Presentation Outline ICHP Annual Meeting September 13-15

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Prescribing Impact on Med‐Use Process • Which dose...650 mg or 1000 mg (adults)? • Dose calculation required for pediatrics • Scheduled vs. PRN • Restrictions to specialists, units, or patient types? Dispensing • Doses < 1000 mg require manipulation • Contents of vial must be administered within 6 hrs • Adequate space in automated dispensing machine (ADM)? Monitoring Impact on Med‐Use Process • Ensure use of < 4 grams per day of APAP ‐ Hold use of combo APAP products 24 to 48 hours post‐op > FDA requiring manufacturers to limit APAP in prescription products to 325 mg per single dosage unit and add a black‐ box warning by 2014 • Cost‐effectiveness ‐ IV to PO conversion ‐ Automatic stop dates/times, e.g. 24 hours after 1st dose Food and Drug Administration. Prescription drug products containing acetaminophen; actions to reduce liver injury from unintentional overdose. Fed Regist. 2011; 76:2691‐7. Conclusions • IV APAP is generally well tolerated at recommended doses • Clinical trials indicate IV APAP is an effective analgesic in a variety of inpatient and outpatient surgical procedures • Use should be limited to ≤ 24 hours postoperatively and patients who can not tolerate PO or PR administration • Institution‐specific strategies are required to ensure safe use of IV APAP Impact on Med‐Use Process Administration • Infusion pump required ‐Errors related to infusion pump programming have been reported to the Institute for Safe Medication Practices (ISMP) > ISMP recommends use of both mg and mL dosing when prescribing and communicating dose information • Y‐site compatibility for patients with multiple infusions Institute for Safe Medication Practices (ISMP).IV acetaminophen and overdoses in kids. ISMP Medication Safety Alert. Apr 2012; 17(8):1,4. Active Learning Assessment Which of the following are issues that must be addressed when evaluating IV APAP for formulary addition? I. Ensuring patients do not receive > 4 gm APAP per 24 hrs II. Manipulation of vials when doses are less than 1 gm III. Risk of infusion pump p perrors if doses not ordered in mg g and mL a. I only b. III only c. I and II d. II and III e. I, II, and III Thank you! dabazia@paloscomm.org 8/29/2012 5
References 1. Rømsing J, Møiniche S, Dahl JB. Rectal and parenteral paracetamol, and paracetamol in combination with NSAIDs, for postoperative analgesia. Br J Anaesth. 2002;88:2<strong>15</strong>–26. 2. Remy C, Marret E, Bonnet F. Effects of acetaminophen on morphine side‐effects and consumption after major surgery: a meta‐analysis of randomized controlled trials. Br J Anaesth. 2005;94:505–<strong>13</strong>. 3. Elia N, Lysakowski C, Tramer M. Does multimodal analgesia with acetaminophen, nonsteroidal antiinflammatory drugs, or selective cyclooxygenase‐2 inhibitors and patient‐controlled analgesia morphine offer advantages over morphine alone? Anesthesiology. 2005;103:1296–304. 8/29/2012 6
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ACTIVITY DESCRIPTION Target Audienc
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Current Challenges • Expansion of
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Examples of Medication Consideratio
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Etiology (Dana Point, 2008) 1’. P
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PAH Therapy Targets Schulze-Neick I
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Chronic Adjuvant Therapies in PAH D
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Cummulative suurvival Survival in I
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ACCF/AHA Consensus PAH Treatment Al
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Study Name Drug SUPER-1 Oral silden
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IV Epoprostenol in PAH Due to Scler
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70 60 50 40 30 20 10 Inhaled Ilopro
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Conclusions • PAH therapy improve
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ESC/ERS Guidelines Galie N, et al.
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FUTURE DIRECTIONS WHICH MAY IMPACT
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Rationale for “Front-Loaded” Ap
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Addressing gthe Challenges g in PAH
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Considerations • Central vs. peri
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Pulmonary Hypertension • Approxim
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Example Cassette Calculations • V
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Assessment Question 1 Which of the
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Illinois Council of Health‐System
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Patient Activity ‐ 1 Patients in
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Hospitalists National Trends • Ja
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Pharmacy Landscape • PGY‐2: So
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Primary Care Physicians by Field, F
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Health Systems Pharmacy and TATAI
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Readings The 21 Irrefutable Laws of
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What is a “Practice Model”? •
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Completing the Self Assessment •
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Residency trained (B23p) Illinois N
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Solving the PPMI Puzzle ‐ Here Ar
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Overview of Value Based Purchasing
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Implementation of Medication‐ rel
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Question #1 Within which programs a
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Solving the PPMI Puzzle‐ Here are
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Discharge Education/Med Rec • New
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Media‐Worthy Trials? Making Sense
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Prevention of Recurrent VTE • Unp
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VTE recurrence during study period
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Which patient might be a candidate
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Azithromycin and CV Death • Endpo
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Azithromycin and CV Death Azithromy
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Hormonal Contraception and VTE •
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• Age • Calendar year • Educa
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ARR=2.20, 2.28 for stroke, MI when
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Which of the following combinations
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3 Months of Treatment for Latent TB
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3 Months of Treatment for Latent TB
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T/F: Rifapentine in combination wit
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2. Which of the following statement
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Fitting the Counseling Piece into M
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Current Evidence: Implementing Bund
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Teach Back Process • Step 1 Expla
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Questions for Consideration and Dis
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Why do we care about ADE? • Adver
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True or False • Medication errors
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Check Point Which of the following
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Proactive Screening Process Patient
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MTI Pilot at NAH PharmD Students tr
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ASHP PPMI Case Study Adding Value:
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Interdisciplinary Teamwork: How Phy
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Highly Effective Healthcare • Wha
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Inter‐Professional Teams ‐ Chan
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Meeting the PPMI Goals for Technolo
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Drug‐Bug Mismatch Example Con’t
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Drug‐Bug Mismatch Build Rules •
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Patient Scanning Compliance Sample
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Global Immunizations 3 • Jan 2012
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Mobile Devices: Beyond Angry Birds
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Google Play • Google Play - Inter
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Other Useful Productivity Apps •
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Mobile Devices: Beyond Angry Birds
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Net Activations by Industry Source:
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News Readers/Aggregators Features S
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Contact Information • E‐mail: -
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Early‐Onset Sepsis • Sign and s
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• BR is on day 2 of cefotaxime wi
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Immunizations: The Superheroes to P
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Current ACIP Recommendations Influe
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Herpes Zoster Vaccine Recommendatio
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Assessment Questions 1. What are th
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HIV Linkage and Retention in Care T
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DHHS Guidelines, March 2012: When t
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Protease Inhibitors • Require “
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Mean Change (mg/ /dL) STARTMRK: Lip
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Page 179 and 180: Staging Stage Criteria (Durie‐Sal
Page 181 and 182: Salvage Therapy Partial List Regime
Page 183 and 184: Bortezomib-Thalidomide-Dexamethason
Page 185 and 186: Case 2 ST is a 76 y/o African Ameri
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Page 191 and 192: New Drugs 2012 Anna Nowobilski‐Va
Page 193 and 194: Pulmonology » Cystic Fibrosis •
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Page 197 and 198: NEW DRUGS AND BIOLOGICALS 2012 RESO
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Page 205 and 206: Green Zone • Patient is not havin
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Page 211 and 212: Unraveling Unraveling The The Puzzl
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Page 223 and 224: Impact of Postoperative Pain • Pi
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Page 231 and 232: A New Approach IV Acetaminophen •
Page 233 and 234: References • Schechter, Leslie N.
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Page 237 and 238: Error Potential • Inadvertent IV
Page 239 and 240: Decolonization Methods • Anti-sep
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Page 251 and 252: Background • Lack of comprehensiv
Page 253 and 254: Results Results‐User User Audits
Page 255 and 256: Special thanks to: • Carol Heunis
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Page 269 and 270: Questions? Residency Project Pearls
Page 271 and 272: The Interview: Your Preparation •
Page 273 and 274: PGY1 Residency Options Carol Heunis
Page 275 and 276: RESIDENCY PROGRAM BASICS • Progra
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CV: The key to a top curriculum vit
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Tips for a Top Notch CV • Focus o
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What is PhORCAS? • PhORCAS is the
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Piecing together the new CHEST guid
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Initiating therapy CHEST 2012 2.1.8
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What is “Consistently Stable?”
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Puzzle # 2A: patient has just compl
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What would you do for JJ? • A. Ho
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Considerations for SB • Bleeding
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Presentation Outline ICHP Annual Meeting September 13-15

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