WOW February 2017

Writing on the Wall
The Johns Hopkins Hospital Department of Pharmacy Newsletter February 2017 Vol. 17 Issue 2
Inside this Issue
A Summary of the
2017 GOLD Guidelines
Update
Angiotensin-
Converting Enzyme
Inhibitor and
Angiotensin Receptor
Blocker: Cost Saving
Projections
Granisetron
Transdermal System 3
NINJAs in the
Children’s Center
A Centralized
Electronic Health
Record: How Close
Are We?
Our “Epic” Summer 5
Fundación Santa Fe de
Bogotá
1
3
4
5
7
A Summary of the 2017 GOLD Guidelines Update
Jessica Merrey, PharmD, MBA, BCPS, BCACP, CGP,
Clinical Pharmacy Specialist, Ambulatory Care
The Global Initiative for Chronic Obstructive Lung Disease (GOLD) released an updated strategy for
the diagnosis, management, and prevention of chronic obstructive lung disease (COPD) in November
2016. This document was originally published in 2001, first updated in 2011, and has been updated annually
since then. These updates have been fairly minor in terms of diagnosis and treatment until this year.
The key changes in the 2017 GOLD guidelines can be segmented into three categories: refined ABCD
assessment tool to further stratify risk, updated treatment algorithm for stable COPD and emphasis on
risk of future exacerbations, and addition of hospital discharge and follow-up criteria, including use of
integrated care team
Refined ABCD assessment tool to further stratify risk
The ABCD tool from the 2011 GOLD update combined patient symptomatic assessment with spirometry
and the risk of exacerbations. 1 However, in predicting mortality, the tool performed no better than
spirometric-only grading. 2 The refined tool attempts to address this by separating the spirometric assessment
from the ABCD grouping of symptoms and exacerbation risk. 1 For example, previously patients
would be categorized as “GOLD D,” the new tool would label the same patient “GOLD Grade 4,
Group D,” where the grade refers to severity of airflow limitation and the letter provides information
regarding symptom burden and exacerbations. A figure of the new tool is below.
Updated treatment algorithm for stable COPD and emphasis on risk of future exacerbations
Long acting beta-agonists (LABA) and long-acting muscarinics (LAMA) are still the mainstay of treatment,
but inhaled corticosteroids (ICS) have been pushed further down the list of appropriate options,
except in the case of overlapping asthma and COPD. 1 The 2017 treatment algorithm is on page 2.
Indispensable Impact 7
Monthly Editors:
Ben Iredell, PharmD
David Choi, PharmD
Editors in Chief:
Tara Feller, PharmD, MPH, BCPS
Molly Wascher, PharmD, BCPS
The Johns Hopkins Hospital
Department of Pharmacy
600 North Wolfe Street
Carnegie 180
Baltimore, MD 21287
(410) 955-6591
Visit us on the web!
www.hopkinspharmacy.org
Group A no longer has a recommendation to use combination LABA + LAMA if monotherapy fails. 1,3
There were no changes to treatment recommendations for patients categorized in Group B. In Group C,
the initial recommendation is a LAMA, which differs from previous versions in which a combination
LABA or LAMA with ICS was the initial recommendation. 1,3 This is because LABA + LAMA combination
was proven superior to LABA + ICS in patients with a history of frequent exacerbations. 4 Similarly,
patients classified as Group D previously were recommended to start with ICS + LABA, or ICS + LA-
MA, with triple therapy as a next step. 1,3 The 2017 guidelines recommend combination LABA + LAMA
first, with addition of ICS if symptoms persist. 1
(continued on page 2)

Page 2 Volume 17; Issue 2
A Summary of the 2017 GOLD Guidelines Update
(continued from page 1)
Addition of hospital discharge and follow-up criteria, including
use of integrated care team
The 2011-2015 versions of the GOLD guidelines provided criteria
for discharge (e.g. ability to use inhaler properly, ability to walk
across room without getting winded, etc.) and recommended follow-up
within four to six weeks (e.g. reassessment of inhaler technique,
status of comorbidities, etc.). 3 The updated guidelines shorten
the recommended follow-up period to 4 weeks, citing a reduced
rate of readmission in patients seen within the shorter timeframe.
1,5 The guidelines also recommend additional follow-up
three months post-discharge to ensure the patient has returned to
stable clinical state. 1 While the guidelines do not mention the value
of a pharmacist specifically, they do encourage the use of coordinated,
integrated care for patients in all settings. Observational
studies in patients with COPD have identified a relationship between
poor inhaler use and symptom control. 6 The updated
GOLD guidelines stress the importance of education and training
in inhaler device technique, and assessment of dosing frequency
and technique at each follow-up visit. 1
References
1. Global Strategy for the Diagnosis, Management and Prevention of
COPD, Global Initiative for Chronic Obstructive Lung Disease
(GOLD) 2017. Available from http://goldcopd.org. Accessed December
2016.
2. Soriano JB, Lamprecht B, Ramirez AS, et al. Mortality prediction in
chronic obstructive pulmonary disease comparing the GOLD 2007
and 2011 staging systems: a pooled analysis of individual patient data.
The Lancet Respiratory Medicine 2015; 3: 443-50.
3. Global Strategy for the Diagnosis, Management and Prevention of
COPD, Global Initiative for Chronic Obstructive Lung Disease
(GOLD) 2016. Available from http://goldcopd.org. Accessed December
2016.
4. Wedzich JA, Banerji D, Chapman KR, et al. Indacaterolglycopyrronium
versus salmeterol-fluticasone for COPD. N Engl J
Med 2016; 374:222-34.
5. Gavish R, Levy A, Dekel OK, et al The Association between hospital
readmission and pulmonologist follow-up visits in patients with
COPD. CHEST 2015; 148:375-81.
6. Melani AS, Bonavia M, Cilenti V, et al. Inhaler mishandling remains
common in real life and is associated with reduced disease control.
Respir Med 2011; 105:930-8.

Page 3 Volume 17; Issue 2
Angiotensin-Converting Enzyme Inhibitor and Angiotensin Receptor Blocker:
Cost Saving Projections via Therapeutic Interchange
Meera Vachhani, PharmD, PGY1 Pharmacotherapy Resident
The angiotensin-converting enzyme inhibitors (ACEI) and angiotensin
receptor blockers (ARB) drug class review completed for
the Johns Hopkins Health System reviewed efficacy, cost, and
safety among these medications. Based on this information, the
drugs’ formulary status and therapeutic interchange protocols were
developed for the JHHS.
The formulary agents selected within the ACEI and ARB drug
classes are captopril, enalapril, enalaprilat, and lisinopril, and
irbesartan, losartan, and valsartan, respectively. Therapeutic interchange
protocols were developed to interchange nonformulary
ACEIs to lisinopril, and nonformulary ARBs to losartan. The implementation
of the therapeutic interchanges outlined above are
projected to result in approximately $25,000 in cost savings annually.
These projections are calculated based on 12-month volume
history from McKesson. Of note, a new combination therapy,
valsartan and sacubitril (Entresto®), was also added to the JHHS
formulary with restriction to continuation of a home medication.
New initiations are restricted to patients on a cardiology service or
those with a cardiology consult.
The ACEI/ARB therapeutic interchange protocols are currently
being built within Epic. Communication to the department will be
disseminated prior to the build changes going live in Epic. The
therapeutic interchange details are outlined in Lexicomp.
References:
1. Furberg CD and Pitt B. Are all angiotensin-converting enzyme inhibitors
interchangeable? J Am Coll Cardiol 2001; 37: 1456-60.
2. Heran BS et al. Blood pressure lowering efficacy of angiotensin receptor
blockers for primary hypertension. Cochrane Database of
S y s t e m a t i c R e v i e w s 2 0 0 8 ; 4 : C D 0 0 3 8 2 2 . D O I :
10.1002/14651858.CD003822.pub2.
3. Matchar DB et al. Systematic review: comparative effectiveness of
angiotensin-converting enzyme inhibitors and angiotensin II receptor
blockers for treating essential hypertension. Ann Intern Med
2008; 148: 16-29.
Granisetron Transdermal System for the Prevention of
Chemotherapy-Induced Nausea and Vomiting
Olivia Akah, Notre Dame of Maryland University, PharmD Candidate 2019
Lauren McBride, PharmD, BCOP, Clinical Pharmacy Specialist, Oncology
Chemotherapy has helped millions of people in the fight against
cancer by destroying cancerous cells. Unfortunately, healthy noncancerous
cells are also destroyed in the process, leading to various
unpleasant side effects. Chemotherapy-induced nausea and vomiting
(CINV) is potentially the most severe and distressing adverse
effect experienced by patients undergoing chemotherapy. To prevent
CINV associated with chemotherapy regimens with a high
emetic risk (i.e., incidence of emesis exceeds 90% if no antiemetics
are administered), the American Society of Clinical Oncology
(ASCO) currently recommends a 3-drug antiemetic regimen consisting
of a NK-1 receptor antagonist (e.g., aprepitant, fosaprepitant)
a type 3 serotonin (5-HT3) receptor antagonist (e.g., granisetron,
ondansetron, palonosetron), and dexamethasone. 1,2
Granisetron is a first generation selective inhibitor of type 3 serotonergic
(5-HT3) receptors with little or no affinity for other serotonin
receptors. It is an antiemetic indicated for the prevention of
nausea and vomiting in patients receiving moderately and/or highly
emetogenic chemotherapy regimens of up to 5 consecutive days
of duration. The drug is structurally and pharmacologically related
to ondansetron. The antiemetic activity of granisetron appears to
be mediated both centrally and peripherally via inhibition of 5-
HT3. 2 Serotonin receptors of the 5-HT3 type are located peripherally
on vagal nerve terminals and centrally in the chemoreceptor
trigger zone of the area postrema. During chemotherapy, mucosal
enterochromaffin cells release serotonin, which stimulates 5-HT3
receptors. This evokes vagal afferent discharge, inducing vomiting.
3
In select patients who are unable to swallow or digest tablets because
of emesis, transdermal antiemetics such as granisetron transdermal
system may be of value. In September 2008, the FDA approved
the use of granisetron transdermal system (GTS) for
CINV. The patch containing 3.1 mg of granisetron/24 hours is
applied approximately 24 to 48 hours before the first dose of
chemotherapy; maximum duration of the patch is 7 days. 3,4
The efficacy and tolerability of transdermal granisetron for the
control of CINV associated with moderately and highly emetogenic
multi-day chemotherapy was assessed in a phase III clinical trial.
The trial (n=641) was a randomized, non-inferiority, active control,
double-blind, double-dummy, parallel group, multinational
study that compared GTS to oral granisetron. Patients were randomized
to oral (2 mg/day, 3-5 days) or transdermal granisetron
(one GTS patch, 7 days), before receiving multi-day chemotherapy.
The primary endpoint was complete control of CINV (i.e. no
vomiting/retching, no more than mild nausea, no rescue medication)
from chemotherapy initiation until 24 h after final administration.
The pre-specified non-inferiority margin was 15%. Results
showed that GTS displayed non-inferiority to oral granisetron;
complete control was achieved by 60% of patients in the
GTS group and 65% in the oral granisetron group (treatment difference,
−5%; 95% confidence interval, −13% to +3%). Both
treatments were well tolerated. 5
The most common adverse effect of GTS is constipation. Skin
reactions such as rash, redness, and itching may occur at the site of
application. GTS is contraindicated in patients with known hypersensitivity
to granisetron or to any of the components of the
patch. The use of granisetron may mask a progressive ileus and/or
gastric distention caused by the underlying condition. Development
of serotonin syndrome has been reported with 5-HT3 receptor
antagonists. Most reports have been associated with concomitant
use of serotonergic drugs such as selective serotonin reuptake
inhibitors (SSRI’s), mirtazapine, lithium, tramadol,
(continued on page 4)

Page 4 Volume 17; Issue 2
Granisetron Transdermal System for the Prevention of Chemotherapy-Induced
Nausea and Vomiting
(continued from page 3)
etc. Safety and efficacy has not been established in pediatric patients.
3,6
Granisetron transdermal patch was recently added to the formulary
at the Johns Hopkins Hospital with restrictions. It is restricted
to oncology inpatients who have not responded to or are intolerant
to at least 2 different agents (one of which must be a 5-HT3
antagonist) with optimized dosing and frequency each for at least
24 hours, or who respond to 5HT‐3 antagonists but are unable to
transition from IV to PO antiemetics.
References
1. Basch E, Prestrud AA, Hesketh PJ, et al; American Society of Clinical
Oncology. Antiemetics: American Society of Clinical Oncology
clinical practice guideline update. J Clin Oncol 2011;29:4189-98.
2. Granisetron [monograph]. In: LexiComp Online [online database].
Hudson, OH: Lexi-Comp. Accessed December 2016.
3. Food and Drug Administration. SANCUSO (Granisetron Transdermal
System) prescribing information (September 2015). http://
w w w . a c c e s s d a t a . f d a . g o v / d r u g s a t f d a _ d o c s /
label/2015/022198s003lbl.pdf . Accessed December 2016.
4. National Comprehensive Cancer Network (NCCN) Clinical Practice
Guidelines in Oncology. Antiemesis (updated 2016). https://
www.nccn.org/professionals/physician_gls/pdf/antiemesis.pdf
Accessed December 2016.
5. Boccia, R.V., Gordan, L.N., Clark, G. et al. Efficacy and tolerability
of transdermal granisetron for the control of chemotherapy-induced
nausea and vomiting associated with moderately and highly emetogenic
multi-day chemotherapy: a randomized, double-blind, phase III
study. Support Care Cancer 2011; 19:1609-17.
6. Chabner B, A., Thompson E. C. Management of Adverse Effects of
Cancer Therapy. Merck Manual Professional Version. https://
www.merckmanuals.com/professional/hematology-and-oncology/
principles-of-cancer-therapy/management-of-adverse-effects-ofcancer-therapy.
Access January 2017.
NINJAs in the Children’s Center
Bethany Sharpless, PharmD, PGY2 Pediatric Pharmacy Resident
When one thinks of the word “ninja,” pediatric acute kidney injury
(AKI) is generally not the first thing that comes to mind.
“NINJA,” or Nephrotoxic Injury Negated by Just-in-time Action,
is a multi-center quality improvement project with the goal of early
identification of non-critically ill pediatric patients at risk for medication-induced
AKI and reduction of the incidence and intensity
of medication-induced AKI. The initiative, based out of Cincinnati
Children’s Hospital Medical Center, began after a retrospective
analysis of hospitalized children showed that rates of AKI increased
from 16% to 45% in pediatric patients with exposure to ≥
3 nephrotoxic medications. 1 In addition, pediatric evidence has
shown that 5 or more days of aminoglycoside exposure was an
independent risk factor for AKI, with rates of kidney injury increasing
with days of therapy. 2 AKI is sometimes more easily
missed in pediatric patients, as a quantitatively small change in
serum creatinine (for example an increase from 0.3 to 0.6) represents
an increase of two times baseline, which qualifies as AKI per
the KDIGO (Kidney Disease Improving Global Outcomes) criteria.
3 Johns Hopkins was the 13 th institution to join the NINJA
collaborative and implemented the program in 2016.
The criteria to identify patients who need closer renal monitoring
are patients on ≥ 3 concomitant nephrotoxic medications or an
aminoglycoside for ≥ 3 days. 4 The group intentionally excluded
critically ill patients as those patients often have risk factors for
nephrotoxicity beyond medications. In 2015, the Cincinnati project
team reported 3.5 years of data. 5 During the period, decreases
in AKI rate (2.96 to 1.06 AKI episodes per 1000 patient-days) as
well as nephrotoxic medication exposure rate (11.64 to 7.24 exposures
per 1000 patient-days) were observed. Multicenter collaborative
data have not yet been published.
While each institution has different workflows, the common goal
is to decrease the intensity of AKI through increased awareness
and monitoring. At JHH, Elys Bhatia of Clinical Analytics created
Image source: Johns Hopkins Children Center
(continued on page 5)

Page 5 Volume 17; Issue 2
NINJAs in the Children’s Center
(continued from page 4)
Acyclovir
Cidofovir
NINJA 61 Medication List
= Therapeutic Monitoring Recommended
Gadopentetate
dimeglumine
(Magnevist)
Ioxaglate meglumine
and ioxaglate
sodium
Valacyclovir
Ambisome Cisplatin Ganciclovir Ioxilan Pentamidine Valganciclovir
Amikacin* Colistimethate Gentamicin* Ketorolac Piperacillin Valsartan
Amphotericin B Cyclosporine* Ibuprofen Lisinopril
Pamidronate disodium
Piperacillin/Tazobactam
Vancomycin*
Aspirin Dapsone Ifosfamide Lithium* Sirolimus* Zoledronic acid
Captopril
Carboplatin
Cefotaxime
Diatrizoate meglumine
Diatrizoate sodium
Enalapril
Indomethacin Losartan Sulfasalazine Zonisamide
Iodixanol
(Visipaque)
Iohexol
(Omnipaque)
Mesalamine
Methotrexate*
Ceftazidime Enalaprilat Iopamidol (Isovue) Mitomycin
Tacrolimus*
Tenofovir
Ticarcillin/
Clavulanic Acid
Cefuroxime Foscarnet Iopromide Nafcillin Tobramycin*
Celecoxib
Gadoextate disodium
(Eovist)
Ioversol Naproxen Topiramate
a Qlikview dashboard that provides the rest of the NINJA team
(Jeff Fadrowski, MD, Elizabeth Goswami, PharmD, and Emma
Sexton, RN) a daily report of patients exposed to nephrotoxic
medications, as well as patients meeting criteria for AKI. If a patient
meets the criteria for increased risk of AKI, the NINJA
team visits the patient’s primary team on the floor with a
“NINJA Alert”. During the conversation, the NINJA team recommends
daily serum creatinine monitoring as well as minimization
of nephrotoxic medications as clinically appropriate. The
NINJAs make the team aware of the patient’s baseline serum
creatinine and tell the team if the patient has AKI. Patients are
followed for the duration of nephrotoxic medication exposure,
and patients with AKI are followed until AKI has resolved for 48
hours.
Although this project currently impacts only our non-critically ill
pediatric patients, awareness of medication-associated AKI risk is
important regardless of patient age. Acute kidney injury is a cause
of patient morbidity and has been shown to have long-term implications
on a patient’s renal function. 6 Pharmacists have an opportunity
to promote early detection of patients with medication
risk factors for AKI, and early intervention by pharmacists can
result in reduction in nephrotoxic medication exposure as well as
incidence of AKI.
References:
1. Moffett B, Goldstein S. Acute kidney injury and increasing nephrotoxic-medication
exposure in noncritically-ill children. Clinical
Journal of the American Society of Nephrology. 2011;6:856-63.
2. Zappitelli M, Moffett B, Hyder A, Goldstein S. Acute kidney injury
in non-critically ill children treated with aminoglycoside antibiotics
in a tertiary healthcare centre: a retrospective cohort study. Nephrology
Dialysis Transplantation. 2010;26:144-50.
3. Summary of Recommendation Statements, KDIGO Clinical Practice
Guideline for Acute Kidney Injury. Kidney International Supplements.
2012;2:8-12.
4. Goldstein S, Kirkendall E, Nguyen H et al. Electronic health record
identification of nephrotoxin exposure and associated acute kidney
injury. Pediatrics. 2013;132:e756-67.
5. Goldstein S, Mottes T, Simpson K et al. A sustained quality improvement
program reduces nephrotoxic medication-associated
acute kidney injury. Kidney International. 2016;9:212-21.
6. Menon S, Kirkendall E, Nguyen H, Goldstein S. Acute kidney injury
associated with high nephrotoxic medication exposure leads to
chronic kidney disease after 6 Months. The Journal of Pediatrics.
2014;165:522-7.

Page 6 Volume 17; Issue 2
A Centralized Electronic Health Record: How Close Are We?
Ben Iredell, PharmD, PGY1 Medication Systems and Operations Resident
A patient is admitted with pneumonia on Friday evening, but she
claims she has a history of anaphylaxis with multiple antibiotics.
She does not recall which ones specifically, and her out of state
Primary Care office will not be open until Monday. Skin testing
aside, the patient may have to go the weekend without antibiotics.
These situations unfortunately happen frequently due to a lack of
universal integration among health systems’ Electronic Health
Records (EHR). However, there are efforts underway to connect
health systems across the country.
In 2004, President George W. Bush set a goal that by 2014, most
Americans should have access to secure electronic health records. 3
The executive order foresaw that medical information would follow
consumers from provider to provider and that each clinician
would have a patient’s complete medical record. Now, in 2017, we
still have yet to reach that goal. A government initiative, endingthedocumentgame.gov,
was implemented to reduce the number
of duplicate documents and tests from provider to provider. 3 In
2009, Congress passed the Health Information Technology for
Economic and Clinical Health Act (HITECH Act), which authorized
the Department of Health and Human Services to spend $30
billion on the expansion of Heath Information Technology
(HIT). 3 The act defines “meaningful use” in terms of HIT and
improving clinical outcomes using EHR technology. 2
While progress at the national level lags, some states are having
success with creating regional Health Information Exchanges
(HIE). The California Integrated Data Exchange (Cal INDEX) is
a nonprofit organization that is funded by two large health insurance
companies in the state. The organization maintains a centralized
EHR that is populated with patient health information by
providers and by insurance claims. While not completely comprehensive,
this is a good start to a one-stop health record. Other
states have created or have plans for similar systems, including
Georgia, Arkansas, and Virginia.
In Maryland, the Chesapeake Regional Information System for our
Patients (CRISP) organization is leading the way towards a centralized
EHR in Maryland and the District of Columbia. 1 The CRISP
Clinical Query Portal is a free tool available now to ambulatory
practices, and the Prescription Drug Monitoring Program
(PDMP), which allows for a common repository of data related to
controlled substance prescribing and dispensing, is one of the
more mature aspects of Maryland’s program.
Besides clinical benefits such as enabling faster diagnoses and improving
comprehensive care, a centralized EHR will save health
systems money. For example, a complete patient record will show
the provider all tests performed on the patient, which may eliminate
duplicate or unnecessary tests. Additionally, providers and
health systems will not spend as much time learning new systems
or transferring health information if it is already synced across all
health systems.
While 2014 has come and gone and nation-wide connected patient
records has yet to be achieved, progress is being made on the local
and national levels. CRISP, while a relatively new system, has the
potential to connect patient records for hospitals and health systems
in Maryland and the District of Columbia. With time, the
hope is that every health system in America will be connected and
each patient’s antibiotic allergies (and other health-related information)
will be available to all providers.
References:
1. CRISP Clinical Query Portal. CRISP. https://www.crisphealth.org/
services/crisp-clinical-query-portal/. Accessed December 2016.
2. Health Information Technology. American College of Emergency Physicians.
https://www.acep.org/Advocacy/Health-Information-
Technology/. Accessed December 2016.
3. Kendall, D., Quill, E. A lifetime electronic health record for every
american. Third Way: Fresh Thinking. http://www.thirdway.org/
report/a-lifetime-electronic-health-record-for-every-american. Accessed
December 2016.
4. Koppel, R.. What do we know about medical errors associated with
electronic medical records? The Health Care Blog. http://
thehealthcareblog.com/blog/2016/01/11/what-do-we-know-aboutmedical-errors-associated-with-electronic-medical-records/.
cessed December 2016.
Ac-
Our “Epic” Summer
Detron Brown, PharmD Candidate, Howard University College of Pharmacy, Class of 2018
Megan Bereda, PharmD Candidate, Purdue College of Pharmacy, Class of 2018
On July 1 st of 2016, the Johns Hopkins Hospital finalized its transition
to Epic as its exclusive electronic health record. This was
one of the largest changes in Hopkins’ history and meant extensive
workflow and standard operating procedure changes. Many were
left feeling uneasy of being able to utilize the system while still
providing the highest level of care. As summer interns in the Critical
Care and Surgery (CCS) Pharmacy, we were tasked with easing
the stress of the transition.
While undergoing the Epic-provided training alongside our
technicians, we recognized that while the training was a great introduction
to the software, we could further serve our technicians
by providing hands-on use of the software. We recognized that if
the training included more real-life experiences and scenarios, the
technician level of comfort would increase significantly. Together
we compiled a technician training program that focused on the six
major functions that we felt were the most vital for technician
success in the new Epic system.
Eighty-six percent of the full-time CCS technicians were cotrained
prior to “Go-Live” on July 1, 2016. Through our individual
training sessions, we were able to teach each of the major func-
(continued on page 7)

Page 7 Volume 17; Issue 2
Our “Epic” Summer
(continued from page 6)
tions and observe each technician’s competence with them. Upon
completion of the mock scenarios prepared in the Epic Hyperspace
training modules, we were able to directly serve as a resource
and observe each technician’s “real-time” competence.
Many technicians cited this training module as a significant factor
in increasing their comfort in maneuvering through the new system.
At ASHP’s Midyear Clinical Meeting in December, we presented
our work and described the benefit of site specific one-onone
training versus non-specific group training. We are forever
grateful for experiences we were able to have over the summer
and the support we received from the CCS pharmacy staff and
summer internship program.
The Johns Hopkins Hospital at Fundación Santa Fe de Bogotá
Mustafa Sidik, CPhT
The Department of Pharmacy had the opportunity to send a pharmacy
technician to the Fundación Santa Fe de Bogotá, an international
affiliate of Johns Hopkins, to present on pharmacy technician
practice during a two day national pharmacy conference. The
hospital had no formal pharmacy technician role, and was seeking
to learn how to effectively implement a successful, sustainable
pharmacy technician position. I was fortunate to be chosen as the
Johns Hopkins representative and wanted to share my experience.
I presented two lecture to approximately 300 pharmacy professionals
from across Colombia: one on the role of the pharmacy
technician in the United States and the other on the role of the
pharmacy technician in medication safety. Following the lectures I
discussed specific pharmacy technician roles with pharmacy and
hospital executives. A tour of the hospital, including the central
pharmacy and many of its satellites rounded out the first day. The
second day was spent in targeted focus groups, where discussions
were held with the hospital’s current pharmacists, associates, and
administrators, as well as representatives from the country’s Board
of Pharmacy and Health Ministry. After the two days, the consensus
was reached that while it is critical for the role of the pharmacy
technician to develop, it is equally as critical for the hospital’s
program to be rooted firmly in education and training to adequately
prepare individuals to be competent pharmacy technicians.
Overall, this trip was an eye-opening experience to all that we take
for granted in pharmacy practice, not only at The Johns Hopkins
Hospital, but the United States as well. Technologies such as Pyxis,
Epic, and DoseEdge which we rely on heavily, are not accessible
in many other countries. This opportunity gave me a newfound
appreciation for the level of progress that The Johns Hopkins
Hospital Department of Pharmacy has achieved and the steps
we are taking to advance pharmacy practice.
Indispensable Impact
Kristen Holt, PharmD, MPH, Pharmacy Administration
Last year, clinical pharmacists made over 90,000 recommendations that benefited the care of patients at The Johns Hopkins Hospital.
These interventions were incorporated by the care team 98% of the time. Using your imagination; how could this patient’s story have
unfolded differently if this pharmacist was not there to intervene?
A pregnant patient was ordered haloperidol short acting 100 mg intramuscularly (IM) once. The pharmacist paged the provider to inform
her that haloperidol should be avoided in the first trimester of pregnancy since there is the potential for limb malformations. In addition,
100 mg IM once should be the long acting and not the short acting formulation. The drug was discontinued.
Pharmacists at Johns Hopkins are dedicated to help patients benefit from their medications safely, effectively, and affordably. Each
scenario illustrates a clinical pharmacist’s indispensable impact.

Page 8 Volume 17; Issue 2
Departmental Continuing
Education
“Medications Associated with
Exacerbation of Heart
Failure”
ACPE Accredited CE
Presentation
Laura Fuller, PharmD, BCPS
Dr. Ken Shermock appointed to the 2018 Pharmacy Forecast
Advisory Committee...Congratulations!
Dr. Kenneth Shermock, PharmD, PhD was invited to be a member
of the ASHP Foundation’s 2018 Pharmacy Forecast Advisory
Committee. The Foundation is celebrating the publication of the
Pharmacy Forecast 2017 in the January 15th edition of AJHP and
is moving forward quickly with planning for the 2018 edition.
February 2, 2017
3:00 PM - 4:00 PM, AIP
Conference Room
February 6, 2017
12:00 PM - 1:00 PM, Zayed 2117
(Lunch provided)
February 15, 2017
7:00 AM - 8:00 AM, AIP
Conference Room
The Pharmacy Forecast Report is a high-profile and impactful
project of the ASHP Foundation. The Report predicts important
developments in eight domains that are likely to challenge pharmacy
practice leaders in hospitals and health systems. Its purpose
is to improve the effectiveness of leaders in hospital and healthsystem
pharmacy practice by helping them plan for the future.
Pharmacy Forecast reports the results of a survey of trend watchers in health-system pharmacy,
analyzes predicted trends, and presents more than 40 authoritative, actionable strategic recommendations
to pharmacy practice leaders. As a member of the committee, Dr. Shermock will
participate in the identification of key issues and trends in healthcare.
February Birthdays
Sun Mon Tue Wed Thu Fri Sat
“Herbal and Homeopathic
Medications:
From Early Civilizations to
Modern Day”
ACPE Accredited CE
Presentation
Robert Green, PharmD
February 21, 2017
12:00 PM - 1:00 PM, Hurd Hall
(Lunch provided)
5 6
Laura Hatfield
7
Dinesh Pun
Annette
Rowden
Julie
Waldfogel
1
Maher Ebeid
Ubong Ibok
Maika Patino
8
Daron Fleet
Laura Fuller
2
Marie Lymon
Victoria
Sammarco
Regina Yun
9
Jason
Topolski
3
Kumaran
Ramakrishnan
Tyrell Schaffer
Hunter Smoot
Cathy Walker
10
Sharaun
Harvell
4
Jason Choe
Ahmed Eid
Eric Fourhman
11
Michelle McCoy
February 28, 2017
3:00 PM - 4:00 PM, AIP
Conference Room
12
Manisha Hong
Adrienne Taylor
Javier Vazquez
13
Carrie Moon
14
Kaitlyn Borries
15
Sharon Addo
Christine
Collins
16
Amy Shofner
17
Sharon
Johnson
18
Michael Evans
Sean Lasota
Modestus
Nwadike
Pharmacotherapy Rounds will
not be held in February due to
residency interviews.
19
Rachel Zamora
20
Julie Gibbons
21
Kristin Gilmore
22
Leah
Georgandellis
23
Rachel Lim
24
Dennisse
Rubio Colon
Stanley Okeke
25
Wayne Borkoski
Ricky Haskey
26
Elizabeth
Goswami
Traize Takla
Deanah Thomas
Tricie Williamson
27 28
Nicole Arwood
Michael
Goldenhorn
Jennifer
Redmon
Michael Veltri