Patients and families are more interested in “what is going to<br />
happen to me” rather than appreciating that statistical<br />
information applies to well defined groups <strong>of</strong> patients who<br />
might or might not be similar to this particular patient.<br />
Ultimately, this session will explore the ethical use <strong>of</strong> evidence<br />
and statistical information as a basis for having meaningful<br />
conversations with patients.<br />
Goals and Objectives<br />
1. The goal <strong>of</strong> this session is to critically access the distinction<br />
between how health care pr<strong>of</strong>essionals provide statistical<br />
information to patients and how patients receive, interpret<br />
and act on that information.<br />
2. To explain the legal and ethical requirements for a valid<br />
informed consent.<br />
3. To highlight the heuristic fallacies patients use to process<br />
statistical information.<br />
4. To demonstrate how explicit ethical reasoning can help<br />
overcome some <strong>of</strong> the barriers patients face when trying to<br />
meaningfully interpret health related and statistical<br />
information.<br />
MRSA in 2010: Trends in Epidemiology &<br />
Pharmacotherapy<br />
Rosemary Zvonar, BScPhm, The Ottawa <strong>Hospital</strong>, Ottawa, ON<br />
Methicillin-resistant Staphylococcus aureus (MRSA) was first<br />
reported in Europe in 1961 and in Canada in 1981. Since then,<br />
the incidence <strong>of</strong> individuals colonized and infected with this<br />
resistant organism has steadily increased in Canada and<br />
worldwide. To complicate matters, a new strain genetically<br />
distinct from the typical healthcare-associated MRSA is now<br />
circulating in the community.<br />
This session will review the current epidemiology <strong>of</strong> MRSA in<br />
Canada, and well as trends and challenges associated with the<br />
treatment <strong>of</strong> MRSA infections. These include uncertainties<br />
regarding vancomycin efficacy, dosing, and toxicity; and the<br />
role <strong>of</strong> new agents with activity against MRSA.<br />
In 2009, guidelines for the therapeutic use <strong>of</strong> vancomycin were<br />
published recommending higher target trough levels for MRSA.<br />
The armamentarium <strong>of</strong> antibiotics for the management <strong>of</strong><br />
MRSA infections has recently expanded to include linezolid,<br />
tigecycline, daptomycin and ceftopibrole. Although these<br />
newer agents <strong>of</strong>fer more treatment options, use may be limited<br />
by lack <strong>of</strong> clinical data, adverse effects and cost. A number <strong>of</strong><br />
“older” antibiotics are being used to treat MRSA infections due<br />
to community-associated strains.<br />
Goals and Objectives<br />
1. To highlight trends in the epidemiology <strong>of</strong> MRSA in Canada.<br />
2. To review some <strong>of</strong> the current controversies associated with<br />
vancomycin therapy.<br />
3. To provide an overview <strong>of</strong> antibiotics for MRSA infections so<br />
that pharmacists can select an appropriate agent for a<br />
patient considering the site and severity <strong>of</strong> infection, and<br />
drug and patient characteristics.<br />
Self-Assessment Questions<br />
1. Identify potential risk factors for non-response to<br />
vancomycin.<br />
2. What are the treatment options for a patient with a serious<br />
skin and s<strong>of</strong>t tissue infection due to MRSA who is intolerant<br />
to vancomycin?<br />
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3. How would you monitor a patient being treated with<br />
linezolid? Daptomycin?<br />
Recent Evidence in COPD Management<br />
Marie-France Beauchesne, BScPhm, MScPhm, PharmD, Faculty<br />
<strong>of</strong> Pharmacy, Université de Montréal, Montréal, QC<br />
The goal <strong>of</strong> this session is to provide pharmacists with an<br />
understanding <strong>of</strong> the benefits and risks associated with triple<br />
pharmacotherapy in COPD (combination <strong>of</strong> long-acting b2<br />
agonist, ICS and tiotropium).<br />
In moderate to severe COPD, inhaled corticosteroids (ICS) have<br />
been shown to reduce the risk <strong>of</strong> exacerbations but are no<br />
longer recommended without concomitant use <strong>of</strong> long-acting<br />
b2 agonists, because recent evidence shows greater benefits<br />
with the combination therapy. A concern about the risk <strong>of</strong><br />
pneumonia with the use <strong>of</strong> high doses <strong>of</strong> ICS in COPD<br />
management exists. More recently, evidence about the benefits<br />
<strong>of</strong> tiotropium in monotherapy and combination therapy has<br />
been demonstrated and will be discussed during this session.<br />
Goals and Objectives<br />
1. To provide pharmacists with an understanding <strong>of</strong> the<br />
benefits and risks associated with the use <strong>of</strong> triple therapy<br />
(combination <strong>of</strong> long-acting b2 agonist, ICS and tiotropium)<br />
in COPD management.<br />
2. To enable pharmacists to evaluate pharmacotherapeutic<br />
needs <strong>of</strong> COPD patients based on their level <strong>of</strong> disease<br />
severity.<br />
Self-Assesment Questions<br />
1. Does tiotropium further reduces the risk <strong>of</strong> COPD<br />
exacerbations when combined with the association <strong>of</strong> a<br />
long-acting b2 agonist and a ICS ?<br />
2. To what extent does current COPD medication reduces<br />
mortality ?<br />
Career Strategic Planning: If You Don’t Know<br />
Where You Are Going, Any Road Will Do<br />
Robin J. Ensom, BScPhm, PharmD, Vancouver Coastal Health –<br />
Providence Health Care, Vancouver, BC<br />
Developing a strategic plan to assist in achieving career goals<br />
may seem like an obvious thing to do, but experience suggests<br />
that for most hospital pharmacists, career progression is as<br />
much the product <strong>of</strong> serendipity as conscious planning.<br />
Whether you are starting your career in hospital pharmacy,<br />
considering an unexpected opportunity, facing a unanticipated<br />
change in employment status or just wondering if your current<br />
role is right for you; this session will provide you with some<br />
strategies and tools to help you to take control <strong>of</strong> your own<br />
destiny.<br />
Drawing on experience in organizational strategic planning,<br />
mentoring hospital pharmacists, personal career planning and<br />
even parenting; this session will engage the participants in<br />
both observing the application <strong>of</strong> strategic career planning<br />
process and considering aspects <strong>of</strong> their own career plan.<br />
Goals and Objectives<br />
1. To provide pharmacists with an approach and some tools to<br />
assist them in defining their career strategic goal<br />
2. To provide pharmacists with an approach and some tools to<br />
assist them in developing an action plan to achieve their<br />
career goal<br />
Self-Assessment Questions<br />
1. What are the elements <strong>of</strong> a SWOT analysis?<br />
2. Identify 3 sources <strong>of</strong> input to assist you with your personal<br />
SWOT analysis.<br />
3. Describe a Force Field Analysis in the context <strong>of</strong> career<br />
planning.<br />
Cultural Competence for Health Care Providers<br />
Mitra Assemi, PharmD, University <strong>of</strong> California, San Francisco<br />
School <strong>of</strong> Pharmacy, Fresno, CA<br />
The goal <strong>of</strong> this session is to provide pharmacists with an<br />
understanding <strong>of</strong> the imperative for and general elements <strong>of</strong><br />
culturally and linguistically competent care and services for<br />
patients.<br />
Canada’s population <strong>of</strong> 31.2 million continues to grow<br />
increasingly diverse. In the 2006 Census, over 200 different<br />
ethnic origins were reported. Currently 1 in 5 individuals<br />
residing in Canada is foreign-born, an increase <strong>of</strong> 13.6% in the<br />
last 5 years, with the largest proportion <strong>of</strong> immigrants arriving<br />
from Asia. In keeping with these trends, 1 out <strong>of</strong> every 5<br />
<strong>Canadian</strong>s is an allophone. As pharmacist-patient discordance<br />
becomes commonplace regardless <strong>of</strong> practice setting,<br />
pharmacists face the challenge <strong>of</strong> tailoring the care and<br />
services they provide to meet the needs <strong>of</strong> and optimize<br />
outcomes for a diverse patient population. Developing and<br />
growing one’s own awareness <strong>of</strong> self and the dynamics <strong>of</strong><br />
difference, broadening one’s knowledge <strong>of</strong> other cultures, and<br />
developing and refining the communication skills required to<br />
bridge difference and work across linguistic barriers are all<br />
essential to providing patient-centered care and improving<br />
health outcomes in the 21st century.<br />
Goals and Objectives<br />
1. Describe how demographic trends influence the imperative<br />
for culturally and linguistically appropriate care and services<br />
2. Define the term “health literacy”<br />
3. Assess the potential impact <strong>of</strong> pharmacist-patient<br />
discordance on communication<br />
4. Describe elements <strong>of</strong> culturally and linguistically appropriate<br />
care<br />
Self-Assessment Questions<br />
1. How do current demographic trends in Canada support the<br />
imperative for culturally and linguistically appropriate care?
2. What is health literacy?<br />
3. How can pharmacist-patient discordance impact<br />
communication?<br />
4. What can pharmacists do to develop and grow their ability to<br />
provide culturally and linguistically appropriate<br />
patient-centered care?<br />
Short Course Therapy for Infectious Diseases: Fact<br />
or Fiction<br />
Linda Dresser PharmD, University Health Network, Toronto, ON<br />
The goal <strong>of</strong> this presentation is to provide pharmacists involved<br />
in the care <strong>of</strong> patients with infectious diseases amenable to<br />
shorter courses <strong>of</strong> therapy with a review <strong>of</strong> the evidence<br />
supporting this approach to management.<br />
Shorter courses <strong>of</strong> antimicrobial therapy have the potential for<br />
many advantages; decreased adverse effects, decreased<br />
emergence <strong>of</strong> resistance, improved patient adherence and<br />
decreased cost for example. Determining which patients may<br />
safely and effectively receive short course therapy is a<br />
challenge and a shift in philosophy <strong>of</strong> care for many clinicians.<br />
Antimicrobial stewardship which embraces the approach <strong>of</strong> the<br />
right antibiotic for the right patient at the right dose for the<br />
right duration is a recognized priority <strong>of</strong> many health-care<br />
institutions around the world. Translating what evidence there<br />
is for safe and effective short course therapy into practice is<br />
one aspect <strong>of</strong> antimicrobial stewardship.<br />
In this presentation the evidence for short course therapy for a<br />
sampling <strong>of</strong> infectious disease syndromes<br />
(community-acquired pneumonia, ventilator-associated<br />
pneumonia, urinary tract infections, intra-abdominal infections,<br />
bacteremias) will be briefly reviewed.<br />
Goals and Objectives<br />
1. To review the evidence for short course therapy for identified<br />
infectious diseases syndromes.<br />
2. To discuss the pharmacists role in translating the evidence<br />
into practice.<br />
Self-Assessment Questions<br />
1. What duration <strong>of</strong> therapy is safe and effective for most<br />
ventilator-associated pneumonias?<br />
2. What are the most appropriate antimicrobial choice and<br />
duration <strong>of</strong> therapy for the management <strong>of</strong> a uncomplicated<br />
cystitis in a non-pregnant woman?<br />
Antimicrobial Dosing in Obesity: A Growing<br />
Problem<br />
Margaret Gray, BSP, Alberta Health Services – North,<br />
Edmonton, AB<br />
Obesity is increasing through most <strong>of</strong> the world’s populations<br />
at an alarming rate, making this a newly emerging threat to<br />
population health. Physiologic changes accompany increased<br />
body mass including changes in glomerular filtration and<br />
distribution <strong>of</strong> antimicrobials into fat tissues.<br />
Pharmacokinetically changes occur in volume <strong>of</strong> distribution<br />
and clearance <strong>of</strong> many antimicrobials.<br />
Evidence regarding the optimal methods <strong>of</strong> addressing the<br />
needed dosage changes associated with obesity is lacking for<br />
many agents, other than those associated with therapeutic<br />
drug monitoring. This talk aims to address the available<br />
evidence, as well as to discuss pharmacodynamic approaches<br />
to drugs where this evidence is lacking to determine what<br />
agents require dosage changes in obesity.<br />
Goals and Objectives<br />
1. To examine the relationship between obesity and the<br />
physiologic changes that accompany it, including changes in<br />
volume <strong>of</strong> distribution and drug clearance.<br />
2. To review the existing evidence for antimicrobial dosage<br />
adjustments required in obesity.<br />
3. To discuss reasonable approaches to managing obese<br />
patients with antimicrobial agents.<br />
Self-Assessment Questions<br />
1. What is the impact <strong>of</strong> weight on estimating renal<br />
(dys)function in patients, and is there a better equation to<br />
use that Cockr<strong>of</strong>t-Gault to determine this?<br />
2. For what antimicrobial classes do we have reasonable<br />
evidence for how to dose in obesity?<br />
3. When is it appropriate to consider ideal body weight, vs<br />
dosing weight, vs total body weight when calculating the<br />
appropriate dose for antimicrobials in obesity?<br />
4. Is there a systematic approach that can be used to determine<br />
the best approach to dose an antimicrobial agent in an<br />
obese patient?<br />
Hot Topics in Emergency Medicine<br />
Peter J. Zed, BSc, BScPhm, ACPR, PharmD, FCSHP, Capital<br />
Health and Dalhousie University, Halifax, NS<br />
The goal <strong>of</strong> this session is to discuss topical issues specific to<br />
pharmacy practice in emergency medicine with particular<br />
attention to advances in pharmacotherapy as well as evidence<br />
for clinical pharmacy practice in emergency medicine.<br />
The Emergency Department (ED) cares for an acutely-ill and<br />
heterogeneous patient population at high-risk for drug-related<br />
problems (DRPs), both prior to presentation and during care in<br />
the ED. Clinical pharmacy services in emergency medicine have<br />
been implemented in many hospitals throughout Canada. In<br />
addition to the having the clinical expertise to identify and<br />
mange DRPs in this diverse patient population, pharmacists<br />
have also demonstrated significant contribution to<br />
improvements in overall care as well as provided contributions<br />
to education and research in emergency medicine.<br />
There are many pharmacotherapy issues unique to emergency<br />
medicine with the ongoing challenge to stay abreast to these<br />
recent advances. This session will review recent advances in a<br />
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number <strong>of</strong> pharmacotherapy issues specific to practice in<br />
emergency medicine which will include procedural sedation<br />
and analgesia, acute pain management and rapid sequence<br />
intubation. <strong>Final</strong>ly, recent review <strong>of</strong> the evidence for clinical<br />
pharmacy practice in emergency medicine will also be<br />
discussed.<br />
Goals and Objectives<br />
1. To discuss evidence for clinical pharmacy services in<br />
emergency medicine.<br />
2. To discuss recent pharmacotherapy advances in the areas <strong>of</strong><br />
procedural sedation and analgesia and acute pain<br />
management<br />
3. To discuss recent pharmacotherapy advances and<br />
controversies for rapid sequence intubation<br />
Self-Assessment Questions<br />
1. What are the clinical activities performed by pharmacists in<br />
the ED that have been shown to improve patient outcomes?<br />
2. What is the optimal pharmacotherapy approach to providing<br />
procedural sedation and analgesia in the ED?<br />
3. What is the optimal induction agent for facilitation <strong>of</strong> rapid<br />
sequence intubation in the ED?<br />
The Challenges <strong>of</strong> Implementing Drug Changes in<br />
the Frail Elderly<br />
Pam Howell, BScPhm, Bruyère Continuing Care, Ottawa, ON,<br />
Cheryl A. Sadowski BScPhm, PharmD Faculty <strong>of</strong> Pharmacy &<br />
Pharmaceutical Sciences, University <strong>of</strong> Alberta, Edmonton, AB<br />
This interactive session will raise pharmacist awareness <strong>of</strong> the<br />
complex challenges surrounding drug treatment in the frail<br />
elderly. These challenges exist in both the implementation <strong>of</strong><br />
medication changes and adherence to changes upon discharge.<br />
Significant medication problems common in geriatrics,<br />
although not unique to this population, include<br />
“polypharmacy”, underutilization, non-adherence, and poor<br />
medication management. These issues are magnified in older<br />
adults as their medications regimens are more complex, and<br />
their health is much frailer, leading to increased risk <strong>of</strong> adverse<br />
events.<br />
Ironically, medication problems may be due to adherence to<br />
clinical practice guidelines. There is a challenge in applying<br />
current guidelines and evidence to a frail geriatric patient.<br />
Often care is provided based on clinical judgement versus<br />
evidence.<br />
Even in an environment that encourages appropriate drug<br />
prescribing, challenges persist after discharge from hospital<br />
and during transfer <strong>of</strong> care. Based on experiences in a geriatric<br />
rehabilitation unit, it is apparent that adherence to drug<br />
recommendations is inconsistent.<br />
Through literature review, we will examine the gap in evidence<br />
and describe how this provides challenges in making<br />
medication decisions. We will also explore how the patient and<br />
primary care team can influence adherence to the medication<br />
regimen.<br />
Sharing <strong>of</strong> clinical knowledge is imperative when the evidence<br />
for recommendations is unclear. Participants will be<br />
encouraged to express their thoughts and experiences on<br />
controversial treatment issues through round table discussions<br />
and patient cases. In addition, we will facilitate a discussion on<br />
feasible options for co-ordinating care out into the community.<br />
Goals and Objectives<br />
1. To identify the challenges encountered when implementing<br />
drug regimen changes in<br />
frail, elderly patients and how adherence to these changes can<br />
be affected after discharge into the community.<br />
2. To enable pharmacists to make decisions regarding when<br />
evidence based guidelines apply to a geriatric patient.<br />
3. To provide pharmacists with the opportunity to generate<br />
solutions to complex cases by engaging them to work<br />
through a patient case and collaborate with their peers.<br />
Self-Assessment Questions<br />
1. How can I effectively simplify drug regimens for complex<br />
geriatric patients?<br />
2. When should I follow clinical practice guidelines for my<br />
geriatric patients?<br />
3. What tools could I implement into my discharge planning<br />
routine that could improve my geriatric patient’s adherence<br />
to medication changes made in hospital?
Call for Abstracts for Posters<br />
2010 Summer Educational Sessions (SES)<br />
Marriott Halifax Harbourfront, Halifax, Nova Scotia<br />
August 7 to 10, 2010<br />
Demande de résumés d’affiches<br />
Séances éducatives d’été (SÉÉ) 2010<br />
Marriott Halifax Harbourfront, Halifax, Nouvelle-Écosse<br />
7-10 août 2010<br />
45<br />
GENERAL INFORMATION<br />
Category<br />
Author must specify the category that best suits the particular<br />
poster.<br />
1. Original Research (includes Pharmaceutical/Basic,<br />
Science/Clinical Research, Drug Use Evaluations, Systematic<br />
Reviews and Meta-Analysis, Pharmacoeconomics Analysis,<br />
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 posters will be presented in a special area at<br />
SES. If your abstract is linked to CSHP 2015 initiatives please<br />
clearly flag this after your category designation in the body <strong>of</strong><br />
your submission email and the unblinded abstract.<br />
Abstract Submissions<br />
All abstract submissions must be submitted no later than 1800<br />
(Eastern Daylight Time) on May 7, 2010.<br />
Abstracts MUST be submitted electronically, online at CSHP’s<br />
Web site (http://www.cshp.ca) and by e-mail to<br />
ddavidson@cshp.ca. Please provide 2 copies <strong>of</strong> your abstract.<br />
One copy should be blinded (remove authors’ affiliations and<br />
identifying features in body <strong>of</strong> abstract). Please indicate in the<br />
filename which copy is blinded. Please submit your file in MS<br />
Word Format.<br />
The following information must be included in your e-mail or<br />
online submission:<br />
• Name <strong>of</strong> corresponding author<br />
• Institution<br />
• Address<br />
• Phone and fax numbers, e-mail address<br />
• Title <strong>of</strong> abstract<br />
• Category under which you wish your abstract to be<br />
considered<br />
Abstract grading is blinded. Abstracts are selected on the basis<br />
<strong>of</strong> scientific merit, originality, level <strong>of</strong> interest to pharmacists,<br />
and compliance with style rules. Guidance for authors and<br />
sample abstracts will be available on the CSHP website shortly<br />
at www.cshp.ca/event/SES2010.<br />
Encore presentations will be considered, in which case the<br />
original conference/date citation must also be submitted.<br />
Clearly indicate that “encore presentation” in the body <strong>of</strong> the<br />
RENSEIGNEMENTS GÉNÉRAUX<br />
Catégorie<br />
L’auteur doit indiquer à laquelle des trois catégories suivantes<br />
l’affiche correspond :<br />
1. Recherche initiale (recherche pharmaceutique ou<br />
fondamentale, recherche scientifique ou clinique,<br />
évaluations de l’utilisation des médicaments, examens<br />
systématiques et méta-analyses, analyses<br />
pharmacoéconomiques, etc.)<br />
2. Observations cliniques<br />
3. Pratique pharmaceutique (projets administratifs, formation<br />
des pr<strong>of</strong>essionnels de la santé, projets liés à la sécurité des<br />
médicaments, etc.)<br />
SCPH 2015<br />
Les affiches ayant un lien avec le projet SCPH 2015 seront<br />
présentées dans une endroit spécial sur les lieux des SÉÉ. Si<br />
votre résumé est en lien avec les objectifs 2015 de la SCPH,<br />
assurez-vous de le mentionner clairement tout de suite après<br />
avoir inscrit la catégorie dans le corps de votre demande par<br />
courriel et votre résumé qui n’est pas anonyme.<br />
Présentation des résumés<br />
Tous les résumés doivent être reçus avant le 7 mai 2010 à 18 h<br />
(heure avancée de l’est).<br />
Le résumé DOIT être présenté par voie électronique. En effet,<br />
vous devez le soumettre sur le site Web de la SCPH<br />
(http://www.cshp.ca.) et l’envoyer par courriel à l’adresse<br />
suivante : ddavidson@cshp.ca. Veuillez fournir deux copies de<br />
votre résumé, dont l’une doit être anonyme (dans le corps du<br />
texte, l’établissement auquel les auteurs sont affiliés et les<br />
renseignements qui révèlent l’identité des auteurs doivent être<br />
supprimés). Le fichier doit être présenté en format MS Word, et<br />
son nom doit préciser quelle copie est anonyme.<br />
Lorsque vous envoyez votre résumé par courriel ou le<br />
soumettez en ligne, vous devez indiquer les renseignements<br />
suivants :<br />
• Nom de l’auteur-ressource<br />
• Établissement<br />
• Adresse<br />
• Numéros de téléphone et de télécopieur, et adresse<br />
électronique<br />
• Titre du résumé<br />
• Catégorie à laquelle le résumé devrait appartenir<br />
La copie anonyme du résumé est celle qui sera évaluée. La<br />
sélection des résumés sera fondée sur la valeur scientifique,
46<br />
email and the unblinded abstract. Research in progress will not<br />
be accepted.<br />
Accepted abstracts will be published in the final program <strong>of</strong> the<br />
Summer Educational Sessions and also in the <strong>Canadian</strong> Journal<br />
<strong>of</strong> <strong>Hospital</strong> Pharmacy.<br />
Authors <strong>of</strong> accepted abstracts will be notified within 3 to 4<br />
weeks. Expenses associated with the submission and<br />
presentation <strong>of</strong> the abstract are the responsibility <strong>of</strong> the<br />
presenter. Early registration fees will apply to all accepted<br />
poster applications. Guidelines for posters will be provided to<br />
authors <strong>of</strong> accepted abstracts.<br />
Failure to comply with style rules could mean rejection <strong>of</strong><br />
submission.<br />
Style Rules<br />
Title should be brief and should clearly indicate the nature <strong>of</strong><br />
the presentation. Do not use abbreviations in the title. List the<br />
authors, institutional affiliation, city, and province. Omit<br />
degrees, titles, and appointments.<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<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<br />
change, 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 />
• Recommended font: Times 12<br />
• Capitalize only the first letter <strong>of</strong> each word <strong>of</strong> the title<br />
l’originalité, l’intérêt pour les pharmaciens et le respect des<br />
règles de présentation. Des directives à l’intention des auteurs<br />
et des exemples de résumés seront affichés d’ici peu sur le site<br />
Web de la SCPH à l’adresse suivante :<br />
www.cshp.ca/event/SES2010.<br />
Vous pouvez nous faire parvenir un résumé pour une affiche<br />
ayant déjà été présentée. En pareil cas, vous devez préciser le<br />
nom et la date de la conférence au cours de laquelle l’affiche a<br />
été produite, et inscrire clairement « affiche en rappel » dans le<br />
texte du courriel et du résumé qui n’est pas anonyme. Les<br />
recherches en cours ne seront pas acceptées.<br />
Les résumés qui auront été acceptés seront publiés dans le<br />
programme final des Séances éducatives d’été et le Journal<br />
canadien de la pharmacie hospitalière.<br />
Les auteurs de ces résumés recevront de nos nouvelles d’ici<br />
trois à quatre semaines. Les frais associés à la présentation des<br />
résumés doivent être assumés par les auteurs. Tous les auteurs<br />
des résumés acceptés auront droit aux frais d’inscription<br />
anticipée. Des directives concernant les affiches seront<br />
fournies aux auteurs dont les résumés auront été acceptés.<br />
Les résumés qui ne respectent pas les règles de présentation<br />
pourront être refusés.<br />
Règles de présentation<br />
Le titre doit être bref, indiquer clairement la nature de la<br />
présentation et ne comprendre aucune abréviation. Le nom des<br />
auteurs, l’établissement auquel ceux-ci sont affiliés ainsi que la<br />
ville et la province où est située l’établissement doivent être<br />
précisés, tandis que les diplômes, les titres et les affectations<br />
ne doivent pas être mentionnés.<br />
Le texte du résumé doit être organisé comme suit,<br />
conformément aux règles propres à la catégorie à laquelle le<br />
résumé appartient :<br />
Recherche initiale :<br />
a. justification<br />
b. objectifs<br />
c. plan de l’étude et méthodologie<br />
d. résultats de l’étude, y compris les analyses statistiques<br />
utilisées, et<br />
e. conclusions de l’étude (les conclusions doivent être<br />
appuyées par les résultats présentés)<br />
Observations cliniques :<br />
a. justification de l’observation clinique<br />
b. description du cas<br />
c. analyse de la causalité<br />
d. évaluation de la documentation, et<br />
e. importance du cas pour les pharmaciens praticiens
• List authors<br />
• List each author’s institutional affiliation and city<br />
• Abstract body (not including title and authors) is limited to<br />
300 words<br />
• A table is equivalent to 30 words<br />
• A graphic is equivalent to 60 words<br />
• Do not indent the start <strong>of</strong> a paragraph<br />
• Use standard abbreviations<br />
• Place special or unusual abbreviations in parentheses after<br />
spelling them the first time they appear<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 />
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 e-mail confirmation by<br />
the deadline, please contact Desarae Davidson by phone at:<br />
(613) 736-9733, ext. 229.<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<br />
œuvre un nouveau programme<br />
d. évaluation du projet, et<br />
e. importance et utilité du concept par rapport à la pratique<br />
actuelle et future<br />
Corps du résumé<br />
• Police recommandée : Times, taille 12<br />
• Seule la première lettre du premier mot du titre doit être en<br />
majuscule<br />
• Les auteurs doivent être nommés<br />
• L’établissement auquel chaque auteur est affilié ainsi que la<br />
ville où se trouve cet établissement doivent être indiqués<br />
• Le corps du résumé (excluant le titre et les auteurs) ne doit<br />
pas dépasser 300 mots<br />
• Un tableau compte pour 30 mots<br />
• Un graphique compte pour 60 mots<br />
• Le début des paragraphes ne doit pas être précédé d’un<br />
alinéa<br />
• Les abréviations reconnues doivent être employées<br />
• Abréviations spéciales ou peu utilisées : la première fois que<br />
le terme est employé, il doit être écrit au long et suivi de<br />
l’abréviation entre parenthèses<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,<br />
des instruments et de l’équipement doivent être employés<br />
47<br />
Confirmation par courriel de la réception du résumé<br />
La réception de votre résumé devrait être confirmée par<br />
courriel. Si vous n’avez pas reçu de confirmation par courriel<br />
avant la date limite, veuillez téléphoner à madame Desarae<br />
Davidson au (613) 736-9733, poste 229.
48<br />
Poster Sessions<br />
Séances d’affichage<br />
2 CSHP<br />
Targeting Excellence<br />
in Pharmacy Practice<br />
CSHP 2015 is a quality program that sets out a<br />
vision <strong>of</strong> pharmacy practice excellence in the<br />
year 2015. Through this project, CSHP<br />
challenges hospital pharmacists to reach<br />
measurable targets for 36 objectives grouped<br />
under 6 goals, all aimed toward the effective,<br />
scientific, and safe use <strong>of</strong> medications and meaningful<br />
contributions to public health. CSHP 2015 applies to inpatients<br />
and outpatients, community and hospital pharmacists, and all<br />
practice settings. Posters identified with a “CSHP 2015” logo<br />
are those judged by the CSHP 2015 Steering Committee to be<br />
particularly relevant to one or more <strong>of</strong> the 36 objectives.<br />
2 SCPH<br />
Point de mire<br />
sur l’excellence en<br />
pratique pharmaceutique<br />
Le projet SCPH 2015 est un programme axé<br />
sur la qualité qui propose une vision de<br />
l'excellence en pratique pharmaceutique en<br />
l'an 2015. Au moyen de ce projet, la SCPH met<br />
les pharmaciens d'établissements au défi<br />
d'atteindre les cibles mesurables de 36<br />
objectifs répartis entre 6 buts, visant tous l'utilisation efficace,<br />
scientifique et sûre des médicaments ainsi que des<br />
contributions significatives à la santé publique. Le projet SCPH<br />
2015 s'applique aux patients hospitalisés et externes, aux<br />
pharmaciens d'hôpitaux et communautaires, et à tous les<br />
milieux de pratique. Les affiches marquées du logo « SCPH<br />
2015 » sont celles que le Comité directeur du projet SCPH 2015<br />
a jugé particulièrement appropriées à l'un ou l'autre des 36<br />
objectifs.<br />
Sunday, January 31, 10:00 – 15:00<br />
Churchill Foyer<br />
1. Incidence <strong>of</strong>, and Risk Factors for, Upper Gastrointestinal Bleeding in<br />
Critically Ill Children: A Systematic Review<br />
2. The Gap between Evidence Based Medicine, Federal Drug Regulations<br />
and Clinical Practice: A British Columbia Health Authority’s Approach<br />
3. Antimicrobial Stewardship at Sunnybrook Health Sciences Centre:<br />
Prospective Audit and Feedback in Critical Care<br />
4. Determination <strong>of</strong> Initial Vancomycin Dosing Recommendations in Burn<br />
Patients – Retrospective Chart Review<br />
5. Bisphosphonates in Osteoporosis: An Analysis Focusing on Drug<br />
Claims by Seniors 2000 to 2007<br />
6. Teaching Residents to Teach: Development <strong>of</strong> a Teaching Rotation for a<br />
Pharmacy Practice Residency<br />
7. Pharmaceutical Care Urgency Framework: Development <strong>of</strong> a Teaching<br />
Tool<br />
8. Monitoring and Documentation <strong>of</strong> Outcomes from Targeted Medication<br />
Interventions: Implementation using the Electronic Documentation<br />
System<br />
9. Description <strong>of</strong> Drug Therapy Problems and Anticoagulation Outcomes<br />
in a Multidisciplinary Anticoagulation Clinic<br />
10. Ziprasidone and Analgesic-Induced Serotonin Syndrome<br />
11. Fluconazole Treatment Failure in Cryptococcal Meningitis<br />
12. Analysis <strong>of</strong> Medication Incidents in Ontario<br />
Monday, February 1, 9:45-14:15<br />
Sheraton Hall<br />
1. Incidence <strong>of</strong> Venous Thromboemolism (VTE) at Sunnybrook Long Term<br />
Care<br />
2. Aortic Graft Vancomycin Intermediate Resistant Staphylococcus aureus<br />
Infection Treated with Ceftobiprole after Linezolid Induced Peripheral<br />
Neuropathy<br />
3. Nephrotoxicity Associated With Ten<strong>of</strong>ovir: A Systematic Review <strong>of</strong><br />
Observational Studies<br />
4. Safety Audit <strong>of</strong> Automated Dispensing Cabinets<br />
5. The Development and Evaluation <strong>of</strong> a Student Pharmacist Clinical<br />
Teaching Unit Utilizing Peer Assisted Learning<br />
6. Potential Interaction between Warfarin and a Chinese Herbal Product<br />
“Qingreling” Resulting in a Bleeding Event<br />
7. Medication Reconciliation across the Spectrum <strong>of</strong> Renal Care and<br />
Across the Province<br />
8. Retrospective Assessment <strong>of</strong> the Effectiveness <strong>of</strong> Standard vs.<br />
Non-standard Preoperative Antibiotics in Preventing Postoperative<br />
Surgical Site Infections in Elective Colectomy Patients<br />
9. Post-<strong>Hospital</strong> Discharge: Medication Discrepancies and Drug Therapy<br />
Problems in Primary Care<br />
10. The Safety <strong>of</strong> Ethanol Infusions for the Treatment <strong>of</strong> Methanol or<br />
Ethylene Glycol Ingestion: An Observational Study<br />
Tuesday, February 2, 12:15-13:50<br />
Sheraton Hall<br />
1. Serotonin Syndrome with Venlafaxine after Change from Peritoneal<br />
Dialysis to Hemodialysis<br />
2. Interventions in a Medical Teaching Unit: Effect <strong>of</strong> a Pharmacist<br />
Attending Rounds Versus Reactive Patient-Care Efforts (INTERVENE)<br />
3. Quality Improvement Evaluation <strong>of</strong> a Pharmacist Managed Warfarin<br />
Dosing Service for Outpatient Venous Thromboembolism.<br />
4. Release <strong>of</strong> Joint Technical Statement on Pharmaceutical Bar Coding in<br />
Canada<br />
5. Qualitative Evaluation <strong>of</strong> the <strong>Canadian</strong> Fabry Disease Initiative<br />
6. Safer Medication Use in Emergency Departments (SAFER MEDs)<br />
7. The Future Plans and Career Expectations <strong>of</strong> Pharmacy Students:<br />
Results from A National Survey<br />
8. Perceived Demands for Practice Experiential Education: Results from A<br />
National Survey Of <strong>Hospital</strong> Pharmacy Directors<br />
9. Comparison <strong>of</strong> Two Approaches to Antibiotic Stewardship<br />
10. Clinical Pharmacy Services Survey for <strong>Canadian</strong> <strong>Hospital</strong>s<br />
11. Implementation <strong>of</strong> a Preoperative Atrial Fibrillation Prophylaxis<br />
Protocol by a Pharmacist with Medical Directives Improves Clinical<br />
Outcomes<br />
Wednesday, February 3, 10:15-15:00<br />
Churchill Foyer<br />
1. Projet pilote d’implantation d’un suivi systématique de la clientèle<br />
asthmatique et Maladie pulmonaire obstructive chronique en<br />
pharmacie communautaire<br />
2. Stability <strong>of</strong> Piperacillin/Tazobactam (Apotex) in Polyvinylchloride Bags<br />
and Polypropylene Syringes<br />
3. Review <strong>of</strong> the Critical Care Insulin Nomogram used at Lakeridge Health<br />
Oshawa (LHO)<br />
4. How Long Does Medication Reconciliation Take?<br />
5. Pharmacological Management <strong>of</strong> Amiodarone-Induced Thyrotoxicosis<br />
Type I in Mitral Valve Replacement<br />
6. Venous Thromboembolism (VTE) Prophylaxis in <strong>Hospital</strong> Patients<br />
7. A Systematic Review <strong>of</strong> the Effect <strong>of</strong> Medication Reconciliation on<br />
Medication Discrepancies and Adverse Drug Events<br />
8. Obtaining the Best Possible Medication History: Comparison <strong>of</strong><br />
Pharmacy Technician versus Pharmacist Obtained Medication Histories<br />
in the Emergency Department<br />
9. Prevalence <strong>of</strong> Vitamin D Deficiency and the Effects <strong>of</strong> Replacement<br />
with Ergocalciferol in Chronic Hemodialysis Patients<br />
10. Improving the safety <strong>of</strong> ambulatory intravenous chemotherapy in<br />
Canada<br />
11. Medication Reconciliation Strategies for Transfer (MRS-T): What is the<br />
optimal strategy?<br />
12. The “Shock Box” Expediting Delivery <strong>of</strong> Antibiotics for Septic Shock
Sunday, January 31 • Dimanche 31 janvier<br />
Incidence <strong>of</strong>, and Risk Factors for, Upper Gastrointestinal<br />
Bleeding in Critically Ill Children: A Systematic Review<br />
Robin Brockhouse-Gunning & Mark Duffett, Hamilton Health Sciences,<br />
Hamilton, ON<br />
Rationale: Critically ill children can develop upper gastrointestinal<br />
bleeding (UGIB), which can be associated with clinically important<br />
complications. The effectiveness <strong>of</strong> prophylaxis for UGIB in children is<br />
unknown. In the absence <strong>of</strong> randomized trials, information on the incidence<br />
and risk factors for UGIB may help target prophylactic interventions to<br />
those children at highest risk.<br />
Objectives: To determine the incidence <strong>of</strong>, and risk factors for, clinically<br />
significant UGIB in critically ill children.<br />
Methods: We searched MEDLINE and EMBASE, and hand-searched<br />
references lists <strong>of</strong> relevant articles. Cohort or case-control studies were<br />
included if they enrolled children (full-term infants to 18 years) in a<br />
pediatric intensive care unit (PICU) and reported some measure <strong>of</strong><br />
incidence or multivariate analysis <strong>of</strong> risk factors for UGIB. We assessed the<br />
methodological quality <strong>of</strong> all included studies.<br />
Results: The search retrieved 425 citations. Of these, 5 citations (enrolling<br />
a total <strong>of</strong> 2478 subjects) were included. We did not pool the results<br />
because <strong>of</strong> heterogeneity in the severity <strong>of</strong> illness and use <strong>of</strong> prophylaxis;<br />
patient characteristics; definitions <strong>of</strong> bleeding; and differences in research<br />
methods. Based on a single study (1006 admissions) the incidence <strong>of</strong><br />
clinically significant UGIB was 1.6%. The incidence <strong>of</strong> all UGIB ranged from<br />
6.4% to 24.5% (3 studies, 2198 admissions). Risk factors for clinically<br />
significant UGIB were evaluated in 1 study and included coagulopathy,<br />
respiratory failure, and PRISM score ≥ 10. These are also risk factors for all<br />
UGIB. Additional risk factors for all UGIB include shock, trauma, operative<br />
procedures <strong>of</strong> at least 3 hours, and pneumonia. Enteral nutrition may be a<br />
protective factor against UGIB.<br />
Conclusion: Information on clinically significant UGIB in children is limited.<br />
Incidence and risk factors vary based on the population studied and<br />
bleeding endpoints used. Future studies should use clinically significant<br />
UGIB as an outcome.<br />
2 CSHP<br />
Targeting Excellence<br />
in Pharmacy Practice<br />
The Gap between Evidence-Based Medicine,<br />
Federal Drug Regulations and Clinical Practice:<br />
A British Columbia Health Authority’s Approach<br />
Doson Chua, St. Paul’s <strong>Hospital</strong>, Vancouver, BC, Angela Lo, Providence<br />
Health Care – Vancouver Coastal Health Authority, Vancouver, BC<br />
Vancouver Coastal Health Authority (VCHA) implemented a therapeutic<br />
interchange policy (TIP) for all angiotensin converting enzyme inhibitors<br />
(ACEI) to be substituted to the formulary ACEI, trandolapril. However,<br />
certain ACEI doses equate to a trandoloparil dose greater than the Health<br />
Canada recommended maximum <strong>of</strong> 4 mg daily. This led to a situation where<br />
the approved TIP would substitute a non-formulary ACEI to a trandolopril<br />
dose that exceeds Health Canada’s recognized trandolopril dosing. To<br />
resolve this dilemma, VCHA systematically reviewed the evidence behind<br />
the approved TIP conversion and publications on a safe and efficacious<br />
maximum dose <strong>of</strong> trandolopril, and requested information from the<br />
<strong>Canadian</strong> and US trandolopril manufacturers. The approved ACEI TIP<br />
conversion is based comparisons between several landmark trials and thus<br />
supported by strong evidence. There is no published data for trandolopril<br />
doses greater than 4mg daily, but the US trandolopril monograph refers to<br />
unpublished, company data supporting doses <strong>of</strong> 8mg daily. The US Food<br />
and Drug Agency also supports a maximum <strong>of</strong> 8 mg daily for trandolapril. It<br />
therefore appears that the trandolopril maximum dose discrepancy is a<br />
result <strong>of</strong> regulatory differences only. VCHA adopted a maximum dose <strong>of</strong><br />
trandolopril 8mg for its ACEI TIP based on the US trandolopril monograph<br />
and the strength <strong>of</strong> evidence behind the approved TIP. The VCHA approach<br />
to this therapeutic dilemma helped bridge the gap between evidence based<br />
medicine, federal drug regulations, and clinical practice. This approach can<br />
be applied to other therapeutic dilemmas that are encountered, particularly<br />
with pharmacotherapeutic interchange policies.<br />
Antimicrobial Stewardship at Sunnybrook Health Sciences<br />
Centre: Prospective Audit and Feedback in Critical Care<br />
Marion Elligsen 1 , Sandra Walker 1 , Nick Daneman 3,4 , Andrew Simor 3,4<br />
1<br />
Sunnybrook Health Sciences Centre, Department <strong>of</strong> Pharmacy<br />
2<br />
University <strong>of</strong> Toronto, Faculty <strong>of</strong> Pharmacy<br />
3<br />
Sunnybrook Health Sciences Centre, Division <strong>of</strong> Infectious Diseases<br />
4<br />
University <strong>of</strong> Toronto, Department <strong>of</strong> Medicine, Toronto, ON<br />
Rationale: Recently, there has been increased pressure to institute formal<br />
antimicrobial stewardship programs in Ontario hospitals to limit<br />
unnecessary use <strong>of</strong> antimicrobials, decrease resistance, decrease<br />
antimicrobial complications and reduce costs. Prospective audit and<br />
feedback has been recommended by pr<strong>of</strong>essional associations and has<br />
been successfully implemented in some institutions because it is<br />
recognized as an effective method <strong>of</strong> introducing antimicrobial<br />
stewardship.<br />
Description <strong>of</strong> Service: The initial target <strong>of</strong> the prospective audit and<br />
feedback program, at our institution, are the critical care units (CRCU,<br />
CVICU, RTBC), since they have the highest rate <strong>of</strong> antimicrobial resistance<br />
and antimicrobial use. All patients admitted to one <strong>of</strong> these units will be<br />
reviewed if they have received one <strong>of</strong> the following antibiotics for at least 2<br />
days: pipercillin-tazobactam, meropenem, ertapenem, imipenem,<br />
cipr<strong>of</strong>loxacin, lev<strong>of</strong>loxacin, moxifloxacin, ceftazidime, ceftriaxone and<br />
vancomycin. The antimicrobial stewardship fellow will review the cultures,<br />
labs and bedside chart and relevant data will be entered into a database.<br />
Each patient will be reviewed with the ID pharmacist and suggestions will<br />
be made based on previously agreed upon criteria for appropriate use <strong>of</strong><br />
targeted antimicrobials. All suggestions will be reviewed by an ID<br />
physician, and if the suggestions are approved, then they will be<br />
communicated to the critical care staff via progress notes and daily<br />
discussion.<br />
Evaluation <strong>of</strong> the Project: Plans to evaluate the acceptance <strong>of</strong> the<br />
program (number <strong>of</strong> accepted suggestions, distribution <strong>of</strong> suggestion type,<br />
reasons for suggestion rejection, and patient outcome) will be evaluated on<br />
a monthly basis. Antibiotic utilization and cost savings will also be<br />
evaluated after 6 months. Resistance rates, incidence <strong>of</strong> C.difficile, average<br />
length <strong>of</strong> stay and mortality will also be compared pre and post<br />
intervention.<br />
Usefulness to Current Practice: Currently there is no formal antimicrobial<br />
stewardship program at Sunnybrook Health Sciences Centre and it is<br />
anticipated that the institution <strong>of</strong> a prospective audit and feedback<br />
program may limit the unnecessary use <strong>of</strong> antimicrobials and therefore<br />
decrease resistance, antimicrobial complications and antimicrobial<br />
expenditures. We hope to have some specific data to share regarding this<br />
incentive by the Pr<strong>of</strong>essional Practice Conference held in February 2010.<br />
Determination <strong>of</strong> Initial Vancomycin Dosing<br />
Recommendations in Burn Patients – Retrospective Chart<br />
Review<br />
Marion Elligsen 1 , Sandra A.N. Walker 1,2 , Scott E.Walker 1,2 , Andrew Simor 3,4<br />
1<br />
Sunnybrook Health Sciences Centre, Department <strong>of</strong> Pharmacy<br />
2<br />
University <strong>of</strong> Toronto, Faculty <strong>of</strong> Pharmacy<br />
3<br />
Sunnybrook Health Sciences Centre, Division <strong>of</strong> Infectious Diseases<br />
4<br />
University <strong>of</strong> Toronto, Department <strong>of</strong> Medicine, Toronto, ON<br />
Rationale: Vancomycin pharmacokinetics are altered in burn patients<br />
resulting in higher dosage requirements to achieve target trough<br />
concentrations. Currently, there are no published empiric dosing<br />
recommendations to target troughs <strong>of</strong> 15-20mg/L for this population.<br />
Objective: This study was conducted to determine vancomycin<br />
pharmacokinetics in burn patients and develop practical initial dosing<br />
recommendations.<br />
Methods: A retrospective chart review <strong>of</strong> 50 burn patients who received<br />
vancomycin was conducted. Pharmacokinetic parameters were calculated<br />
using first order equations.<br />
Results: A CART analysis revealed that clearance was highest in the first 14<br />
days post burn. All pharmacokinetic parameters were significantly<br />
(p 14 days post-burn. The geometric mean (95% CI)<br />
pharmacokinetic parameters in patients receiving vancomycin within 14<br />
49
50<br />
days post burn were: t1/2 6.18 (5.64-6.77) hr; Vd 0.86 (0.79-0.95) L/kg and<br />
Cl 7.88 (6.95-8.93) L/hr. For patients receiving vancomycin after 14 days<br />
post burn: t1/2 7.12 (6.57-7.71) hr; Vd 0.70 (0.65-0.75) L/kg and Cl 5.66<br />
(5.24-6.13) L/hr. Using Monte Carlo simulation the most commonly used<br />
empiric dosing regimen (1g q12h) would only attain target troughs with a<br />
probability <strong>of</strong> 14 days post burn.<br />
Conclusions: This study has made recommendations for initial vancomycin<br />
dosing in burn patients. However, the maximum probability <strong>of</strong> attaining<br />
troughs between 15–20mg/L with these dosing recommendations is only<br />
20–25%. Therefore, monitoring <strong>of</strong> vancomycin serum concentrations is<br />
required to ensure targets are achieved. In addition, the pharmacokinetics<br />
will change with respect to time post-burn necessitating continued periodic<br />
monitoring <strong>of</strong> serum concentrations and subsequent dosage adjustment.<br />
Bisphosphonates in Osteoporosis: An Analysis Focusing on<br />
Drug Claims by Seniors 2000 to 2007<br />
M. Gaucher, J. Hunt, <strong>Canadian</strong> Institute for Health Information, Ottawa, ON<br />
Rationale: Bisphosphonates are effective in reducing the risk <strong>of</strong> fractures<br />
and are used to prevent and treat osteoporosis. Between 2000 and 2007,<br />
new bisphosphonate chemicals and dosage formulations were introduced<br />
into Canada, and new evidence and practice guidelines emerged.<br />
Objective: This analysis identified trends in the use <strong>of</strong> three<br />
bisphosphonates used for osteoporosis in seniors on public drug programs<br />
in six <strong>Canadian</strong> provinces between 2001-2002 and 2006-2007.<br />
Study Design and Methods: Claims level data from the National<br />
Prescription Drug Utilization Information System (NPDUIS) Database were<br />
analyzed for seniors on public drug programs in Alberta, Saskatchewan,<br />
Manitoba, New Brunswick, Nova Scotia and Prince Edward Island. The<br />
analysis examined trends in the use <strong>of</strong> bisphosphonates among seniors,<br />
including trends in the use <strong>of</strong> daily and weekly therapy. It also examined a<br />
surrogate measure for compliance with therapy.<br />
Results: The age–sex standardized rate <strong>of</strong> bisphosphonate use across all<br />
provinces increased from 8.9% in 2001–2002, to 12.9% in 2006–2007. The<br />
rate <strong>of</strong> use among females (20.4%) was more than six times the rate <strong>of</strong> use<br />
among males (3.3%). The rate <strong>of</strong> use <strong>of</strong> weekly therapy increased from<br />
0.1% to 8.4%, while use <strong>of</strong> daily therapy dropped from 9.3% to 5.3%.<br />
Measures <strong>of</strong> compliance showed similar results for patients on daily and<br />
weekly therapy.<br />
Conclusion: This analysis provides insight into how the introduction <strong>of</strong> new<br />
chemicals and dosage formulations affected bisphosphonate use among<br />
seniors. There was a significant shift to the use <strong>of</strong> newer therapies as well<br />
as from daily to weekly therapy. There was little difference in compliance<br />
between daily and weekly users.<br />
Teaching Residents to Teach: Development <strong>of</strong> a Teaching<br />
Rotation for a Pharmacy Practice Residency<br />
Henry Halapy, Tom Chin, Sharan Lail, Cheryl Reid, Lucy Chen, Ann Leung and<br />
Janice Wells, St. Michael’s <strong>Hospital</strong>, Toronto, ON<br />
Rationale: <strong>Pharmacists</strong> are increasingly called upon to teach students as<br />
part <strong>of</strong> their daily clinical activities. In fact, academic teaching is one <strong>of</strong> the<br />
objectives <strong>of</strong> CHPRB accredited residency programs (1). However, residency<br />
training has <strong>of</strong>ten overlooked this important skill (2). Our program<br />
attempted to address this apparent training deficiency by developing and<br />
implementing a resident teaching rotation.<br />
Description/Implementation: A longitudinal and multi-faceted teaching<br />
rotation was designed and implemented in 2006 containing a series <strong>of</strong><br />
activities for the resident to complete over the residency year. The first<br />
activity involved resident-led discussion around adult education theory.<br />
Topics included setting learning objectives, learning and teaching styles<br />
(including self-directed learning), principles <strong>of</strong> feedback, and techniques<br />
about one-to-one and small group learning. The second activity involved<br />
giving a didactic session to pharmacy technicians, and included setting<br />
learning objectives, developing the content and delivering the session. The<br />
third activity consisted <strong>of</strong> leading a group <strong>of</strong> undergraduate pharmacy<br />
students in two interactive mini case discussions. The resident was<br />
responsible for picking the topic and patient case, setting learning<br />
objectives, selecting and providing the students with appropriate articles,<br />
leading the students through the case discussion using small group<br />
learning techniques while maximizing student participation.<br />
Evaluation: Three residents have completed the teaching rotation.<br />
Feedback about the rotation was solicited through residency evaluation<br />
forms. Residents said this rotation was a valuable learning experience,<br />
helped them gain teaching experience, and increased confidence to teach<br />
pharmacy students in the future. Student evaluations <strong>of</strong> the resident-led<br />
case discussions indicated a positive learning experience. Students rated<br />
the resident through a five point scale (1 to 5, 5 being the highest score),<br />
giving mostly 4’s and 5’s to score the learning experience.<br />
Conclusion: The resident teaching rotation has been a valuable addition to<br />
the residency curriculum and to the resident’s learning experience.<br />
CHPRB accreditation standards 2010.<br />
http://www.cshp.ca/programs/residencyTraining/Surveyinfo_e.asp<br />
Accessed October 6th, 2009.<br />
Executive <strong>of</strong> the <strong>Hospital</strong> Pharmacy Residency Forum <strong>of</strong> Ontario. Position<br />
Paper on the Role <strong>of</strong> <strong>Hospital</strong> Residency <strong>Program</strong>s in Clinical Training and<br />
Pr<strong>of</strong>essional Development in the Era <strong>of</strong> the Proposed Entry-Level Doctor <strong>of</strong><br />
Pharmacy <strong>Program</strong>. CJHP. 2006;59(4).<br />
Pharmaceutical Care Urgency Framework: Development <strong>of</strong><br />
a Teaching Tool<br />
Lawrence Jackson 1 , Diane Vella 2 and Dean Yang 1<br />
1<br />
Department <strong>of</strong> Pharmacy, Veterans Centre, Sunnybrook Health Sciences<br />
Centre, Toronto and<br />
2<br />
Pharmacy student, Leslie Dan Faculty <strong>of</strong> Pharmacy, University <strong>of</strong> Toronto<br />
Rationale: Drug therapy problem (DTP) identification and prioritization are<br />
key functions <strong>of</strong> the pharmaceutical care practitioner and must be acquired<br />
by Pharmacy students. Guidance is available for prioritization <strong>of</strong> multiple<br />
DTPs, but is lacking with respect to the timeliness for addressing individual<br />
DTPs. An urgency framework, similar to triage was considered a useful tool<br />
to address this gap.<br />
Description <strong>of</strong> the Project: Focus groups <strong>of</strong> Pharmacy students and<br />
experienced pharmacists were conducted separately to test the<br />
reasonableness <strong>of</strong> a proposed framework for categorizing the urgency with<br />
which clinical situations should be addressed.<br />
Method: An urgency categorization scheme for DTPs that assigns a<br />
timeframe to the pharmacist’s or other clinician’s actions, which is akin to<br />
triage, was proposed. The categories <strong>of</strong> urgency include critical, high,<br />
medium and low, and each has a corresponding timeframe. The concept <strong>of</strong><br />
importance was used to describe the patient’s perspective and includes<br />
aspects such as risk for harm and motivating factors such as the usefulness<br />
<strong>of</strong> available treatments, and the patient’s values and preferences. The<br />
authors created 43 examples <strong>of</strong> clinical conditions corresponding to the<br />
various levels <strong>of</strong> urgency and sought to corroborate these assumptions in<br />
the focus groups.<br />
Evaluation: Focus group participants were asked to rate the urgency and<br />
timeframe for action for each clinical example. Pharmacy students agreed<br />
less <strong>of</strong>ten with the predetermined urgency categorization <strong>of</strong> the examples<br />
(R2=0.61) compared to pharmacists (R2=0.807). A similar difference was<br />
found for timeframe and was attributed to inexperience. The 4-level<br />
urgency framework with corresponding timeframes and degree <strong>of</strong><br />
importance concepts were unanimously endorsed by Pharmacy students<br />
and pharmacists.<br />
Importance to Practice: Pharmacy students perceived that the framework<br />
would be useful to them in their undergraduate education and pharmacists<br />
perceived that the framework would be useful for instruction <strong>of</strong> students<br />
during clinical rotations.<br />
2 CSHP<br />
Targeting Excellence<br />
in Pharmacy Practice<br />
Monitoring and Documentation <strong>of</strong> Outcomes from<br />
Targeted Medication Interventions:<br />
Implementation using the Electronic<br />
Documentation System<br />
Lawrence Jackson 1 , Diane Vella 2 , Kate Dewhurst 3 , Dean Yang 1 , Debbie<br />
King-Totty 3 , Valerie Madill 3 , Ean Sagadraca 3 , Ria Spee 3 , Maria Chang 4 ,<br />
Evelyn Williams 4 ,<br />
Departments <strong>of</strong> Pharmacy 1 , Pharmacy student 2 , Leslie Dan Faculty <strong>of</strong><br />
Pharmacy, U<strong>of</strong>T, Nursing 3 and Medicine 4 , Veterans Centre, Sunnybrook<br />
Health Sciences Centre, Toronto, ON
Rationale: We have shown that a monitoring resource guide and a<br />
paper-based communication system are effective strategies for increasing<br />
the frequency <strong>of</strong> documentation by nurses <strong>of</strong> outcomes from targeted<br />
medication interventions. However, the number <strong>of</strong> communications<br />
declined over time. The purpose <strong>of</strong> this project was to evaluate the impact<br />
<strong>of</strong> an electronic documentation system for communicating changes in<br />
pharmacotherapy among nurses and identify any challenges to<br />
implementing this process change.<br />
Description <strong>of</strong> the Project: Intensive one-to-one education and the<br />
monitoring resource guide were provided to nurses <strong>of</strong> nursing home-level<br />
unit. A pre and post audit <strong>of</strong> nursing documentation was used to evaluate<br />
the impact <strong>of</strong> this process change and a survey was used to capture<br />
satisfaction among nurses.<br />
What was Done: A clinical nurse educator and pharmacy student<br />
instructed nurses individually to ensure their familiarity with roles and<br />
responsibilities, and skill in using the electronic documentation system.<br />
Each medication alert entered in the computer appeared on a “To do list” to<br />
guide nursing actions. A pharmacy summer student conducted an audit <strong>of</strong><br />
nursing notes one month pre and post implementation to determine the<br />
quantity and quality <strong>of</strong> documentation, and administered a satisfaction<br />
survey.<br />
Evaluation: Documentation increased from 42% to 64% after one month.<br />
Although only 9/22 (40%) interventions were entered electronically, 8/9 <strong>of</strong><br />
these entries resulted in documentation, indicating the value <strong>of</strong> the “To do<br />
list” as a communication tool. There was a high degree <strong>of</strong> satisfaction with<br />
the process change among nurses, and in terms <strong>of</strong> improving team<br />
interactions, awareness <strong>of</strong> the patient’s progress and medication side<br />
effects. Individual engagement <strong>of</strong> nurses by a clinical nurse educator, and<br />
the monitoring guide were considered success factors.<br />
Importance to Practice: This information/skill transfer initiative has<br />
improved team functioning and resulted in more information being<br />
available to support decisions related to pharmacotherapy.<br />
Encore Presentation<br />
2 CSHP<br />
Targeting Excellence<br />
in Pharmacy Practice<br />
Description <strong>of</strong> Drug Therapy Problems and<br />
Anticoagulation Outcomes in a Multidisciplinary<br />
Anticoagulation Clinic<br />
Nicole Parker, Natalie Crown, Charlie Bayliff, George Dresser, Alejandro,<br />
Lazo-Langner, Richard Kim, London Health Sciences Centre, University<br />
<strong>Hospital</strong>, London, ON<br />
Rationale: A new multidisciplinary anticoagulation clinic has become<br />
operational within our institution. The purpose <strong>of</strong> this study was to<br />
evaluate clinic services and to assess impact on non-anticoagulation<br />
related drug therapy problems (DTPs) in an under-serviced patient<br />
population.<br />
Objectives: Objectives were 3-fold: to describe the types <strong>of</strong> DTPs identified<br />
and resolved in patients without a family physician; to assess quality <strong>of</strong><br />
anticoagulation control; and to evaluate patient satisfaction.<br />
Methods: A retrospective chart review was conducted to describe the<br />
types <strong>of</strong> DTPs documented, detected and resolved in patients without<br />
family physicians. Adequacy <strong>of</strong> anticoagulation control was assessed by<br />
calculating percentage time in range (PTIR) using the Rosendaal linear<br />
interpolation method in all patients followed for at least 3 months. PTIR<br />
was reported as target INR ± 0.5 units, and expanded PTIR as target INR ±<br />
0.7 units. To evaluate patient satisfaction, a survey was developed and<br />
mailed to patients who had been actively followed for at least 3 months.<br />
Patients ranked agreement with 10 statements on a 5-point Likert scale.<br />
Results: As <strong>of</strong> May 2009, 99 patients were actively followed or had been<br />
followed for at least 3 months. Of the total patients seen in clinic, 17%<br />
(n=22) did not have a family physician. 36 DTPs were detected and 86%<br />
were resolved. The most common DTPs identified were “unnecessary drug<br />
therapy” and “dosage too low”. The mean PTIR was 63% and the mean<br />
expanded PTIR was 80%. Overall, 68% (41/60) patients responded to the<br />
satisfaction survey, and 100% were satisfied with the care provided by the<br />
clinic.<br />
Conclusions: A number <strong>of</strong> DTPs were detected in patients without a family<br />
MD and a high proportion were resolved. The observed PTIR is consistent<br />
with the values reported in the literature and patients are highly satisfied<br />
with the care received.<br />
Ziprasidone and Analgesic-Induced Serotonin Syndrome<br />
Jessica Stovel, Joel Lamoure, Jennifer Barr, London Health Sciences Centre,<br />
London, Ontario, Jatinder Takhar, University <strong>of</strong> Western Ontario, London,<br />
Ontario<br />
Rationale: Serotonin syndrome diagnosis involves a triad <strong>of</strong> changes:<br />
cognitive, neuromuscular, and autonomic. These symptoms will <strong>of</strong>ten start<br />
to develop within 2 hours <strong>of</strong> increasing the synaptic level <strong>of</strong> serotonin,<br />
usually resulting from polypharmacy. Serotonin syndrome necessitates<br />
early identification as death may result within hours in severe cases.<br />
Description: A 10-year old boy weighing 44 kg presented to hospital with<br />
an arm fracture. The patient’s medical history includes<br />
obsessive-compulsive disorder, Tourette Syndrome, and ADHD. Home<br />
medications include fluvoxamine, divalproex and methylphenidate.<br />
Ziprasidone was started in the past 48 hours. Intra-operatively, the patient<br />
received fentanyl, prop<strong>of</strong>ol, and morphine. Post-operatively, the patient<br />
received codeine and morphine.<br />
Post-operatively in hospital, the patient experienced two syncopal events<br />
with autonomic abnormalities (BP 146/97, HR 126), as well as elevated<br />
creatine kinase (417 U/L). Over the next 48 hours neuromuscular changes<br />
(tremor and blepharospasm), cognitive changes (confusion, short-term<br />
amnesia), and further autonomic changes (diaphoresis, flushing) occurred.<br />
Ziprasidone and opioid analgesics were discontinued within 24 hours <strong>of</strong> the<br />
syncopal episodes, however the patient was inadvertently re-challenged<br />
with olanzapine. This resulted in severe agitation requiring restraints.<br />
Assessment <strong>of</strong> Causality: A temporal relationship between symptom<br />
onset and medications suggests highly probable serotonin syndrome. Over<br />
24 hours, the patient demonstrated marked cognitive, autonomic, and<br />
neuromuscular improvements with discontinuation <strong>of</strong> ziprasidone and<br />
opiates. The Naranjo Probability Scale yields a score <strong>of</strong> 10, suggesting a<br />
highly probable adverse drug event.<br />
Evaluation <strong>of</strong> the Literature: There is only one previous case report<br />
involving the addition <strong>of</strong> ziprasidone to a stable regimen <strong>of</strong> citalopram<br />
resulting in serotonin syndrome. There have been two published pediatric<br />
cases documenting post-operative serotonin syndrome in patients stable<br />
on serotonergic agents.<br />
Importance to Pharmacy Practitioners: Proactive identification and<br />
awareness <strong>of</strong> cognitive, neuromuscular, and autonomic changes linked to<br />
polypharmacy can decrease serotonin-associated morbidity and mortality.<br />
Fluconazole Treatment Failure in Cryptococcal Meningitis<br />
Bonnie Thieu, Edward Ralph, Zafar Hussain, Anne Marie Bombassaro,<br />
London Health Sciences Centre, London, ON<br />
Rationale: Cryptococcal meningitis (CM) is a life-threatening opportunistic<br />
infection that occurs predominantly in AIDS patients. Fluconazole is the<br />
treatment <strong>of</strong> choice for maintenance therapy. A case <strong>of</strong> recurrent CM<br />
despite high dose fluconazole administration is reported.<br />
Description <strong>of</strong> Case: A 44-year-old AIDS patient presented with increasing<br />
headaches over 5 days, accompanied by severe neck pain, photophobia,<br />
phonophobia and general malaise. The medical history was significant for<br />
CM diagnosed 7 months earlier.<br />
On examination the patient was suspected <strong>of</strong> having recurrent CM despite<br />
receiving fluconazole 600mg/day for the past 7 months. Potential reasons<br />
for fluconazole treatment failure, including compliance, interactions,<br />
absorption, resistance, and immune reconstitution syndrome, were<br />
investigated. Culture positivity <strong>of</strong> the cerebrospinal fluid for Cryptococcus<br />
ne<strong>of</strong>ormans excluded the latter phenomenon. Intravenous amphotericin B<br />
and oral flucytosine were initiated.<br />
Assessment <strong>of</strong> Causality: Increases in MIC between the initial and current<br />
episodes were observed for the following antifungals, with the exception <strong>of</strong><br />
amphotericin B (1mg/L):<br />
fluconazole 1 mg/L and 64 mg/L<br />
itraconazole 0.06 mg/L and 0.12 mg/L<br />
voriconazole ≤0.03 mg/L and 0.25 mg/L.<br />
Evaluation <strong>of</strong> Literature: High-level resistance to fluconazole, among<br />
isolates <strong>of</strong> Cryptococcus ne<strong>of</strong>ormans in North America, is uncommon (1% at<br />
≥64mg/L). A correlation between MICs ≥16mg/L and fluconazole treatment<br />
failure has been suggested in case series involving predominantly AIDS<br />
patients with CM. Only a limited number <strong>of</strong> reports documenting sequential<br />
51
52<br />
increases in MIC and treatment failure in individual patients, similar to this<br />
case, have been published.<br />
Importance <strong>of</strong> Case to Pharmacy Practitioners: While susceptibility<br />
testing is not recommended for routine care <strong>of</strong> patients with CM, it may be<br />
beneficial in cases <strong>of</strong> relapse or refractory disease, particularly when<br />
obvious reasons for treatment failure such as compliance, interactions, and<br />
malabsorption have been excluded. Recognition <strong>of</strong> azole exposure as a risk<br />
factor for increased MICs and for cross-resistance is key to selecting<br />
appropriate alternative therapy.<br />
2 CSHP<br />
Targeting Excellence<br />
in Pharmacy Practice<br />
Toronto, ON<br />
Analysis <strong>of</strong> Medication Incidents in Ontario<br />
Roger Cheng, Certina Ho, Carol Lee, Sibylle von Guttenberg,<br />
Lindsay Yoo, Institute for Safe Medication Practices Canada,<br />
Rationale: The Ontario Medication Incident Database (OMID) developed<br />
by the Institute for Safe Medication Practices Canada (ISMP Canada) has<br />
been capturing medication incidents since 2000. Analysis <strong>of</strong> the OMID can<br />
help identify high-risk areas in the medication-use process.<br />
Description and Steps Taken: As <strong>of</strong> April 2008, 30,612 medication<br />
incidents have been voluntarily reported by 58 Ontario institutions and<br />
facilities and by individual practitioners. A quantitative analysis was<br />
performed with a focus on the severity <strong>of</strong> outcome <strong>of</strong> the incidents and<br />
medication-use areas associated with these incidents.<br />
Evaluation: Most (90.10%) <strong>of</strong> the voluntarily reported medication incidents<br />
were associated with no harm, but 1,169 incidents (3.81%) were associated<br />
with a harm or death outcome. The three most common types <strong>of</strong><br />
medication incidents resulting in harm or death were dose omission<br />
(27.89%), incorrect dose (27.20%), and incorrect drug (13.77%). The top 10<br />
individual medications reported as causing harm or death through<br />
medication incidents were insulin, morphine, hydromorphone, heparin,<br />
fentanyl, warfarin, furosemide, potassium, metoprolol, and oxycodone.<br />
Drugs from floor stock (15.14%), intravenous solutions (13.26%), and<br />
infusion devices (8.98%) accounted for a significant proportion <strong>of</strong> the<br />
medication incidents reported as causing harm or death. The most common<br />
causes were miscommunication <strong>of</strong> drug order (9.92%), staff education<br />
problems (7.78%), environmental, staffing, or workflow problems (7.19%),<br />
and lack <strong>of</strong> quality control or independent check systems (6.16%).<br />
Conclusion: It is impossible to infer the probability <strong>of</strong> specific incidents on<br />
the basis <strong>of</strong> the voluntary reports, but the OMID analysis suggests that<br />
there is a potential to significantly reduce preventable patient harm by<br />
focusing on several or specific high-risk medication-use areas.<br />
Importance: As the OMID continues to accumulate data over time, trends<br />
and changes in medication incident patterns will be identified. OMID will<br />
continue to provide guidance to Ontario, and help identify new areas <strong>of</strong><br />
focus to enhance medication safety.<br />
Monday, February 1 • Lundi 1 er février<br />
Incidence <strong>of</strong> Venous Thromboemolism (VTE) at Sunnybrook<br />
Long Term Care<br />
Froozan Amin 1 , Larry Jackson 2 , Tracy Chan 3 ,<br />
1<br />
Long Term Care Pharmacist, Sunnybrook Veterans Centre, Toronto,<br />
2<br />
Long Term Care Pharmacist; Clinical Coordinator, Sunnybrook Veterans<br />
Centre, Toronto,<br />
3<br />
Pharmacy Student, University <strong>of</strong> Toronto, Toronto, ON<br />
Rationale: Venous thromboembolism (VTE) is an important cause <strong>of</strong><br />
morbidity and mortality in hospitalized medical patients. <strong>Hospital</strong>ization<br />
itself causes an 8 fold increase in the risk <strong>of</strong> VTE. Large randomized clinical<br />
trials showed safety and efficacy <strong>of</strong> pharmacological prophylaxis in<br />
hospitalized medical patients (50-60% decrease in VTE ) with lowest<br />
bleeding risks. However, little is known <strong>of</strong> the VTE risk among patients<br />
residing in long term care (LTC) settings.<br />
Description <strong>of</strong> the Project: An observational study was performed in a<br />
511-bed LTC facility to characterize VTE incidence. Evidence-based guidelines<br />
exist for hospitalized medical patients; however there is not enough<br />
evidence or guidelines for medically ill Long Term Care patients.<br />
What was Done: Data on all new VTE events occurring in LTC residents was<br />
collected during the period from January 2007 to February 2009. Data was<br />
also collected on demographic parameters, clinical status, diagnosis,<br />
coincident medications, use <strong>of</strong> anticoagulant or antiplatelet medications<br />
and requirement for transfer to acute care.<br />
Evaluation: Results showed 23 new VTE cases <strong>of</strong> which 21 cases were deep<br />
vein thrombosis (DVT) alone, 1 case <strong>of</strong> pulmonary embolus (PE) and 1 case<br />
<strong>of</strong> DVT + PE. Less than 20% <strong>of</strong> patients were on anticoagulant prophylaxis at<br />
time <strong>of</strong> the VTE event. All patients had 1 or more risk factors for VTE. The<br />
most common risk factors found were immobilization, acute change <strong>of</strong><br />
health status and cancer.<br />
Importance to Practice: Elderly patients residing in LTC facilities with risk<br />
factors including immobility, an acute change in health status and cancer<br />
appear to be at increased risk <strong>of</strong> VTE. Clinicians may consider short-term<br />
pharmacological prophylaxis for selected patients, especially those who<br />
experience an acute change <strong>of</strong> health status. However, there is no evidence<br />
for the efficacy or cost-effectiveness <strong>of</strong> primary prevention after the first 3<br />
months <strong>of</strong> immobilization.<br />
Aortic Graft Vancomycin Intermediate Resistant<br />
Staphylococcus aureus Infection Treated with Ceftobiprole<br />
after Linezolid Induced Peripheral Neuropathy<br />
Christina Candeloro, Kim Delamere, London Health Sciences Centre, London,<br />
Ontario<br />
Rationale: With the emergence <strong>of</strong> vancomycin intermediate resistant<br />
Staphylococcus aureus (VISA) infections antibiotic selection is becoming<br />
increasingly difficult. Ceftobiprole, an advanced generation cephalosporin<br />
demonstrates in-vitro activity against methicillin-resistant Staphylococcus<br />
aureus (MRSA) and VISA and was recently approved for use in complicated<br />
skin and skin structure infections (cSSSI). We report a case <strong>of</strong> safe and<br />
effective <strong>of</strong>f-label use <strong>of</strong> this new cephalosporin in treating a VISA infection.<br />
Description: A 45-year old male received vancomycin post Bentall<br />
procedure after developing an MRSA aortic graft infection. Over a 13 month<br />
vancomycin treatment period, increasing MICs were observed with<br />
emergence <strong>of</strong> VISA (MIC 4 mg/L) from blood cultures. Linezolid 600 mg i.v.<br />
q12h was started and 3 months later the patient presented with<br />
paresthesias <strong>of</strong> the distal lower limbs limiting mobility. The polyneuropathy<br />
was temporally linked with linezolid, other drug and physiologic causes<br />
were ruled out, and linezolid was discontinued. Alternative agents were<br />
considered but ceftobiprole was chosen as salvage therapy. Ceftobiprole<br />
500 mg i.v. q8h administered over 2 hours was initiated for 50 days. Signs<br />
and symptoms <strong>of</strong> infection and blood cultures remained negative<br />
throughout ceftobiprole treatment. No serious adverse effects were<br />
observed.<br />
Evaluation <strong>of</strong> the Literature: Two published randomized controlled trials <strong>of</strong><br />
ceftobiprole in humans have demonstrated noninferiority to vancomycin +/-<br />
ceftazidime in cSSSI. Several clinical efficacy trials for pneumonia are<br />
awaiting publication. To date there are no published, unpublished or<br />
currently recruiting efficacy trials <strong>of</strong> ceftobiprole in cardiovascular infections.<br />
Nausea and dysgeusia are the most commonly reported adverse events.<br />
Importance to Pharmacy Practitioners: Ceftobiprole represents a new and<br />
potentially safe alternative in treating MRSA and VISA infections.<br />
Nephrotoxicity Associated With Ten<strong>of</strong>ovir: A Systematic<br />
Review <strong>of</strong> Observational Studies<br />
Amanda Chan 1 , Mark Duffett 1,2 , ACPR; Alissa Koop 3<br />
1<br />
Department <strong>of</strong> Pharmacy,<br />
2<br />
Department <strong>of</strong> Pediatrics, and<br />
3<br />
Special Immunology Services Clinic, McMaster University Medical Center,<br />
Hamilton, ON
Rationale: The incidence and significance <strong>of</strong> nephrotoxicity associated with<br />
ten<strong>of</strong>ovir when used to treat HIV is unknown. In clinical trials, it is rare (
54<br />
theoretically augment the effects <strong>of</strong> warfarin. Radix glycyrrhizae contains<br />
coumarin derivatives, and could theoretically elevate INR. In vitro data<br />
suggests that flavonoids found in scutellariae can reversibly inhibit CYP2C9,<br />
the enzyme responsible for S-warfarin metabolism. No pharmacologic basis<br />
for interaction was found for the remaining ingredients.<br />
Importance <strong>of</strong> Case to Pharmacy Practitioners: Patients receiving<br />
warfarin therapy should be counseled to consult with their pharmacist prior<br />
to beginning any new medication. Through increased reporting <strong>of</strong><br />
warfarin-herb interactions, it is hoped adverse reactions can be prevented.<br />
2 CSHP<br />
Targeting Excellence<br />
in Pharmacy Practice<br />
Medication Reconciliation across the Spectrum <strong>of</strong><br />
Renal Care and Across<br />
the Province<br />
Dan Martinusen, Royal Jubilee <strong>Hospital</strong>, Victoria, BC and the British<br />
Columbia Provincial Renal Agency<br />
Medication reconciliation has been noted to improve patient outcomes.<br />
Dialysis patients may well be one <strong>of</strong> the highest risk groups for medication<br />
misadventures. The average dialysis patient prescribed 13 medications by<br />
multiple prescribers resulting in many daily doses. Moreover, these<br />
prescriptions change frequently given the acuity <strong>of</strong> this patient population.<br />
Given the fragility <strong>of</strong> these patients, the consequences <strong>of</strong> medication<br />
misadventures can be severe and is one the causes <strong>of</strong> the frequent<br />
hospitalizations seen in this group.<br />
The BC Provincial Renal Agency embarked upon an ambitious project to<br />
develop medication reconciliation and then to spread it to all dialysis<br />
patients in the province, with future expansion to transplant and pre-dialysis<br />
patients. Central to the system is the Agency’s “PROMIS” database that<br />
includes medication orders. Reports can be produced that enable<br />
medication reconciliation, medication pr<strong>of</strong>iles, hospital admission and<br />
discharge medication prescriptions.<br />
Two hundred and 60 (260) reconciliations were performed demonstrating an<br />
average <strong>of</strong> 19 medication orders. First reconciliation encounters<br />
demonstrated an average <strong>of</strong> 6.3 discrepancies requiring an average <strong>of</strong> 6.8<br />
orders to resolve them. Second reconciliation encounters with patients<br />
identified 2 discrepancies on average and 2.7 orders written to resolve<br />
them. Medication reconciliation using this system resulted in a dramatic<br />
reduction in discrepancies. Additionally, we demonstrated that on repeat<br />
reconciliations at six months, the number <strong>of</strong> discrepancies identified was<br />
dramatically lower.<br />
This unique approach allows for continuous reconciliation in the outpatient<br />
setting that flows through to hospital admission and discharge to any<br />
hospital in the province. Reconciliation occurs at least every six months and<br />
can be flexible to be nurse, pharmacist, pharmacy technician or prescriber<br />
driven.<br />
Patients benefit from improved safety and outcomes. Prescribers benefit by<br />
having accurate medication pr<strong>of</strong>iles, having accurate hospital admission<br />
and discharge orders available easily. The Agency benefits through improved<br />
medication data to correlate outcomes to demonstrate and drive best<br />
practice.<br />
This poster links directly with CSHP 2015 initiatives (Goals 1, 2, 5.5, 5.6 and<br />
6.1)<br />
This is an ENCORE PRESENTATION presented at the National <strong>Canadian</strong><br />
Patient Safety Institute Forum on Patient Safety & Quality in April <strong>of</strong> this<br />
year.<br />
Retrospective Assessment <strong>of</strong> the Effectiveness <strong>of</strong><br />
Standard vs. Non-standard Preoperative<br />
in Pharmacy Practice Antibiotics in Preventing Postoperative Surgical<br />
Site Infections in Elective Colectomy Patients<br />
2 CSHP<br />
Targeting Excellence<br />
Irina Rajakumar, John Baskette, Anne Marie Bombassaro. London Health<br />
Sciences Center, London, ON<br />
Rationale: Appropriate prophylactic antibiotics administered before<br />
colorectal surgery significantly decrease rates <strong>of</strong> surgical site infections<br />
(SSI). Inappropriate antibiotic use, however, can lead to increased microbial<br />
resistance, adverse events and costs.<br />
Objectives: The objectives <strong>of</strong> this review were to compare the effectiveness<br />
<strong>of</strong> standard versus non-standard prophylactic antibiotics in preventing<br />
postoperative SSI and to assess compliance with Safer Healthcare Now<br />
guidelines for appropriate use <strong>of</strong> prophylactic antibiotics.<br />
Methods: A retrospective chart review was conducted for adult elective<br />
colectomy patients between November 2008 and April 2009. Antibiotic use<br />
on or after postoperative day three, excluding treatment <strong>of</strong> other<br />
documented infections, was used as an indicator for SSI. Incidence <strong>of</strong> SSI,<br />
antibiotic costs, length <strong>of</strong> stay, readmission within 30 days, and percent <strong>of</strong><br />
patients with appropriate antibiotic selection, timing, and discontinuation<br />
were recorded.<br />
Results: Of the 101 patients whose charts were reviewed, 80 (79%) had<br />
received institutional standard prophylactic antibiotic regimen (cefazolin<br />
plus metronidazole). The majority <strong>of</strong> non-standard antibiotics consisted <strong>of</strong><br />
the combination <strong>of</strong> cipr<strong>of</strong>loxacin and metronidazole (17 <strong>of</strong> 21). Postoperative<br />
antibiotic use was similar between the standard and non-standard groups,<br />
33.8% and 33.3% respectively. No statistically significant difference was<br />
observed between groups in SSI rates, antibiotic costs, length <strong>of</strong> stay, and<br />
readmission. Time <strong>of</strong> preoperative antibiotic administration was<br />
documented in 96 <strong>of</strong> 101 patient charts. Seventy two percent (70/96) <strong>of</strong><br />
antibiotic administration occurred within 60 minutes <strong>of</strong> surgery. Significantly<br />
more patients in the non-standard group received their preoperative<br />
antibiotic doses on time (100% versus 66%, p=0.0014). Sixty nine percent<br />
(70/101) <strong>of</strong> patients had prophylactic antibiotics discontinued within 24<br />
hours after surgery.<br />
Conclusion: In patients undergoing elective colorectal surgery, no<br />
difference was observed in the postoperative antibiotic use between<br />
standard and broader spectrum non-standard prophylactic antibiotics. Rates<br />
<strong>of</strong> appropriate antibiotic selection, timing <strong>of</strong> administration and<br />
discontinuation were below targets established by guidelines.<br />
2 CSHP<br />
Targeting Excellence<br />
in Pharmacy Practice<br />
Post-<strong>Hospital</strong> Discharge: Medication<br />
Discrepancies and Drug Therapy Problems<br />
in Primary Care<br />
Karen Cameron 1 , Victoria Siu 2 , Patricia Marr 1 , Bassem Hamandi 2 , Olavo<br />
Fernandes 2<br />
1<br />
Toronto Western <strong>Hospital</strong> Family Health Team, Toronto, ON<br />
2<br />
Toronto General <strong>Hospital</strong>, Toronto, ON,<br />
Background: Patients transitioning from hospital to home are at risk <strong>of</strong><br />
post-discharge medication discrepancies and drug therapy problems (DTPs).<br />
Differences between medications taken by patients at home compared to<br />
prescribed directions <strong>of</strong>ten lead to medication errors and adverse events<br />
after acute care discharge. At the time <strong>of</strong> our study, Toronto Western Family<br />
Health Team (TWFHT) did not have a formal, standard practice for<br />
post-discharge medication management. Further, the role <strong>of</strong> family health<br />
team pharmacists in post-discharge care had not been described in<br />
published literature. Therefore we sought a better understanding <strong>of</strong> the<br />
frequency and characteristics <strong>of</strong> post-discharge discrepancies and DTPs.<br />
Objectives: To determine the number <strong>of</strong> patients with at least 1 discrepancy<br />
requiring clarification and those with at least 1 DTP linked to medication<br />
information transfer within 14 days post-discharge. Secondly, to characterize<br />
discrepancies, DTPs and report their status at follow-up within 45 days<br />
post-discharge.<br />
Method: Patients admitted for > 48 hours and discharged from a hospital<br />
were identified. Patients discharged to nursing home, another institution or<br />
not actively visiting TWFHT were excluded. The study process involved a<br />
pharmacist visit scheduled within 14 days post-discharge. At this visit, a<br />
pharmacist conducted medication reconciliation and a pharmaceutical care<br />
assessment to identify discrepancies and DTPs respectively. Medication<br />
discrepancies were classified by standard types and contributing factors.<br />
DTPs were assessed for link to medication information transfer and<br />
classified according to seven standard categories. Follow-up encounters<br />
within 45 days post-discharge were conducted to determine the status <strong>of</strong><br />
identified discrepancies and DTPs.<br />
Results: From February to June 2009, 30 patients were included in the<br />
study. At the initial visit, 24 (80%) patients had at least 1 discrepancy<br />
requiring clarification and 23 (77%) had at least 1 DTP linked to medication<br />
information transfer. The most common types <strong>of</strong> discrepancies were<br />
differences in drug 27 (52%) and dose 14 (27%). Patient and system factors<br />
appeared to contribute equally to discrepancies. Of all the DTPs identified,<br />
50% were linked to medication information transfer. The most common DTPs
linked to information transfer were 22 adverse drug events (35%) and 13<br />
dose being too low (18%), with a similar trend in all DTPs observed.<br />
Conclusion: Medication discrepancies and DTPs linked to medication<br />
information transfer occur commonly after hospital discharge. It is<br />
incumbent upon primary care practitioners, including family health team<br />
pharmacists to understand and develop ways to optimize post-discharge<br />
safety. Ultimately, a medication management strategy after acute care<br />
discharge should incorporate both medication reconciliation and<br />
pharmaceutical care.<br />
The Safety <strong>of</strong> Ethanol Infusions for the Treatment <strong>of</strong><br />
Methanol or Ethylene Glycol Ingestion: An Observational<br />
Study<br />
Mary Kate Wedge; Sabrina Natarajan; Christel Johanson; Rakesh Patel;<br />
Andrew Gee; Salmaan Kanji; The Ottawa <strong>Hospital</strong>, Ottawa, ON<br />
Rational: Methanol or ethylene glycol ingestion can result in significant<br />
morbidity or death unless prompt evaluation and treatment is initiated.<br />
Despite traditional and widespread use <strong>of</strong> ethanol as antidotal therapy, the<br />
safety <strong>of</strong> infusions is not well described. Current guidelines promote the use<br />
<strong>of</strong> fomepizole as preferred therapy for toxic alcohol ingestions. An<br />
evaluation <strong>of</strong> the safety and ease in titrating ethanol infusions is necessary<br />
given the availability <strong>of</strong> an alternative antidote.<br />
Objective: To evaluate the safety and ease in titrating ethanol infusions for<br />
the treatment <strong>of</strong> methanol or ethylene glycol poisonings in a retrospective<br />
observational study.<br />
Study Design and Methods: <strong>Hospital</strong> records <strong>of</strong> adults seen in the<br />
Emergency Department <strong>of</strong> The Ottawa <strong>Hospital</strong> for the treatment <strong>of</strong><br />
methanol or ethylene glycol ingestion were reviewed for a 10-year period.<br />
Data with respect to patient demographics, severity <strong>of</strong> illness, ethanol dose<br />
titration, adverse events, and patient outcomes was collected by a single<br />
investigator using a standardized case report form.<br />
Results: Data was analyzed using SPSS version 16.0. Overall, 154 patient<br />
records were reviewed, and 66 patients with toxic alcohol ingestions were<br />
included in the analysis. Fifty-two patients were treated with ethanol<br />
infusions. At least one adverse event was identified in 83% <strong>of</strong><br />
ethanol-treated patients. During the infusion, the median [range] number <strong>of</strong><br />
ethanol serum concentration measurements was 6.5 [0-24.0]. Only 164 <strong>of</strong><br />
the 404 ethanol levels measured were within the target range, and 41% were<br />
followed by an inappropriate dose response to a non-therapeutic ethanol<br />
serum concentration.<br />
Conclusion: These results suggest that adverse events are common with<br />
intravenous ethanol infusions and current practice for dose titration is<br />
inefficient. Despite the lack <strong>of</strong> superiority evidence in favor <strong>of</strong> fomepizole<br />
over ethanol, fomepizole may be a safer and easier antidote to administer.<br />
55<br />
Tuesday, February 2 • Mardi 2 février<br />
Serotonin Syndrome with Venlafaxine after Change from<br />
Peritoneal Dialysis to Hemodialysis<br />
Krista Biederman, London Health Sciences Centre, London, ON, Amanda<br />
Cherry, London Health Sciences Centre, London, ON<br />
Rationale: Depression is seen in up to 1/3 <strong>of</strong> patients with chronic kidney<br />
disease and the use <strong>of</strong> antidepressants in this population is common.<br />
Venlafaxine is indicated for the treatment <strong>of</strong> depression and has also been<br />
implicated in reports <strong>of</strong> serotonin syndrome (SS). Venlafaxine and its active<br />
metabolite are renally cleared. Venlafaxine is not cleared by intermittent<br />
hemodialysis (IHD) and currently there is no literature to describe its<br />
clearance via peritoneal dialysis (PD).<br />
Description: A 59 year old male with end-stage renal disease presented to<br />
the hospital with a 7 day history <strong>of</strong> altered mental status, tachycardia,<br />
vomiting, hallucinations, violent behavior and myoclonus <strong>of</strong> the limbs and<br />
face. Less than 3 weeks before admission the patient’s dialysis was<br />
switched from PD to IHD. Prior to admission the patient was stable on<br />
venlafaxine 225mg daily for at least 2 years. Venlafaxine was held on<br />
admission. Within 48 hours, there was a dramatic improvement in most<br />
symptoms described with complete resolution <strong>of</strong> myoclonus on the third<br />
day.<br />
Assessment <strong>of</strong> Causality: A temporal relationship between the change in<br />
dialysis modality and onset <strong>of</strong> symptoms was identified. The patient<br />
showed marked improvement in symptoms 48 hours after venlafaxine was<br />
discontinued. The Naranjo Probability Scale yields a score <strong>of</strong> 4, suggesting<br />
a possible adverse drug reaction. Venlafaxine was not re-administered.<br />
Evaluation <strong>of</strong> Literature: There are reports <strong>of</strong> venlafaxine-associated SS.<br />
The time frame <strong>of</strong> resolution is consistent with other case reports <strong>of</strong><br />
venlafaxine-associated SS. There are no case reports specifically <strong>of</strong> SS<br />
associated with venlafaxine after a change from PD to IHD.<br />
Importance to Pharmacy Practitioners: It is important for pharmacists to<br />
understand the potential for differences in drug clearance between dialysis<br />
modalities and resultant adverse drug effects such as serotonin syndrome<br />
in patients who are changing dialysis modalities.<br />
2 CSHP<br />
Targeting Excellence<br />
in Pharmacy Practice<br />
Interventions in a Medical Teaching Unit: Effect<br />
<strong>of</strong> a Pharmacist Attending Rounds Versus<br />
Reactive Patient-Care Efforts (INTERVENE)<br />
Zack J Dumont, Regina Qu’Appelle Health Region Department <strong>of</strong> Pharmacy<br />
Practice Regina, SK, Lynette Kolodziejak, Regina Qu’Appelle Health Region<br />
Department <strong>of</strong> Pharmacy Practice, Regina, SK, Nicole Bidwell, Regina<br />
Qu’Appelle Health Region Department <strong>of</strong> Pharmacy Practice, Regina, SK,<br />
Alexandra Martinson, Regina Qu’Appelle Health Region Department <strong>of</strong><br />
Pharmacy Practice, Regina, SK<br />
Rationale: Research has shown that pharmacist participation on rounds<br />
may decrease medication errors, adverse drug events, and drug costs.<br />
Objectives: To determine the number, type, time taken to perform, and<br />
acceptance rate <strong>of</strong> pharmacist interventions performed during patient-care<br />
rounds on a medical teaching unit (MTU); to compare the interventions to<br />
activities shown in the literature to have a positive impact on patient-care;<br />
and to compare interventions between a control and study phase.<br />
Design & Methods: A prospective, controlled trial. During the control<br />
phase pharmacists provided standard service to the MTU and did not<br />
attend patient-care rounds. During the study phase, pharmacists<br />
participated on daily MTU rounds in addition to providing standard<br />
services. <strong>Pharmacists</strong> recorded each intervention over four weeks; 2 weeks<br />
per phase. Interventions were categorized into activities identified in the<br />
literature to be <strong>of</strong> benefit to patients. Time taken to perform interventions<br />
included work-up and wait-time for physician acceptance/rejection.<br />
Results: <strong>Pharmacists</strong> performed 80 interventions during MTU rounds, 90%<br />
were accepted. Of the interventions identified in the literature to be <strong>of</strong><br />
benefit the most commonly recorded were “recommending alternative<br />
therapy” (44 interventions, 82% accepted), “clarifying/correcting an order”<br />
(20 interventions, 100% accepted), and “providing drug information” (6<br />
interventions, 100% accepted). On average, the time required per<br />
intervention was 12.4 minutes. During the control phase, pharmacists<br />
performed 18 interventions, 81% were accepted, requiring a mean <strong>of</strong> 177.2<br />
minutes per intervention.<br />
Conclusion: Proactive pharmacist participation on MTU patient-care<br />
rounds resulted in a larger, more efficient, number <strong>of</strong> beneficial<br />
interventions than reactive patient-care.<br />
2 CSHP<br />
Targeting Excellence<br />
in Pharmacy Practice<br />
Quality Improvement Evaluation <strong>of</strong> a Pharmacist<br />
Managed Warfarin Dosing Service for Outpatient<br />
Venous Thromboembolism.<br />
Patrick Fitch, Department <strong>of</strong> Pharmaceutical Services, Victoria General<br />
<strong>Hospital</strong>, Winnipeg, Manitoba; Julie Mistri, Department <strong>of</strong> Pharmaceutical<br />
Services, Victoria General <strong>Hospital</strong>, Winnipeg, MB; Alexander Persowich,<br />
Clinical Institute <strong>of</strong> Applied Research and Education, Victoria General<br />
<strong>Hospital</strong>, Winnipeg, MB<br />
Rationale: We implemented a pharmacist managed warfarin dosing service<br />
for outpatients initiated on warfarin for treatment <strong>of</strong> venous<br />
thromboembolism, using one <strong>of</strong> two previously validated dosing<br />
nomograms (initial dose 5 mg or 10 mg) to guide warfarin dosing (expected
56<br />
therapeutic INR in 5 days). The purpose <strong>of</strong> the project was to evaluate the<br />
effectiveness <strong>of</strong> the service.<br />
Description <strong>of</strong> Project: We conducted a retrospective audit <strong>of</strong> pharmacy<br />
pr<strong>of</strong>iles and patient charts for all patients admitted to the service between<br />
April 1, 2008 and March 31, 2009. Data abstracted included: demographic<br />
information; indication for anticoagulation; frequency <strong>of</strong> use <strong>of</strong> each<br />
nomogram; deviations from the nomogram and reasons for deviations;<br />
number <strong>of</strong> treatment days on each nomogram; number <strong>of</strong> patients with INR<br />
> 3.0 and interventions for INR > 3.0.<br />
Evaluation: Fifty seven patients were included (mean age 62.2 yrs, 47.4%<br />
male). The primary indication for anticoagulation was deep vein thrombosis<br />
(82.5%). The majority <strong>of</strong> patients (64.9%) used the 10 mg nomogram.<br />
Eighty-six percent <strong>of</strong> patients achieved a therapeutic INR. Deviations from<br />
the nomograms were required for 52.7% <strong>of</strong> patients to achieve therapeutic<br />
INR. The most common reasons for deviation from the nomograms were:<br />
treatment duration exceeding nomogram duration (21%); INR not rising fast<br />
enough (28.9%); and INR rising too fast (13.1%). The time to achieve target<br />
INR was longer than that reported in previous studies using these or similar<br />
nomograms. No patients had an INR greater than 4.5 or required vitamin K.<br />
Conclusions: Our pharmacist managed warfarin dosing program is a safe,<br />
effective method <strong>of</strong> initiating warfarin therapy in outpatients requiring<br />
anticoagulation. Additional investigation is required to determine reasons<br />
for the extended time required to achieve target INR. Pharmacist education<br />
is required to reduce the number <strong>of</strong> protocol deviations.<br />
Release <strong>of</strong> Joint Technical Statement on Pharmaceutical<br />
Bar Coding in Canada<br />
Ensom, Robin, Regional Director, Pharmacy, Vancouver Coastal Health and<br />
Providence Health Care, Vancouver, BC; Sheppard, Ian, Project Lead,<br />
Institute for Safe Medication Practices – Canada (ISMP-Canada), Toronto,<br />
ON; Leonard Pierrette, Senior Advisor – National Partners, <strong>Canadian</strong> Patient<br />
Safety Institute (CPSI), Ottawa, ON; Hyland, Sylvia, Vice-President and<br />
Chief Operation Officer, Institute for Safe Medication Practices – Canada,<br />
Toronto, ON<br />
Bar coding as a point-<strong>of</strong>-care scanning system, combined with a<br />
computerized database, ensures that the right drug, in the right dose and<br />
by the right route <strong>of</strong> administration, is being given to the right patient at<br />
the right time. Bar coding, when integrated with other advanced<br />
technologies, serves as an automated, reliable, and independent double<br />
check at the point <strong>of</strong> care, for prescriber order entry, and electronic<br />
medication administration records.<br />
A multiphase project for pharmaceutical bar coding, co-led by CPSI and<br />
ISMP-Canada, is guided by an Implementation Committee composed <strong>of</strong><br />
stakeholders, and supported by a 34-member Technical Task Force. A first<br />
outcome, recognizing the need for a national standard, was endorsement<br />
<strong>of</strong> the adoption <strong>of</strong> the GS1 global standard for automated identification <strong>of</strong><br />
pharmaceutical products.<br />
Multiple stakeholders have been involved to ensure that the development<br />
<strong>of</strong> a joint technical statement for pharmaceutical bar coding in Canada<br />
considered all healthcare sector requirements for implementing bar coding<br />
within the healthcare system. The statement also recognizes the<br />
evolutionary nature <strong>of</strong> the implementation process with advancing<br />
technologies and recognizing the varied levels <strong>of</strong> readiness in the<br />
healthcare sectors.<br />
A 34-member Technical Task Force, with representation from<br />
pharmaceutical manufacturers, supply chain organizations, health and<br />
information technology, retail pharmacy, institutional pharmacy, and health<br />
standards organizations, and GS1 Canada, have reached consensus on a<br />
joint technical statement with requirements for bar code components and<br />
symbologies, medications included in bar code categories, packaging<br />
levels, and bar code placement.<br />
Strategic alliances and stakeholder engagement for this national and<br />
comprehensive collaboration, envisioned to have multiple phases, will<br />
continue to be developed, including communication and sustainability<br />
strategies. Its purpose is widespread utilization <strong>of</strong> bar coding technology in<br />
order to add a layer <strong>of</strong> medication safety and to our healthcare system.<br />
Organizations providing support and funding for the project will be<br />
acknowledged.<br />
Qualitative Evaluation <strong>of</strong> the <strong>Canadian</strong> Fabry Disease<br />
Initiative<br />
Mark Embrett 1 , Neil J. MacKinnon 2 , Tom Rathwell 1 , and Daryl Pullman 3<br />
1<br />
School <strong>of</strong> Health Administration, Dalhousie University, Halifax, Nova Scotia<br />
2<br />
College <strong>of</strong> Pharmacy, Dalhousie University, Halifax, Nova Scotia<br />
3<br />
Faculty <strong>of</strong> Medicine, Memorial University, St. John’s, Newfoundland and<br />
Labrador<br />
Rationale: The <strong>Canadian</strong> Fabry Disease Initiative (CFDI) is a national study<br />
designed to assess the effectiveness <strong>of</strong> two treatment options for the rare<br />
Fabry disease. This initiative provides a unique opportunity for robust<br />
research that can contribute to a future Common Drug Review evaluation<br />
on these two treatments.<br />
Objectives: (1) Evaluate the CFDI using input from key informants; and (2)<br />
determine the initiative’s merit, assess its value and provide feedback to<br />
health pr<strong>of</strong>essionals, patients and decision makers.<br />
Study Design and Methods: This study used an ideal qualitative methods<br />
strategy composed <strong>of</strong> interview transcripts, a holistic-inductive design and<br />
content analysis. In May-June 2009, key informants, including CFDI<br />
patients, CFDI investigators, provincial and pharmaceutical representatives,<br />
were interviewed about their experiences with the CFDI. Content analysis<br />
was applied to identify core consistencies and meanings that allowed core<br />
themes to emerge and develop from the data.<br />
Results: Eighteen participants were interviewed, resulting in nine within<br />
and four between group themes. Within group analysis suggested: (1)<br />
Patients are concerned about the restrictions a clinical trial placed on<br />
access to therapy; (2) CFDI investigators believe the database and<br />
monitoring are essential components to treating rare diseases, but the CFDI<br />
is not the ideal model; (3) Provincial representatives believe research<br />
should not be a foundation for drug access; and (4) Pharmaceutical<br />
representatives perceived the CFDI as a poorly designed answer to a<br />
reimbursement problem. Between group analysis revealed that the CFDI as<br />
an important initiative in Canada. However, it is not the solution to many <strong>of</strong><br />
the issues related to reimbursement for expensive drugs for rare diseases.<br />
Conclusion: Three conclusions emerged: (1) The CFDI was a temporary<br />
solution to a reimbursement problem, (2) No group was completely<br />
satisfied with the CFDI; and, (3) The CFDI can and should be redesigned to<br />
better accommodate each group’s needs.<br />
Safer Medication Use in Emergency Departments (SAFER<br />
MEDs)<br />
Stacy Ackroyd-Stolarz 1,2 , Neil MacKinnon* 1 , Peter Zed 1,2 , Nancy Murphy 2 ,<br />
1<br />
College <strong>of</strong> Pharmacy, Dalhousie University<br />
2<br />
Department <strong>of</strong> Emergency Medicine, Dalhousie University<br />
Rationale: Emergency Departments (EDs) frequently see patients for<br />
medication-related problems, yet there are there are few cost-effective<br />
ways to measure the extent <strong>of</strong> the problem on an ongoing basis to guide<br />
prevention strategies.<br />
Objective: To demonstrate the feasibility <strong>of</strong> using routinely collected data<br />
to identify adverse drug events (ADEs) in patients presenting to EDs.<br />
Study Design and Methods: This retrospective cross-sectional pilot study<br />
was conducted in four EDs in Capital District Health Authority from<br />
November 1, 2007 to October 31, 2008. The primary outcome measure was<br />
the occurrence <strong>of</strong> an ADE identified from the ED Information System using<br />
validated screening criteria.<br />
Results: In 673 (0.5%) <strong>of</strong> 142,433 eligible patient records, an ADE was the<br />
main reason for the ED visit. Medications most frequently implicated in<br />
ADEs were analgesics and anti-pyretics (142 <strong>of</strong> 673 [21.1%]), psychotropic<br />
medications (121 [18.0%]), and other sedatives and hypnotics (95 [14.1%]).<br />
Patients presenting with an ADE were more likely female (57.7%, p=0.004)<br />
and younger (median age 37.0 vs. 43.0, p
healthcare utilization underscore the value in identifying these ADEs. The<br />
information is routinely collected, readily available and accessible for low<br />
cost. Moreover, data can be obtained without any impact on clinical staff.<br />
These attributes increase the utility for ongoing system-level monitoring.<br />
The Future Plans and Career Expectations <strong>of</strong> Pharmacy<br />
Students: Results from a National Survey<br />
Sean D. Higgins 1 , Neil J. MacKinnon 1 , Janet Cooper 2 , Heather Mohr 2 , Kelly<br />
Hogan 2 , and Derek Jorgenson 3<br />
1<br />
College <strong>of</strong> Pharmacy, Dalhousie University, Halifax, NS<br />
2<br />
<strong>Canadian</strong> <strong>Pharmacists</strong> Association, Ottawa, ON<br />
3<br />
University <strong>of</strong> Saskatchewan College <strong>of</strong> Pharmacy and Nutrition,<br />
Saskatoon, SK<br />
Rationale: Canada’s pharmacy students are key stakeholders in the future<br />
<strong>of</strong> the pr<strong>of</strong>ession. Students have critical insights about the future <strong>of</strong><br />
pharmacy and important perspectives on pharmacy education, the labour<br />
market, and the skills and competencies required for practice.<br />
Objectives: A survey was developed for Canada’s pharmacy students to: 1.<br />
gain insight into the understanding and support for the future vision for the<br />
pr<strong>of</strong>ession as outlined by the Blueprint for Pharmacy, and, 2. assess<br />
pharmacy students’ future expectations as a pharmacy pr<strong>of</strong>essional in<br />
relation to the vision.<br />
Study Design and Methods: A web-based survey was developed as part<br />
<strong>of</strong> the <strong>Canadian</strong> <strong>Pharmacists</strong> Association’s Moving Forward initiative, and<br />
was made available for all <strong>of</strong> Canada’s undergraduate pharmacy students<br />
for approximately one month during October 2007. The survey contained<br />
seven questions addressing demographics, and 22 questions addressing<br />
the future plans and expectations and exposure to the job market.<br />
Results: Based on the responses <strong>of</strong> the 1250 respondents, the amount <strong>of</strong><br />
time students would ideally spend in direct patient care during their career<br />
is much greater than the amount <strong>of</strong> time they actually expect to spend<br />
doing so, while the opposite is true for amount <strong>of</strong> time spent in<br />
dispensing/distribution. While pharmacy students feel quite positive about<br />
both the quantity and quality <strong>of</strong> career opportunities, they <strong>of</strong>ten find it<br />
difficult to reconcile the realities <strong>of</strong> distribution-based pharmacy with the<br />
hope to practice pharmaceutical care.<br />
Conclusion: Based on the insights into the future plans and career<br />
expectations <strong>of</strong> Canada’s pharmacy students, it is clear that Canada’s<br />
future pharmacists desire a practice model that closely emulates that<br />
outlined in the Blueprint for Pharmacy. Employers, educators and practicing<br />
pharmacists could use these results to gain a better understanding <strong>of</strong> the<br />
perspective <strong>of</strong> pharmacy students.<br />
Perceived Demands for Practice Experiential Education:<br />
Results from a National Survey <strong>of</strong> <strong>Hospital</strong> Pharmacy<br />
Directors<br />
Jason Howorko 1 , Sean D Higgins 2 , Neil J MacKinnon 2 , and Myrella Roy 3 , for<br />
the <strong>Canadian</strong> <strong>Society</strong> <strong>of</strong> <strong>Hospital</strong> <strong>Pharmacists</strong><br />
1<br />
Pharmacy Manager, Alberta Health Services, Red Deer, AB<br />
2<br />
College <strong>of</strong> Pharmacy, Dalhousie University, Halifax, NS<br />
3<br />
<strong>Canadian</strong> <strong>Society</strong> <strong>of</strong> <strong>Hospital</strong> <strong>Pharmacists</strong>, Ottawa, ON<br />
Rationale: <strong>Hospital</strong>-based practice experience is a key part <strong>of</strong> the<br />
education <strong>of</strong> pharmacy students in Canada. At same time, demands placed<br />
upon Canada’s hospital pharmacy departments for experiential placements<br />
are growing due to the transition to entry-level PharmD (ELPD) programs<br />
and larger class sizes in many pharmacy programs.<br />
Objectives: A survey was developed by the <strong>Canadian</strong> <strong>Society</strong> <strong>of</strong> <strong>Hospital</strong><br />
<strong>Pharmacists</strong> (CSHP) to: 1. gain insight into the concerns <strong>of</strong> hospital<br />
pharmacy directors related to pharmacy experiential education, and 2.<br />
assess the capacity to increase the number and length <strong>of</strong> student<br />
placements.<br />
Study Design and Methods: A web-based survey was developed by CSHP<br />
and made available to <strong>Canadian</strong> hospital pharmacy directors in May 2009.<br />
The survey contained questions addressing demographics, issues related<br />
to the capacity for student training to experiential training demands. Both<br />
quantitative and qualitative analyses were completed.<br />
Results: Seventy-four hospital pharmacy directors completed the survey<br />
for a response rate <strong>of</strong> 35.9%, representing approximately 50,000 hospital<br />
beds. Only 14% <strong>of</strong> respondents indicated that their institution would be<br />
able to provide longer or greater numbers <strong>of</strong> clinical practice rotations for<br />
pharmacy students. The qualitative analysis revealed several concerns<br />
related to the lack <strong>of</strong> capacity to expand experiential training, as<br />
exemplified by the following quotes: “Lack <strong>of</strong> physical space and resources<br />
is a huge constraint” and “we already stretch our limited resources to take<br />
on as many students as possible, but if timing <strong>of</strong> rotations/season for<br />
rotations were more flexible we might be able to provide more training.”<br />
The respondents are open to new innovative models <strong>of</strong> providing practical<br />
experiential training.<br />
Conclusion: <strong>Hospital</strong> pharmacy leaders are committed to providing<br />
experiential education, but are concerned that they cannot meet future<br />
demands. These concerns result from lack <strong>of</strong> preceptors, financial<br />
constraints and other operational factors. It cannot be assumed that<br />
hospitals can take on more experiential education without significant<br />
changes to the system.<br />
Comparison <strong>of</strong> Two Approaches to Antibiotic Stewardship<br />
Karen Riley 1,2 , Lynn Nadeau 1<br />
Department <strong>of</strong> Pharmacy, Hotel Dieu Grace <strong>Hospital</strong> and Windsor Regional<br />
<strong>Hospital</strong>, Windsor Ontario<br />
Rationale: The benefits <strong>of</strong> antibiotic stewardship programs include<br />
improvement to patient care and financial gains for the hospital. Several<br />
possible interventions have been proposed by the ISMP Ontario<br />
Antimicrobial Stewardship Project.<br />
Description: We describe the processes used by 2 distinct hospitals within<br />
the same city to decrease antibiotic use.<br />
Steps Taken: At site 1, an antibiotic review committee exists and an<br />
Infectious Diseases pharmacy specialist prospectively audits antibiotic use<br />
and provides feedback, and utilizes intravenous to oral stepdown and renal<br />
dosing medical directives. Defined Daily Dose (DDD) data is based on<br />
purchase data since individual patient data is not available.<br />
Table 1: Stewardship Item Site 1 Site 2<br />
Implementation <strong>of</strong> antibiotic stewardship (AS)<br />
team<br />
joint<br />
Prospective audit with intervention and feedback yes-ID RPh no<br />
Retrospective audit and feedback yes yes<br />
Drug use evaluations/reviews no yes<br />
Formulary restrictions and preauthorization yes yes<br />
Automatic stop orders yes yes<br />
Education yes yes<br />
joint<br />
Antimicrobial handbook joint joint<br />
Academic detailing no no<br />
Policies restricting non-academic detailing no no<br />
Guidelines and clinical pathways yes yes<br />
Antimicrobial order forms yes yes<br />
Computerized order sets no no<br />
Specific criteria for use <strong>of</strong> combination therapy no no<br />
Streamlining or de-escalating yes no<br />
Dose optimization yes yes<br />
Parenteral to oral conversion yes yes<br />
Automatic drug substitution polices yes yes<br />
Guided therapy in CPOE no no<br />
Implementation <strong>of</strong> antibiograms joint joint<br />
Restricted microbiology susceptibility reporting joint joint<br />
Computer-aided screening <strong>of</strong> microbiology data no no<br />
Implementation <strong>of</strong> short course antimicrobial<br />
therapy<br />
Implementation <strong>of</strong> hospital scorecard on AS no no<br />
no<br />
no<br />
57
58<br />
Site 2 aligned and reactivated its Infection Control Committee. <strong>Pharmacists</strong><br />
follow similar medical directives to site 1. DDD is based on patient data.<br />
Stewardship items implemented at the 2 sites are listed in Table 1.<br />
Evaluation: Despite having similar programs in place for antibiotic<br />
stewardship, evaluation <strong>of</strong> the DDD data indicates that prospective audit<br />
and feedback performed by an Infectious Diseases trained pharmacist<br />
results in an overall reduction <strong>of</strong> antibiotic consumption by 27% at site 1<br />
and an overall increase in antibiotic consumption by 16% at site 2.<br />
Usefulness to Practice: Of the initiatives employed to provide antibiotic<br />
stewardship, results from these 2 institutions demonstrate that prospective<br />
audit and feedback appears to provide the greatest benefit in reducing<br />
antibiotic use.<br />
2 CSHP<br />
Targeting Excellence<br />
Clinical Pharmacy Services Survey for <strong>Canadian</strong><br />
<strong>Hospital</strong>s<br />
in Pharmacy Practice<br />
Karen Riley, Antoinette Duronio, Department <strong>of</strong> Pharmacy,<br />
Hotel Dieu Grace <strong>Hospital</strong>, Windsor, ON<br />
Rationale: A survey was developed to examine pharmacy services in<br />
<strong>Canadian</strong> hospitals and to create a benchmark for comparison to other<br />
institutions if developing a residency program.<br />
Description: Directors <strong>of</strong> Pharmacy from across Canada were asked to<br />
complete a survey which examined specific questions about clinical<br />
pharmacy services, antimicrobial stewardship programs, and the uptake <strong>of</strong><br />
technologies to improve medication safety. In contrast to the Lilly survey,<br />
our survey focused on clinical pharmacy aspects and programs within<br />
institutions.<br />
Steps Taken: The survey was developed using criteria from previous<br />
studies examining clinical pharmacy services in the United States,<br />
antimicrobial stewardship programs, and uptake <strong>of</strong> technologies in<br />
Canada.<br />
Surveys were distributed to the directors <strong>of</strong> pharmacy <strong>of</strong> hospitals within<br />
Canada. Respondents will receive a blinded copy <strong>of</strong> all surveys completed.<br />
Evaluation: Approximately 24% <strong>of</strong> institutions surveyed responded<br />
(n=34). Roughly 40% <strong>of</strong> respondents were from hospitals with greater than<br />
400 beds compared to 60% <strong>of</strong> hospitals with less than 400 beds.<br />
Respondents were from all provinces except Saskatchewan.<br />
Small differences in numbers <strong>of</strong> pharmacotherapy specialists and drug<br />
protocols were observed between larger community and teaching<br />
hospitals. Little difference between community hospitals over 300 beds<br />
compared to teaching hospitals exceeding 400 beds was detected with<br />
respect to the number <strong>of</strong> Pharm Ds, pharmacotherapy specialists, director<br />
credentials or the number <strong>of</strong> pharmacist-managed drug protocols. (see<br />
Table 1 below)<br />
Usefulness to Practice: With the thrust to develop more residency<br />
programs in order to increase residency-trained hospital pharmacists, as<br />
encouraged in the 2015 CHSP goals, hospital pharmacies can benchmark<br />
their own activities against teaching hospitals or hospitals with similar<br />
demographics that already have residency programs in place.<br />
2 CSHP<br />
Targeting Excellence<br />
in Pharmacy Practice<br />
Outcomes<br />
Implementation <strong>of</strong> a Preoperative Atrial<br />
Fibrillation Prophylaxis Protocol by a Pharmacist<br />
with Medical Directives Improves Clinical<br />
AU: Y. Shamiss, Y. Khaykin, T. Elmowafy, R. Khaykin, M. Beardsall, S. Martin,<br />
S. Skerratt, B. Pick, L. Hutchinson, L. Heinrich, A. Verma, Z. Wulffhart, C.<br />
Peniston, Southlake Regional Health Center, Newmarket, ON<br />
Objective & Rationale: Atrial fibrillation (AF) is a complication <strong>of</strong><br />
cardiovascular surgery (CVS) can be associated with increased length <strong>of</strong><br />
stay (LOS) and higher mortality. Prophylactic administration <strong>of</strong> Amiodarone<br />
and beta blockers (BB) has been shown to reduce the incidence <strong>of</strong><br />
postoperative AF. Translation <strong>of</strong> this evidence into clinical practice has not<br />
been assessed.<br />
Methods: To evaluate the utility <strong>of</strong> a preoperative AF prophylaxis algorithm<br />
routinely applied by a Pharmacist supported by medical directives vs<br />
standard care, baseline, procedural and outcomes data were prospectively<br />
collected on 59 consecutive patients scheduled for CVS 05/2008-07/2008<br />
who were assessed and treated by a pharmacist at the preoperative clinic<br />
and a historic cohort 249 consecutive patients undergoing CVS<br />
01/2006-08/2006 without a pharmacist intervention.<br />
Results: 5 <strong>of</strong> the pharmacist’s patients and 12 <strong>of</strong> the historical patients<br />
were in permanent AF and were excluded. Baseline characteristics did not<br />
differ (76%male, average age66 +/-11yrs, LAD42+/-6mm, EF 1.5/4, NYHA 1,<br />
diabetes 30%, AF history13%, hypertension 60%). Pharmacist’s patients<br />
were more likely to have valve surgery alone (17% vs 5%, p=0.01) and less<br />
likely CABG alone (50vs.81%, p
Wednesday, February 3 • Mercredi 3 février<br />
Projet pilote d’implantation d’un suivi systématique de la<br />
clientèle asthmatique et Maladie pulmonaire obstructive<br />
chronique en pharmacie communautaire<br />
Delphine Bercier 1 , Frédéric Julien-Baker 2 , Lucie Blais 3 , Lyne Lalonde 3 ,<br />
Marie-France Beauchesne 3<br />
1<br />
Pharmacie Jean-François Guévin, Montréal, QC<br />
2<br />
Pharmacie Marc Champagne, Montréal, QC,<br />
3<br />
Faculté de pharmacie, Université de Montréal, Montréal, QC<br />
Titre : Projet pilote d’implantation d’un suivi systématique de la clientèle<br />
asthmatique et ayant une maladie pulmonaire obstructive chronique en<br />
pharmacie communautaire.<br />
Introduction : L’implantation d’un programme de suivi de la<br />
pharmacothérapie par le pharmacien communautaire pourrait améliorer la<br />
maîtrise de l’asthme et de la maladie pulmonaire obstructive chronique<br />
(MPOC), mais ceci ne semble pas avoir été évalué au Québec.<br />
Objectifs : Évaluer la faisabilité d’implanter un suivi systématique (SS) de<br />
la clientèle asthmatique et MPOC en pharmacie communautaire et<br />
secondairement évaluer l’impact préliminaire de ce programme sur la<br />
maîtrise de ces maladies.<br />
Méthodes : Après avoir reçu une formation, les pharmaciens participants<br />
ont recruté des patients asthmatiques et MPOC adultes admissibles au<br />
projet (qui prennent de façon régulière des médicaments pour le traitement<br />
de l’asthme ou de la MPOC) à leur pharmacie communautaire. Les étapes<br />
du SS étaient planifiées sur 3 rencontres (à 0, 3 et 6 mois) et comprenaient<br />
l’évaluation de la maîtrise de la maladie, de la technique d’inhalation ainsi<br />
que l’enseignement au patient.<br />
Résultats : Au total, 19 pharmaciens ont participé au projet, et 13 de<br />
ceux-ci ont recruté 35 sujets. Plus de 75% des étapes prévues dans le SS<br />
ont été appliquées, et les pharmaciens ont rédigés un total de 19 opinions<br />
pharmaceutiques pour lesquelles 31 suggestions ont été émises au<br />
médecin traitant. Une diminution statistiquement significative de 0,058<br />
exacerbations par patient-mois de MPOC et une amélioration de 13,72%<br />
statistiquement significative de la technique d’inhalation pour l’ensemble<br />
des sujets ont été observées. De plus, les résultats indiquent une<br />
amélioration (différence numérique) de la maîtrise de la maladie (asthme et<br />
MPOC), du nombre de patients ayant visité un centre d’enseignement, et<br />
de la possession d’un plan d’action. Il n’y avait pas de différence<br />
statistiquement significative pour l’adhésion au traitement.<br />
Conclusion : Ces résultats préliminaires sont favorables à l’implantation<br />
du SS en pharmacie communautaire et l’impact semble prometteur sur la<br />
maîtrise de l’asthme et de la MPOC.<br />
Stability <strong>of</strong> Piperacillin/Tazobactam (Apotex) in<br />
Polyvinylchloride Bags and Polypropylene Syringes<br />
Ronald F. Donnelly, The Ottawa <strong>Hospital</strong>, Ottawa ON<br />
Rationale: The product monograph for buffer-free, EDTA free<br />
piperacillin/tazobactam (Apotex) states that small volume infusions should<br />
be used immediately after preparation. These recommendations do not<br />
allow for batch production <strong>of</strong> minibags or syringes in a CIVA setting.<br />
Objectives: To determine the physical compatibility and chemical stability<br />
<strong>of</strong> solutions containing buffer-free, EDTA free piperacillin/tazobactam<br />
(Apotex) packaged in PVC bags and stored at 5°C and PFL over a 28 day<br />
period or polypropylene syringes store at 5°C or -10°C (7 days).<br />
Methods: On day 0 vials <strong>of</strong> piperacillin/tazobactam were reconstituted<br />
with SWI and then further diluted, in triplicate, to either 22.5 or 90 mg/mL<br />
with either D5W or NS and stored in PVC minibags. Separate vials were<br />
diluted with SWI to 150 mg/mL and packaged in polypropylene syringes.<br />
After sample collection on day 0, containers were stored at either 5°C or<br />
-10°C and protected from light. Subsequently on days 7, 14, 21 and 28,<br />
samples were collected and analyzed in duplicate. Analysis was conducted<br />
using a validated stability-indicating HPLC method. Physical compatibility<br />
was accessed by monitoring color, clarity and pH.<br />
Results: All samples remained clear and colorless through day 28 <strong>of</strong> the<br />
study. There was only a slight change in pH (≈0.6 pH units) over the course<br />
<strong>of</strong> the study with a trend towards becoming more acidic. There was a slight<br />
difference in stability based on concentration <strong>of</strong> piperacillin with the more<br />
dilute solutions being the most stable.<br />
Conclusions: Both concentrations <strong>of</strong> piperacillin/tazobactam solution<br />
were found to be physically compatible and chemically stable in either D5W<br />
or NS in PVC bags for 28 days when stored at 5°C and PFL. Solutions<br />
diluted with sterile water for injection and packed in polypropylene<br />
syringes were stable for 7 days when frozen at -10ºC and 21 days when<br />
stored at 5ºC and PFL.<br />
Review <strong>of</strong> the Critical Care Insulin Nomogram used at<br />
Lakeridge Health Oshawa (LHO)<br />
Dr. L. Huzel, RCPSC Internal Medicine & Respirology, Critical Care Physician<br />
Leader, Paddy Grayhurst RPh, Pr<strong>of</strong>essional Practice Leader, Pharmacy<br />
Services, Michelle Hung, Pharmacy Student, Lakeridge Health Corp,<br />
Oshawa ON<br />
Background: Interest in intensive insulin therapy (IIT) was created by the<br />
results <strong>of</strong> vanden Berghe’s 2001 study “Intensive Insulin Therapy in the<br />
intensive care unit” in ventilated surgical ICU patients. In 2006 LHO<br />
approved the use <strong>of</strong> an Insulin Nomogram based on literature and the<br />
experience <strong>of</strong> critical care units in our geographical area. Despite the<br />
frequency <strong>of</strong> its use, the Insulin Nomogram was not readily accepted by<br />
nursing and physician staff. The publication <strong>of</strong> the NICE-SUGAR trial in<br />
March 2009 prompted a review <strong>of</strong> our nomogram results.<br />
Methods: A review <strong>of</strong> 21 charts was completed. Data collection included<br />
blood sugar results, insulin rate and adherence to the nomogram, factors<br />
that may have influenced pronounced blood sugar changes such as drug or<br />
IV changes. Critical care nurses were surveyed for their impressions <strong>of</strong> the<br />
effectiveness, safety and ease <strong>of</strong> use <strong>of</strong> the nomogram.<br />
Results: The definition <strong>of</strong> euglycemia at LHO differs from van den Berghe’s.<br />
Target blood sugar is 5.1-8 mmol/L. Euglycemic results were documented<br />
40.2% <strong>of</strong> the time, hyperglycemia 46.2% including the reading prior to<br />
initiating the nomogram. Hypoglycemia as documented in 13.6% <strong>of</strong><br />
readings with all defined as mild or borderline. No blood sugars 2.2 mmol/L<br />
or lower were recorded.<br />
Re-examining the data using an adjusted target blood sugar <strong>of</strong> 5.1-10<br />
mmol/L, incorporating a recommendation <strong>of</strong> the NICE-SUGAR trial,<br />
euglycemia increased to 58.3%, hyperglycemia falls to 28.1% with<br />
hypoglycemic results unchanged.<br />
Nursing indicated the nomogram is complex, requiring careful review even<br />
by experienced RNs prior to each intervention. Nursing requested that their<br />
pr<strong>of</strong>essional judgement be built into the nomogram.<br />
Conclusions: The insulin nomogram in use at LHO appears to be effective<br />
in lowering elevated blood sugars without inducing hypoglycemia. Efforts<br />
to simplify the document and incorporate NICE-SUGAR and nursing<br />
recommendations are underway.<br />
2 CSHP<br />
Targeting Excellence<br />
How Long Does Medication Reconciliation Take?<br />
Sara Ingram, Sassha Orser, Rajini Retnasothie, Olavo<br />
in Pharmacy Practice<br />
Fernandes (1) University Health Network, Toronto, ON (2) Leslie<br />
Dan Faculty <strong>of</strong> Pharmacy, University <strong>of</strong> Toronto, Toronto, ON<br />
Rationale: A common and practical inter-pr<strong>of</strong>essional question in planning<br />
to implement admission medication reconciliation is: how much health care<br />
pr<strong>of</strong>essional time is required to sustain this patient safety activity<br />
successfully? The purpose <strong>of</strong> this investigation was to determine the time<br />
required for various stages <strong>of</strong> the medication reconciliation (MedRec)<br />
process for admitted patients to 2 tertiary care teaching hospitals.<br />
Description: Primary objectives were to define and quantify the time<br />
required for a pharmacist or a trained pharmacy student to complete<br />
admission MedRec for Emergency/General Medicine patients. Data was<br />
collected over a 4 week time period per pharmacist/student. Patients on<br />
whom MedRec had been completed during that time were included.<br />
Measurements included total time, as well as amount <strong>of</strong> time required for<br />
each step in the process, including: 1) information gathering 2) patient<br />
interview 3) documentation, and 4) discrepancy resolution. Timing<br />
differences related to level <strong>of</strong> training, or hospital site were also evaluated.<br />
Timing information was collected by the individual performing MedRec by<br />
estimating the number <strong>of</strong> 5 minute time intervals required to perform each<br />
<strong>of</strong> the tasks in the process.<br />
59
60<br />
Evaluation: Data was collected on 387 patients by 8 pharmacists and 2<br />
pharmacy students from March-September 2009. The mean total time<br />
required for MedRec was 25.63 +/-9.01 minutes. The mean times for each<br />
stage were: information gathering (7.77+/-3.60), patient interview<br />
(6.61+/-4.76), documentation (6.60+/-3.11), and discrepancy resolution<br />
(4.65+/-3.00). No significant time differences were detected for type <strong>of</strong><br />
clinician (pharmacist or student) or hospital site.<br />
Importance: This study helped quantify time required to complete the<br />
MedRec process with trained pharmacy clinicians. Findings from this study<br />
can support effective hospital planning for clinician resources to implement<br />
MedRec as well as strategies to improve efficiency. A similar evaluation can<br />
be completed with other disciplines, including nursing.<br />
Pharmacological Management <strong>of</strong> Amiodarone-Induced<br />
Thyrotoxicosis Type I in Mitral Valve Replacement<br />
Joanne Lau, London Health Sciences Centre, London, ON, Rita Dhami,<br />
London Health Sciences Centre, London, ON<br />
Rationale: Amiodarone-induced thyrotoxicosis (AIT) delays urgent cardiac<br />
surgeries as achieving euthyroidism may require months despite<br />
pharmacotherapy. Patients are at risk <strong>of</strong> thyroid storm if exposed to<br />
anesthesia and surgery while hyperthyroid. Multiple case reports<br />
demonstrate successful conversion to euthyroidism by thyroidectomy,<br />
however only one case report describes an AIT Type II patient undergoing<br />
urgent surgery without conversion to euthyroidism.<br />
Description: A 53-year old female with atrial fibrillation, requiring urgent<br />
mitral valve replacement (MVR) for mitral valve stenosis and regurgitation<br />
had signs and symptoms <strong>of</strong> hyperthyroidism subsequently diagnosed as<br />
AIT Type I. Amiodarone was discontinued and methimazole was started, to<br />
no effect. The patient was then symptomatically controlled with<br />
propylthiouracil 200 mg TID, dexamethasone 2 mg BID, propranolol 80 mg<br />
BID, and pacemaker rate controlled. Thyroid levels improved modestly but<br />
remained elevated. Thyroidectomy could not be performed because MVR<br />
requiring anticoagulation was urgently needed. Post-MVR, signs and<br />
symptoms <strong>of</strong> thyroid storm were absent and the patient was successfully<br />
discharged.<br />
Assessment <strong>of</strong> Causality: Resolution <strong>of</strong> hyperthyroid symptoms occurred<br />
with initiation <strong>of</strong> propylthiouracil, dexamethasone, and propranolol<br />
therapy. Treatment success <strong>of</strong> propylthiouracil over methimazole may be<br />
due to its mechanism <strong>of</strong> inhibiting T4 conversion to active T3.<br />
Evaluation <strong>of</strong> the Literature: There is one case report <strong>of</strong> necessary<br />
surgery (excluding thyroidectomies to treat AIT) in unresolved AIT Type II.<br />
Propylthiouracil, prednisone, and propranolol achieved symptom control,<br />
but the patient remained hyperthyroid. Despite this, percutaneous<br />
tracheotomy was performed and the patient experienced recurrent<br />
thyrotoxicosis unresponsive to treatment and died 7 days later. The authors<br />
recommend thyroidectomy be performed with percutaenous tracheotomy<br />
in this setting.<br />
Importance to Pharmacy Practitioners: Urgency <strong>of</strong> surgery may preclude<br />
rapid resolution <strong>of</strong> AIT by thyroidectomy. This case demonstrates the<br />
plausibility <strong>of</strong> pharmacologic resolution <strong>of</strong> hyperthyroid symptoms and<br />
suppression <strong>of</strong> thyroid storm peri- and post-surgery where thyroidectomy is<br />
not possible.<br />
Venous Thromboembolism (VTE) Prophylaxis in <strong>Hospital</strong><br />
Patients<br />
Shelley McKinney, Lakeridge Health Corp, Oshawa ON<br />
In December 2008, Lakeridge Health, a 538 bed community general<br />
hospital system with 3 acute care sites in Durham Region, Ontario, began<br />
the Venous Thromboembolism (VTE) Prophylaxis patient safety project for<br />
Medicine, General and Orthopaedic surgery inpatient services. The project<br />
was sponsored by the Medical Advisory Committee under the direction <strong>of</strong><br />
an Inter-pr<strong>of</strong>essional Taskforce including Director <strong>of</strong> Pharmacy, Chair <strong>of</strong><br />
Pharmacy & Therapeutics Committee and Drug Utilization Pharmacist.<br />
VTE is the number one preventable cause <strong>of</strong> mortality and morbidity in<br />
hospitals. Previously, LH participated in a research study which identified<br />
low rates <strong>of</strong> patients receiving appropriate pharmacological and<br />
mechanical VTE prophylaxis compared to clinical guidelines. Our low VTE<br />
rates created momentum to improve clinical performance and a<br />
comprehensive strategy was created. Pharmacy staff worked with clinicians<br />
to design interventions that would improve our VTE prophylaxis rates.<br />
Interventions included pre-printed admission orders with VTE prophylaxis<br />
options and a trigger tool report for daily VTE prophylaxis assessment to all<br />
hospital physicians. This report listed all patients on a specific floor with<br />
their VTE pharmacological prophylaxis. The project team initiated VTE<br />
awareness in the hospital through communiqués and educational sessions.<br />
Continuous audits for medical, surgical and orthopaedic patients were also<br />
conducted to measure performance and compared to the baseline audits.<br />
These audits measured whether or not eligible patients were receiving<br />
appropriate VTE prophylaxis. At baseline, appropriate prophylaxis in<br />
medicine, surgery and orthopaedic groups was observed in 59/102 (58%),<br />
34/72 (47%) and 19/22 (86%) <strong>of</strong> patients. After interventions, appropriate<br />
prophylaxis increased to 117/152 (77%), 36/43 (83%) and 30/33 (90%) <strong>of</strong><br />
patients in the respective groups. The improvement between baseline and<br />
post-intervention rates was 19% (p = 0.0012), 36% (p= 0.0001) and 4%<br />
(p=0.5960). Annual audits on VTE prophylaxis are planned to monitor and<br />
sustain the success achieved in the project.<br />
2 CSHP<br />
Targeting Excellence<br />
in Pharmacy Practice<br />
A Systematic Review <strong>of</strong> the Effect <strong>of</strong> Medication<br />
Reconciliation on Medication Discrepancies and<br />
Adverse Drug Events<br />
Emily Muir, St. Joseph’s Healthcare, Hamilton ON, Christine Wallace, St.<br />
Joseph’s Healthcare, Hamilton ON<br />
Rationale: Medication Reconciliation (MedRec) is a process that seeks to<br />
prevent adverse drug events by reconciling medications at all transition<br />
points <strong>of</strong> care. Accreditation Canada assesses admission medication<br />
reconciliation as a performance measure indicator for patient safety.<br />
Despite the implementation <strong>of</strong> MedRec programs in hospitals, little is<br />
known about their outcomes.<br />
Objectives: The objective <strong>of</strong> this systematic review was to determine if the<br />
introduction <strong>of</strong> a formalized medication reconciliation program decreases<br />
the number <strong>of</strong> patients with a medication discrepancy as well as actual or<br />
potential discrepancy-related adverse drug events (ADEs)<br />
Study Design and Methods: A search <strong>of</strong> PubMed (MEDLINE), Embase,<br />
IPA, CINAHL, Cochrane, and references <strong>of</strong> selected articles yielded 241<br />
articles. Five studies which evaluated formalized MedRec programs were<br />
found to be suitable for inclusion. Data pertaining to medication<br />
discrepancies and the incidence <strong>of</strong> adverse drug events or potential<br />
adverse drug events was extracted.<br />
Results: In the included studies, the percentage <strong>of</strong> patients with one or<br />
more medication discrepancies without a formalized MedRec process<br />
ranged from 36.5 to 53 %. With a formalized MedRec program, the<br />
percentage <strong>of</strong> patients with one <strong>of</strong> more unresolved medication<br />
discrepancies was decreased (2.8 to 26.9%). Two studies measured<br />
adverse drug events or potential adverse drug events. One study found the<br />
incidence <strong>of</strong> discrepancy- related ADEs to be 14.5%, which decreased to<br />
2.3% once the MedRec program was implemented. A second study rated<br />
potential ADEs and found that with the introduction <strong>of</strong> a MedRec program,<br />
only 12.9% <strong>of</strong> patients (as compared to 29.9% <strong>of</strong> control patients) had one<br />
or more potential ADEs that were likely to cause possible or probable<br />
patient discomfort and/or clinical deterioration.<br />
Conclusions: Medication reconciliation decreases the percentage <strong>of</strong><br />
patients with medication discrepancies and likely decreases the incidence<br />
<strong>of</strong> adverse drug events. More research is needed to assess the clinical<br />
outcomes <strong>of</strong> medication reconciliation programs.<br />
2 CSHP<br />
Targeting Excellence<br />
in Pharmacy Practice<br />
Obtaining the Best Possible Medication History:<br />
Comparison <strong>of</strong> Pharmacy Technician versus<br />
Pharmacist Obtained Medication Histories in the<br />
Emergency Department<br />
Rochelle Myers, The Moncton <strong>Hospital</strong>; Lauza Saulnier, Moncton Health<br />
Authority; Odette Gould, Mount Allison University, Moncton, NB<br />
Rationale: Obtaining an accurate and complete medication list (e.g. best<br />
possible medication history (BPMH)) is the first step in completing<br />
medication reconciliation. The ability <strong>of</strong> pharmacy technicians to obtain<br />
medication histories compared to pharmacists has not been formally<br />
assessed.
Objectives: Study objectives were to assess whether pharmacy<br />
technicians can perform a BPMH as accurately and completely as<br />
pharmacists, and determine if both groups met national norms for<br />
unintentional discrepancies and success index for medication<br />
reconciliation.<br />
Design and Methods: Patients presenting to the emergency department<br />
were prospectively enrolled to be interviewed separately by a pharmacist<br />
and a technician, with information recorded on a standard medication<br />
reconciliation form. Forms were compared following each set <strong>of</strong> interviews,<br />
and discrepancies were clarified with the patient. Pharmacy technicians<br />
were trained in taking BPMH prior to patient enrolment.<br />
Results: Fifty-nine patients were included. <strong>Pharmacists</strong> and technicians did<br />
not differ significantly in whether their patients had prescription (X2 (1,<br />
N=59) = 1.11, p = .29) or OTC (X2 (1, N = 59) = .15, p = .70) discrepancies.<br />
Mean prescription and OTC discrepancies per patient were not significantly<br />
different between the two groups (t(58)=.15, p = .88; t(58) = -.22, p = .83).<br />
Both groups were significantly lower than the national average for<br />
unintentional discrepancies per patient and significantly higher than the<br />
national average for success index.<br />
Conclusions: Trained pharmacy technicians can obtain a BPMH with as<br />
much accuracy and completeness as pharmacists. Both groups were<br />
significantly superior to the national average for unintentional<br />
discrepancies and success index for medication reconciliation.<br />
Prevalence <strong>of</strong> Vitamin D Deficiency and the Effects <strong>of</strong><br />
Replacement with Ergocalciferol in Chronic Hemodialysis<br />
Patients<br />
Quinton S., Chong D., Donnelly S., St. Michael’s <strong>Hospital</strong>, Toronto, ON<br />
Rationale: Vitamin D deficiency is common in patients on hemodialysis.<br />
Supplementing with ergocalciferol in this population may improve<br />
parameters related to anemia, bone mineral metabolism and glucose<br />
control.<br />
Objectives: To determine the prevalence <strong>of</strong> vitamin D deficiency in<br />
outpatients on hemodialysis. To assess the effect <strong>of</strong> ergocalciferol on<br />
25(OH) vitamin D (vitamin D) concentrations and its effect on anemia, bone<br />
and glucose related laboratory parameters.<br />
Study Design and Methods: This was a retrospective cohort study in a<br />
tertiary university hospital. All patients attending the hemodialysis clinic<br />
had vitamin D concentrations obtained and those who were deficient (
62<br />
Evaluation and Results: Key elements identified and incorporated into our<br />
strategy include integration <strong>of</strong> and accounting for the Best Possible<br />
Medication History (BPMH) and pre-transfer medications, sign-<strong>of</strong>f capacity,<br />
prescriber intention for all medications readily accessible, clear delineation<br />
<strong>of</strong> ownership while maintaining shared responsibilities among clinicians, a<br />
plan for comprehensive sign-over <strong>of</strong> care <strong>of</strong> the patient, and standardized<br />
training for all disciplines. A key element that could not be incorporated<br />
into our model due to technical limitations is the ability to directly link the<br />
reconciliation process to the generation <strong>of</strong> medication orders.<br />
Of the <strong>Canadian</strong> hospitals interviewed (n=16), 69% use a specific tool, 56%<br />
incorporate the BPMH, 75% link the process with the ordering <strong>of</strong><br />
medications and 81% make the prescriber intention available to all<br />
clinicians. The top 3 challenges are unclear ownership <strong>of</strong> tasks, limited<br />
resources for collection <strong>of</strong> the BPMH and clinician education.<br />
Importance: The optimal strategy includes integration <strong>of</strong> BPMH and<br />
pre-transfer medications, delineation <strong>of</strong> ownership, and use <strong>of</strong> a tool that<br />
incorporates intention for medications and a sign<strong>of</strong>f process. These key<br />
elements can be utilized in designing a tool and practice model to facilitate<br />
communication with the goal <strong>of</strong> minimizing medication discrepancies and<br />
preventing patient harm at internal transfer.<br />
The “Shock Box” Expediting Delivery <strong>of</strong> Antibiotics for<br />
Septic Shock<br />
Rosemary Zvonar, The Ottawa <strong>Hospital</strong>, Ottawa ON<br />
Rationale: Multiple studies have demonstrated that timely and<br />
appropriate antibiotic administration in patients with severe infection<br />
decreases patient mortality. A 7.6% decrease in survival was observed in<br />
patients with septic shock with each hour delay in appropriate<br />
antimicrobial administration in one landmark study. The time to initial<br />
antibiotic dose was the greatest predictor <strong>of</strong> survival in the multivariate<br />
analysis. The “Shock Box” was therefore developed at The Ottawa <strong>Hospital</strong><br />
in order to expedite delivery <strong>of</strong> the first antibiotic dose(s) in patients with<br />
severe sepsis/septic shock.<br />
Description: The “Shock Box” is an easy to grab box containing the most<br />
common antibiotics used in the management <strong>of</strong> severe infection. It<br />
provides ready access to antibiotics for treatment <strong>of</strong> patients with septic<br />
shock 24 hours a day, thus avoiding delays associated with order<br />
processing and delivery. The boxes were placed on the Medicine,<br />
Hematology-Oncology and Intensive Care (ICU) units and on the RACE<br />
(Rapid Assessment <strong>of</strong> Critical Events) carts. All antibiotics in the box were<br />
made available in the Emergency Department (ED).<br />
Evaluation: Between November 1, 2008 and August 15, 2009 the shock<br />
boxes were used 122 times, by the following services:<br />
Hematology/Oncology (77%), General Medicine (18%), ICU (3%) and other<br />
(2%). (Data from the ED was not available.) Fifty-one charts were reviewed<br />
in detail. The Shock Box was used appropriately (i.e., for severe sepsis,<br />
septic shock, meningitis) in 22/51 (43%) cases. For instances where both<br />
the time the antibiotic was ordered and time administered were available,<br />
the average time to first dose administration was 0.68 hours (compared to<br />
a historic average <strong>of</strong> 2.72 hours).<br />
Summary: The availability <strong>of</strong> a “Shock Box” expedites delivery <strong>of</strong> the initial<br />
antibiotic dose for patients with severe sepsis. Ongoing education is<br />
required so that use <strong>of</strong> the box is reserved for its original intention.<br />
Poster Abstract Reviewers<br />
Réviseurs des présentations par affiches<br />
Sincere appreciation is extended to the abstract reviewers for<br />
PPC 2010.<br />
Educational Services Committee<br />
Carolyn Bubbar<br />
Elaine Chong<br />
Judy Chong<br />
Rochelle Gellatly<br />
Jeff Nagge<br />
Payal Patel<br />
Kat Timberlake<br />
Research Committee<br />
Mary H.H. Ensom<br />
Salmaan Kanji<br />
Sheri Koshman<br />
Glen Pearson<br />
Kerry Wilbur<br />
Peter Zed<br />
Adjudicators<br />
Margaret Ackman<br />
Trudy Arbo<br />
Clarence Chant<br />
Olavo Fernandes
CSHP New Fellows<br />
Nouveaux associés de la SCPH<br />
CSHP Fellow status is conferred by the Board <strong>of</strong> Fellows upon<br />
CSHP members who have demonstrated noteworthy, sustained<br />
service and excellence in the practice <strong>of</strong> pharmacy in an<br />
organized healthcare setting.<br />
Board <strong>of</strong> Fellows 2009-2010<br />
Conseil des associés 2009-2010<br />
Chairperson<br />
Présidente:<br />
Margaret Colquhoun, FCSHP<br />
Past Chair<br />
Président sortant:<br />
Glen Pearson, FCSHP<br />
Board Members<br />
Membres du Conseil<br />
Peter Loewen, FCSHP<br />
Jim Mann, FCSHP<br />
Richard Slavik, FCSHP<br />
Peter Zed, FCSHP<br />
Carolee Awde-Sadler (ex-<strong>of</strong>ficio member)<br />
Marianna Leung, BScPhm, ACPR, PharmD, BCPP,<br />
BCPS, FCSHP<br />
Marianna Leung received her Bachelor <strong>of</strong><br />
Science degree in Pharmaceutical Sciences<br />
from the University <strong>of</strong> British Columbia,<br />
completed her hospital pharmacy<br />
residency at St. Paul’s <strong>Hospital</strong> in<br />
Vancouver, and graduated with a Doctor <strong>of</strong><br />
Pharmacy (PharmD) Degree from the<br />
University <strong>of</strong> Toronto. Marianna is also<br />
board certified with the Board <strong>of</strong> Pharmaceutical Specialties in<br />
both psychiatry and pharmacotherapy.<br />
Marianna has an interesting opportunity to function in various<br />
roles during her hospital pharmacy career as a Clinical<br />
Pharmacist, Staffing/Residency Coordinator, interim Pharmacy<br />
Leader, and is currently a Clinical Pharmacy Specialist in<br />
Nephrology. After completing her hospital residency, she<br />
started as a Clinical Pharmacist at St. Paul’s <strong>Hospital</strong>,<br />
specializing in psychiatry. During this time, she initiated clinical<br />
pharmacy services in the psychiatry program, conducted<br />
multiple research projects, and developed a laxative<br />
withdrawal protocol designed to help patients with anorexia or<br />
bulimia to wean <strong>of</strong>f laxatives, which has been adopted by the<br />
BC Eating Disorders <strong>Program</strong>.<br />
After completing her PharmD degree, she acted as an interim<br />
Residency Coordinator before transitioning to her current role<br />
<strong>of</strong> Clinical Pharmacy Specialist in Nephrology. She has<br />
developed various guidelines and protocols, including<br />
hemodialysis catheter-related bacteremia, chronic pruritus in<br />
dialysis patients, which have been adopted by the BC Provincial<br />
Renal Agency for province-wide use. In addition, her research<br />
projects have won a number <strong>of</strong> awards at both pharmacy,<br />
provincial, and national Nephrology conferences.<br />
Marianna has also had the good fortune to learn from her many<br />
pharmacy students, pharmacy residents, and PharmD students<br />
while precepting their research projects and clinical rotations in<br />
psychiatry and nephrology. She was recognized for her<br />
mentorship role with the Mentorship Award at CSHP-BC Branch<br />
and the Veteran Preceptor <strong>of</strong> the Year Award at Vancouver<br />
Coastal Health/Providence Healthcare.<br />
Marianna has been involved in several institutional and<br />
provincial nephrology committees, e.g. Renal End <strong>of</strong> Life<br />
Committee, BC Nephrology Days Planning, BC Provincial Renal<br />
Agency Vascular Access Task Force. She has been actively<br />
involved with various CSHP and College committees. She is<br />
currently a member <strong>of</strong> the <strong>Program</strong>s Committee at CSHP BC<br />
Branch, a PEBC assessor, and is a reviewer for Annals <strong>of</strong><br />
Pharmacotherapy and CJHP. Her pr<strong>of</strong>essional interests include<br />
direct patient care activities specifically in chronic disease<br />
management, continuous quality improvement initiatives,<br />
effective medication use, as well as promoting self-directed<br />
learning, education and teaching.<br />
John McBride, RPh, MSc, FCSHP<br />
John is a graduate <strong>of</strong> the University <strong>of</strong><br />
Toronto, (Bachelor <strong>of</strong> Science, Pharmacy,<br />
1981) and Queen’s University (Master <strong>of</strong><br />
Science, Community Health and<br />
Epidemiology, 1995). He completed a<br />
hospital pharmacy residency at the Ottawa<br />
General <strong>Hospital</strong> in 1982 and was a staff<br />
pharmacist, pediatric oncology at the<br />
<strong>Hospital</strong> for Sick Children, Toronto (1982-3). In 1984, John<br />
accepted a staff position as oncology and research pharmacist<br />
at the Kingston General <strong>Hospital</strong> (KGH) and Kingston Regional<br />
Cancer Centre. In 1991, John assumed the role <strong>of</strong> Manager,<br />
Clinical Pharmacy Services at KGH and was the Director <strong>of</strong><br />
Pharmacy Services from 1996 to 2008. John is currently the<br />
Director <strong>of</strong> Pharmacy at the Lennox and Addington County<br />
General <strong>Hospital</strong> in Napanee and a consultant for the Institute<br />
<strong>of</strong> Safe Medication Practices Canada.<br />
John has held a number <strong>of</strong> external memberships and<br />
appointments with organizations including the National Cancer<br />
Institute <strong>of</strong> Canada, Clinical Trials Group, the <strong>Canadian</strong> <strong>Hospital</strong><br />
Pharmacy Residency Board, the provincial Drug Quality and<br />
Therapeutics Committee, the national Advisory Committee on<br />
Pharmaceuticals for the Common Drug Review, the Council <strong>of</strong><br />
Academic <strong>Hospital</strong>s <strong>of</strong> Ontario, and HealthForce Ontario. His<br />
areas <strong>of</strong> pr<strong>of</strong>essional interest include medication safety,<br />
formulary and drug utilization review, and pharmacy education.<br />
John is the Past President <strong>of</strong> the Ontario Branch <strong>of</strong> the<br />
<strong>Canadian</strong> <strong>Society</strong> <strong>of</strong> <strong>Hospital</strong> <strong>Pharmacists</strong>.<br />
63
64<br />
Doris Nessim, BScPhm, RPh, MA, FCSHP<br />
Doris Nessim has over 15 years <strong>of</strong> health<br />
care and pharmacy leadership, including<br />
project management with enabling health<br />
care technologies, as well as pharmacy<br />
practice, education and research<br />
experience.<br />
In her prior roles, Doris worked as a Project<br />
Manager with a large healthcare<br />
information technology company, Cerner Corporation, as well<br />
as an independent health care consultant. In these roles, Doris<br />
worked with large teaching and community hospitals in the<br />
U.S. and Canada, facilitating interdisciplinary teams to develop<br />
their strategic objectives, selection criteria, and<br />
implementation plan and execution with enabling technologies<br />
with Pharmacy information systems, point <strong>of</strong> care, clinical<br />
decision-support s<strong>of</strong>tware, and other medication safety-related<br />
health care technologies.<br />
Currently, Doris is the Director <strong>of</strong> Pharmacy Services with North<br />
York General <strong>Hospital</strong>, a large community teaching hospital<br />
located in Toronto, ON, Canada. In addition to providing overall<br />
strategic and fiscal planning and leadership for acute care and<br />
ambulatory care Pharmacy Services, Doris provides visionary<br />
leadership for advancing safe medication practices at each<br />
stage <strong>of</strong> the medication use process, across the continuum <strong>of</strong><br />
care. Recent initiatives have included collaboration with<br />
Emergency Medicine, Family & Community Medicine, Medical,<br />
and Surgical <strong>Program</strong>s toward the development and<br />
implementation <strong>of</strong> a Pharmacist-Lead Anticoagulation<br />
Management Service, preparations for using bar code<br />
technology to enhance safety in the medication procurement,<br />
dispensing and administering processes, as well as the<br />
implementation <strong>of</strong> the advanced skill set Pharmacist<br />
Practitioner roles, aligned with the <strong>Hospital</strong>’s Cancer Care,<br />
Elder Care, Family & Community Medicine <strong>Program</strong>s, and<br />
Infectious Diseases Service, among other key leadership and<br />
patient safety initiatives. Doris is also a coleader <strong>of</strong> the<br />
hospital’s eHealth strategies with electronic medication<br />
integration and computerized provider order entry, and is the<br />
corporate lead for the implementation <strong>of</strong> medication<br />
reconciliation in the acute care and ambulatory care settings.<br />
Doris has been very active with CSHP and CSHP Ontario Branch,<br />
such as through prior roles with the Educational Services<br />
Committee, and work in co-writing as well as coordinating the<br />
CSHP Guidelines on the <strong>Pharmacists</strong>’ Role in Home Health Care.<br />
She is currently the Chair <strong>of</strong> the CSHP Homecare PSN, Chair <strong>of</strong><br />
the <strong>Hospital</strong> Pharmacy Leadership Association <strong>of</strong> Toronto and<br />
Area <strong>Hospital</strong>s, and Council Member, <strong>Hospital</strong> Practice, District<br />
16, with the Ontario College <strong>of</strong> <strong>Pharmacists</strong>.<br />
Doris is well published and has led numerous presentations on<br />
topics such as critical success factors for implementing<br />
computerized prescriber order entry, areas <strong>of</strong> process<br />
breakdowns and improvement in the medication management<br />
process, and on clinical and operational pharmaceutical<br />
services, including home care medication management.<br />
Doris is a graduate from the Faculty <strong>of</strong> Pharmacy, University <strong>of</strong><br />
Toronto, and subsequently completed her residency in <strong>Hospital</strong><br />
Pharmacy Practice with the Toronto General <strong>Hospital</strong>, as well as<br />
a Master <strong>of</strong> Arts with the Ontario Institute for Studies in Higher<br />
Education, University <strong>of</strong> Toronto.<br />
Doris is actively involved with supporting and providing student<br />
teaching initiatives with both the University <strong>of</strong> Toronto as well<br />
as University <strong>of</strong> Waterloo Pharmacy programs. She is Assistant<br />
Pr<strong>of</strong>essor, Status, with the Leslie Dan Faculty <strong>of</strong> Pharmacy,<br />
University <strong>of</strong> Toronto.<br />
Anne Marie Whelan, BScPhm, PharmD, FCSHP<br />
Anne Marie Whelan graduated with her<br />
Bachelor <strong>of</strong> Science in Pharmacy from<br />
Dalhousie University, and after practicing<br />
for four years in community pharmacy, she<br />
obtained her Doctor <strong>of</strong> Pharmacy degree<br />
from the Medical University <strong>of</strong> South<br />
Carolina and went on to complete a<br />
speciality Residency in Family Medicine.<br />
Anne Marie is currently an Associate Pr<strong>of</strong>essor at the College <strong>of</strong><br />
Pharmacy at Dalhousie University in Halifax, Nova Scotia. At the<br />
College, she teaches therapeutics, primarily in areas related to<br />
women’s health. She has been awarded the Dr. Jessie I.<br />
MacKnight Award for excellence in pharmaceutical teaching<br />
three times. She played a leadership role in the implementation<br />
and evaluation <strong>of</strong> the College <strong>of</strong> Pharmacy’s unique<br />
problem-based learning curriculum. This led to a national<br />
teaching award, recognition by an American education<br />
organization and several presentations and publications. She<br />
has chaired many committees at the College including the<br />
Admissions Committee and Self-Assessment Committees. At a<br />
national level, Anne Marie has been a councillor and then<br />
President <strong>of</strong> the Association <strong>of</strong> Faculties <strong>of</strong> Pharmacy <strong>of</strong> Canada<br />
(AFPC). She recently co-chaired the Planning and Host<br />
Committee <strong>of</strong> the AFPC Conference held in Halifax in June 2009.<br />
She is currently an AFPC representative to the Pharmacy<br />
Examining Board <strong>of</strong> Canada.<br />
Anne Marie holds a joint appointment with the Dalhousie<br />
University Family Medicine Clinic at the Queen Elizabeth II<br />
Health Sciences Centre. She is one <strong>of</strong> the first pharmacists in<br />
Canada to establish clinical pharmacy services in a family<br />
medicine practice that trains family physicians. Currently she<br />
serves as a consultant, available for patient consults and drug<br />
information requests. She teaches family medicine residents<br />
both informally, and formally, by providing lectures as part <strong>of</strong><br />
their curriculum. Over the years, she has participated on<br />
several committees and been involved in Family Medicine<br />
research projects.<br />
Anne Marie’s main research interests are in the areas <strong>of</strong><br />
women’s health, pharmacy education and clinical practice. In<br />
collaboration with other Halifax researchers, Anne Marie is<br />
examining the accessibility and use <strong>of</strong> emergency<br />
contraception in Nova Scotia from the perspective <strong>of</strong> women,<br />
pharmacists and physicians. She has also collaborated on<br />
several projects evaluating the evidence examining the safety
and efficacy <strong>of</strong> natural products advocated for women’s health.<br />
She has written continuing education review articles and<br />
presented seminars on a variety <strong>of</strong> topics related to women’s<br />
health. She represents CPhA on the SOGC-CPhA Working Group<br />
on Contraception and is a member <strong>of</strong> the Scientific Advisory<br />
Council for Osteoporosis Canada. In the area <strong>of</strong> pharmacy<br />
education, Anne Marie has worked with colleagues at the<br />
College <strong>of</strong> Pharmacy to document the implementation and<br />
evaluation <strong>of</strong> the problem-based learning curriculum. While<br />
establishing her clinical practice in Family Medicine, Anne<br />
Marie delivered presentations and published articles<br />
describing this unique practice.<br />
Anne Marie has been an active member <strong>of</strong> CSHP since 1991.<br />
She has reviewed award applications and presented continuing<br />
education lectures at both the local and national levels. She<br />
has published articles in the <strong>Canadian</strong> Journal <strong>of</strong> <strong>Hospital</strong><br />
Pharmacy and served as a reviewer. During Anne Marie’s tenure<br />
as president <strong>of</strong> AFPC, she worked closely with CSHP on the<br />
“Conference on Improving the Quality <strong>of</strong> Pharmaceutical Care in<br />
North America”. This was an initiative <strong>of</strong> CSHP, the American<br />
<strong>Society</strong> <strong>of</strong> Health Systems <strong>Pharmacists</strong> and the Mexican<br />
Association <strong>of</strong> <strong>Hospital</strong> <strong>Pharmacists</strong>, intended to facilitate<br />
development <strong>of</strong> clinical pharmacy services and education in<br />
Mexico. In addition to Committee work, Anne Marie prepared a<br />
presentation for delivery at the conference held in Mexico.<br />
65<br />
Faculty<br />
Conférenciers<br />
CSHP would like to recognize<br />
the generous contributions <strong>of</strong><br />
the following speakers:<br />
La SCPH désire souligner les<br />
généreuses contributions des<br />
conférenciers suivants:<br />
Trudy Arbo<br />
PharmD<br />
Alberta Health Services<br />
Calgary, AB<br />
Mitra Assemi<br />
PharmD<br />
University <strong>of</strong> California at San<br />
Francisco<br />
Fresno, CA<br />
Bill Bartle<br />
PharmD, FCSHP<br />
Sunnybrook Health Science<br />
Centre<br />
Toronto, ON<br />
Marie-France Beauchesne<br />
PharmD<br />
Universite de Montreal<br />
Montreal, QC<br />
Danette Beechinor<br />
PharmD<br />
Centre for Family Medicine<br />
Kitchener, ON<br />
Lisa Burry<br />
PharmD<br />
Mount Sinai <strong>Hospital</strong><br />
Toronto, ON<br />
Clarence Chant<br />
PharmD, FCSHP<br />
St. Michaels <strong>Hospital</strong><br />
Toronto, ON<br />
Anna Chiu<br />
BScPhm<br />
Trillium Health Centre<br />
Mississauga, ON<br />
Timothy Christie<br />
MHSc, PhD<br />
Saint John Regional <strong>Hospital</strong><br />
Saint John, NB<br />
Doson Chua<br />
PharmD, BSCPC(AQ)<br />
Providence Healthcare<br />
Vancouver, BC<br />
Michael Cohen<br />
RPh<br />
Institute for Safe Medication<br />
Practices<br />
Horsham, PA<br />
Natalie Crown<br />
PharmD<br />
London Health Sciences<br />
Centre<br />
London, ON<br />
Lisa Dolovich<br />
PharmD<br />
St. Joseph’s Healthcare<br />
Hamilton, ON<br />
Linda Dresser<br />
PharmD<br />
University Health Network<br />
Toronto, ON<br />
Robin Ensom<br />
PharmD, FCSHP<br />
Vancouver Coastal Health,<br />
Providence Health Care<br />
Vancouver, BC<br />
Barbara Farrell<br />
PharmD, FCSHP<br />
Bruyère Continuing Care<br />
Ottawa, ON<br />
Olavo Fernandes<br />
PharmD<br />
University Health Network<br />
Toronto, ON<br />
Jimmy Fung<br />
BScPhm<br />
Credit Valley <strong>Hospital</strong><br />
Mississauga, ON<br />
Uchenwa Genus<br />
BScPhm<br />
York Central <strong>Hospital</strong><br />
Richmond Hill, ON<br />
Alfred Gin<br />
PharmD, FCSHP<br />
Health Sciences Centre<br />
Winnipeg, MB<br />
Margaret Gray<br />
BSP<br />
Misericordia Community<br />
<strong>Hospital</strong>, Alberta Health<br />
Services Pharmacy Services<br />
Edmonton, Alberta<br />
Pam Howell<br />
BScPhm<br />
Bruyere Continuing Care<br />
Ottawa, ON<br />
Sandra Howie<br />
PharmD<br />
Mount Sinai <strong>Hospital</strong><br />
Toronto, ON<br />
Jason Howorko<br />
BSP<br />
Alberta Health Services<br />
Red Deer, AB<br />
Jin-Hyeun Huh<br />
BScPhm<br />
Toronto Western <strong>Hospital</strong><br />
Toronto, ON<br />
Cynthia Jackevicius<br />
PharmD, FCSHP<br />
Western University <strong>of</strong> Health<br />
Sciences<br />
Los Angeles, CA<br />
Derek Jorgenson<br />
PharmD<br />
University <strong>of</strong> Saskatchewan<br />
Saskatoon, SK<br />
Salmaan Kanji<br />
PharmD<br />
Ottawa Research Institute<br />
Ottawa, ON<br />
Heather Kertland<br />
PharmD<br />
St. Michael’s <strong>Hospital</strong><br />
Toronto, ON<br />
Tom Kouroukis<br />
MD, MSc, FRCP(C)<br />
Juravinski Cancer Centre<br />
Hamilton, ON<br />
Catriona Le May Doan
66<br />
Kori Leblanc<br />
PharmD<br />
University Health Network<br />
Toronto, ON<br />
Peter Loewen<br />
PharmD, FCSHP<br />
Vancouver Coastal Health<br />
Vancouver, BC<br />
Neil MacKinnon<br />
PhD, FCSHP<br />
Dalhousie University<br />
Halifax, NS<br />
Christiane Mayer<br />
BPharm<br />
Universite de Montreal<br />
Montreal, QC<br />
Linda Methot<br />
BScPhm<br />
Kingston General <strong>Hospital</strong><br />
Kingston, ON<br />
Bruce Millin<br />
BScPhm<br />
Fraser Health Autority<br />
Langley, BC<br />
Allan Mills<br />
PharmD<br />
Trillium Health Centre<br />
Mississauga, ON<br />
Christine Mitry<br />
BScPhm<br />
University Health Network<br />
Toronto, ON<br />
Mits Miyata<br />
BScPhm<br />
Fraser Health Authority<br />
Langley, BC<br />
Janice Munroe<br />
BScPhm<br />
Fraser Health Authority<br />
Langely, BC<br />
Dante Morra<br />
MD, MBA, FRCP(C)<br />
University Health Network<br />
Toronto, ON<br />
Jeff Nagge<br />
PharmD<br />
University <strong>of</strong> Waterloo<br />
Kitchener, ON<br />
Julie Pellerin<br />
BScPhm, MSc<br />
University <strong>of</strong> Alberta<br />
Edmonton, AB<br />
Patrick Robertson<br />
PharmD<br />
Saskatoon Health Region<br />
Saskatoon, SK<br />
Cheryl Sadowski<br />
PharmD<br />
University <strong>of</strong> Alberta<br />
Edmonton, AB<br />
Anjana Sengar<br />
BScPhm<br />
Trillium Health Centre<br />
Mississauga, ON<br />
Stephen Shalansky<br />
PharmD, FCSHP<br />
Providence Healthcare<br />
Vancouver, BC<br />
Diana Spizzirri<br />
RPh, BScPham, Med<br />
Ontario College <strong>of</strong><br />
<strong>Pharmacists</strong><br />
Toronto, ON<br />
Linda Strand<br />
PharmD,PhD,DSc(Hon)<br />
Medication Management<br />
Systems Inc.<br />
Minneapolis, MN<br />
Brian Schwartz<br />
MD<br />
Ontario Agency for Health<br />
Protection and Promotion<br />
Toronto, ON<br />
Ann Szutke-Fournier<br />
BPharm<br />
Health Canada<br />
Ottawa, ON<br />
Vincent Teo<br />
PharmD<br />
Sunnybrook Health Sciences<br />
Centre<br />
Toronto, ON<br />
Kat Timberlake<br />
PharmD<br />
The <strong>Hospital</strong> for Sick Children<br />
Toronto, ON<br />
Peter Thomson<br />
PharmD<br />
Health Sciences Centre<br />
Winnipeg<br />
Winnipeg, MB<br />
Marita Tonkin<br />
PharmD<br />
Hamilton Health Sciences<br />
Centre<br />
Hamilton, ON<br />
Ross Tsuyuki<br />
PharmD<br />
University <strong>of</strong> Alberta<br />
Edmonton, AB<br />
Karen Tulloch<br />
PharmD<br />
Vancouver Coastal Health<br />
Vancouver, BC<br />
Regis Vaillancourt<br />
PharmD, FCSHP<br />
Children’s <strong>Hospital</strong> <strong>of</strong> Eastern<br />
Ontario<br />
Ottawa, ON<br />
Amita Woods<br />
PharmD<br />
University Health Network<br />
Toronto, ON<br />
Peter Zed<br />
PharmD, FCSHP<br />
Capital Health<br />
Halifax, NS<br />
Rosemary Zvonar<br />
BScPhm, ACPR<br />
The Ottawa <strong>Hospital</strong><br />
Ottawa, ON
67<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 ...........................................................................208/210<br />
Apotex Inc. ............................................................................112<br />
Amerisourcebergen Canada..........................................237/239<br />
AstraZeneca Canada Inc. ...............................................211/213<br />
Baxter ..........................................................................305/307<br />
Baxa Corporation..................................................................402<br />
B. Braun Medical ..................................................................405<br />
Boehringer-Ingelheim Canada Ltd. ...............................200/202<br />
<strong>Canadian</strong> Forces....................................................................136<br />
Cardinal Health Canada .................................................105/107<br />
Carmel Pharma Canada Inc. ..................................................140<br />
CIHI.......................................................................................132<br />
CPDN..............................................................................108/110<br />
CPSI......................................................................................245<br />
Eli Lilly Canada Inc................................................................403<br />
Galenova ..............................................................................306<br />
Health Canada......................................................................400<br />
Healthmark Ltd.....................................................................207<br />
Hospira Healthcare ........................................................309/311<br />
ISMP Canada.........................................................................134<br />
Leo Pharma Inc. ....................................................................310<br />
Company Booth #<br />
Compagnie Kiosque #<br />
Lexi-Comp Inc. ......................................................................409<br />
MDA Inc. ..............................................................................408<br />
Mylan Pharmaceuticals Inc. ..................................................401<br />
Novartis Pharma Canada Inc. .................................................111<br />
Omega Laboratories Limited ................................................304<br />
Omnicell ................................................................................101<br />
Ovarian Cancer Canada.........................................................144<br />
PCCA Canada Corp. ...............................................................410<br />
Pharmacy.ca .........................................................................205<br />
Pharmacy Examining Board...................................................411<br />
Pharmascience .....................................................................209<br />
Pfizer Canada Inc. ..................................................100/102/104<br />
PPC ...............................................................................301/303<br />
Sandoz Canada Inc. .....................................................300/302<br />
San<strong>of</strong>i-aventis/Bristol-Myers Squibb ...................................233<br />
Schering Plough Canada Inc. ................................................235<br />
SDM Specialty Health Network.............................................204<br />
Sepracor Pharmaceuticals Inc. .............................................206<br />
Teva ......................................................................................201<br />
Thomson Reuters .................................................................308<br />
Uman....................................................................................203
Join Us!<br />
CSHP MEMBERSHIP HAS MANY 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 62-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 />
● Partner Discount <strong>Program</strong>s<br />
● Fellows <strong>Program</strong><br />
● Pharmacy Specialty Networks (PSNs)<br />
●<br />
Products and Services<br />
● Pr<strong>of</strong>essional Liability/Malpractice Insurance<br />
● Research and Education Foundation<br />
For more information about CSHP member benefits, please contact:<br />
Robyn Rockwell, Membership Administrator<br />
T: 613-736-9733, ext. 222 | F: 613-736-5660 | E: rrockwell@cshp.ca | www.cshp.ca
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