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November 30, 2020

ASHP’s Midyear Clinical Meeting is Unstoppable

Dear Colleagues,

The 55th Annual Midyear Clinical Meeting and Exhibition is about to kick off! We have a wonderful week ahead packed with world-class educational programming, exciting speakers, and opportunities to connect with colleagues and enrich your practice. This year’s theme is “Unstoppable,” and more than 23,000 attendees will have the opportunity to come together, Dec. 6 –10, on our virtual platform to knowledge share, network, and experience the largest gathering of pharmacists in the world in a new and unique way. Registration will remain open through Dec. 10, so there is still time to register and take advantage of everything the meeting has to offer.

We are delighted to welcome our keynote speaker, award-winning actor, producer, director, and COVID-19 survivor, Tom Hanks, on the morning of Monday, Dec. 7. We are also very pleased to welcome Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, joining us on Wednesday, Dec. 9. Please note that these special events will only be available for viewing during the scheduled session days and times. You don’t want to miss these extraordinary speakers.

The 2020 Midyear also features:

  • More than 175 hours of continuing education
  • More than 4,600 posters
  • 1,328 booths in the Residency Showcase (29% increase over 2019)
  • 132 exhibitors/booths

The Midyear Clinical Meeting is the longest, continually running clinical pharmacy meeting in the world. This year, against the backdrop of a global pandemic, ASHP promises to bring you an unstoppable Midyear, offering the most timely and relevant content to support contemporary practice and the best possible patient care.

Our 55th meeting brings together our profession’s best and brightest subject matter experts who will share their knowledge about current pharmacy practice in an ever-changing healthcare landscape.

The distribution and administration of the anticipated COVID-19 vaccines are top of mind and on Monday, Dec. 7, ASHP will hold the first of two late-breaking COVID-19 vaccine sessions. Monday’s session will focus on clinical considerations. A second session will be held on Wednesday, with a focus on operational considerations. In addition to the late-breaking vaccine sessions, we have 18 relevant and informative sessions that will keep you up-to-date on the latest developments related to COVID-19 response and recovery.

Monday will also feature a special Town Hall hosted by Paul C. Walker, Pharm.D., FASHP, chair of the ASHP Task Force on Racial Diversity, Equity, and Inclusion. Dr. Walker will present the Task Force’s draft recommendations for new and enhanced efforts ASHP should take to address issues of racial diversity, equity, and inclusion impacting Black, Indigenous and People of Color. The Task Force will consider feedback from the Town Hall and other channels in preparing a final report and recommendations to submit to the ASHP Board of Directors in January 2021.

This year’s Midyear marks the first anniversary of the ASHP Innovation Center. The center seeks to elevate the vital role hospital and health-system pharmacy practitioners play in new and emerging science, and position pharmacy practitioners as influencers in developing systems that advance patient safety and quality care. This year’s Midyear offers a wealth of programming dedicated to implementing and using innovative strategies and solutions to further pharmacy practice, including two critical on-demand sessions: Innovations in Drug Information Practice and Research; and Advanced and Innovative Roles in the Specialty Pharmacy Setting. Later in the week, on Thursday, Dec. 10, we have a session highlighting the pros and cons of new technologies that have improved patient care safety and efficiency.

As part of the ASHP Innovation Center, the ASHP Foundation is currently accepting applications for a competitive grant program to support projects that demonstrate the impact of optimizing health information technology and digital transformation that enhance safe and effective use of medications. The grant program is available for interprofessional healthcare teams with a pharmacist as principal investigator. The deadline for applications is Feb. 4, 2021.

I encourage attendees to check out the ASHP Midyear Virtual Posters. With our virtual platform, you can review poster PDFs and audio clips summarizing each project. Authors will be available for real-time video Q & A chats alongside their virtual posters.

These are just a handful of the highlights from the largest gathering of pharmacists in the world. Be sure to follow us on social media @ASHPOfficial and #ASHP2020 on Twitter, Facebook, Instagram, and LinkedIn, and look for News & Views, the official Midyear newspaper, which will be delivered digitally to all attendees via a daily e-mail. Also, be sure to check out ashptv.com for daily interviews, member stories, and content.

The success of this unstoppable Midyear Clinical Meeting is due to the tremendous work of hundreds of ASHP members and staff, and we are pleased to showcase their efforts and share this event with you.

Finally, I would like to wish all of our members a safe and healthy holiday season. Thank you for being a member of ASHP and for all you do for your patients and our profession during these very challenging times.

Sincerely,

Paul

November 13, 2020

Pharmacists Take the Lead in Providing Vaping Interventions

Kimberly Novak, Pharm.D., BCPS, BCPPS, FPPA, with PGY2 residents Becca Wytiaz and Mara Rubin.

AN INCREASE IN THE USE OF E-CIGARETTES AMONG adolescents in the U.S. is erasing recent progress in reducing overall tobacco use in this population, according to alarming statistics from the Centers for Disease Control. Some 27.5% of high schoolers and 10.5% of middle schoolers reported current use of e-cigarettes, the CDC reported in a recent issue of the Morbidity and Mortality Weekly Report, creating an immense opportunity for pharmacists to get involved.

Vaping and COVID-19

In 2019, there was a surge in E-cigarette or vaping product use-associate lung injury (EVALI) which was particularly noted in adolescents and young adults. Interestingly, there was an observed decrease in EVALI cases early in 2020, explained Kimberly Novak, Pharm.D., BCPS, BCPPS, FPPA, an advanced patient care pharmacist in pediatric and adult cystic fibrosis at Nationwide Children’s Hospital in Columbus, Ohio. “This was originally attributed to increased public awareness of vaping and strategies aimed at reducing marketing and access of flavored vaping products of preferred by this population,” said Dr. Novak. “However, this decrease also corresponded with the initial surge in COVID-19 cases and many state-mandated stay-at-home rules as well as increased implementation of work-from-home and virtual school policies.”

As many of these policies were loosened in the summer months, health care practitioners have noted an increase again in EVALI cases, perhaps due to less supervision as parents returned to onsite work, she added.

Pharmacist roles

In general, e-cigarette usage in adolescents “has blown up among this population way more than people suspected, particularly because it’s so easy to hide, and it doesn’t smell,” said Dr. Novak. “This snuck up on us as a society with very little regulation, and now we’re working backward, trying to catch up to this epidemic that got out of the bag before we got a hold on it.”

Kyle Mays, Pharm.D., BCPPS, discusses cessation options with a teenage patient.

Pharmacists can play several important roles in patient care regarding e-cigarette usage and related lung injuries, said Dr. Novak, an ASHP member since 1998. In teaching hospitals like hers, pharmacists provide continuity where attending physicians and residents may change over. They also can monitor trends in nicotine usage, and, because patients view pharmacists differently than their physicians, they may share more information about medication histories with them.

Typical agents prescribed to help curb nicotine cravings, like varenicline (Chantix) and bupropion (Zyban, Wellbutrin), are not indicated for people under the age of 18, noted Justin Reinert, Pharm.D., BCCCP, a clinical assistant professor at the Ben and Maytee Fisch College of Pharmacy at the University of Texas at Tyler. This doesn’t mean physicians aren’t prescribing them for this population, he said, but pharmacists can employ motivational interviewing techniques and assess patients’ readiness to change.

Interventions to reduce usage

In addition, pharmacists can use their medication expert hat to advise primary care teams on different vaping products used by teens, said Kyle Mays, Pharm.D., BCPPS, a critical care pharmacist with SSM Health Cardinal Glennon Children’s Hospital in St. Louis. When his hospital saw a recent surge in illnesses among patients using THC-related vaping compounds, some of his colleagues weren’t aware these products were linked to lung injuries because of the solvents and vitamin E they contained. If patients are admitted with severe lung illnesses and are intubated and can’t speak, Dr. Mays and colleagues play detective, eliminating potential causes or ordering urine toxicology screens.

Justin Reinert, Pharm.D., BCCCP

In an effort to address e-cigarette usage in his area, Dr. Reinert is directing a two-fold intervention. Pharmacists and doctoral pharmacy students are providing educational in-services and assemblies in local schools, as well as surveying high school students about their use of nicotine products. Then, beginning this fall, pharmacy students will provide nicotine cessation programs in schools, targeted to high schoolers who may have violated a tobacco or nicotine use policy.

Among over 100 students they surveyed so far, about 78% reported using these products, said Dr. Reinert, an ASHP member since 2013. “Students are primarily into vaping, but it’s important to be cognizant of other things out there,” he noted. “Kids are still smoking cigarettes, they’re still using cigar wrappers for marijuana. The addictive component of the devices remains nicotine.”

Dr. Reinert tries to use shock value to educate the students, asking how many of them who drive and pump gas would stick the gas nozzle into their mouths and inhale. “There are components in these vaping cartridges that are identical to components of unleaded gasoline—lead, mercury, nickel, cadmium and heavy metals, etc.,” he said. “The students have no idea, which is terrible, but it also highlights the need for targeted education at this age group, which I think pharmacists are uniquely positioned to accomplish.”

Strategies for pharmacists    

The pharmacists offered advice on working with adolescent patients and their families:

  • Take an objective yet compassionate stance. “Don’t tell them they’re [doing something] wrong,” Dr. Novak said, as that can cause the patient to shut down and not disclose information. Instead, acknowledge that they may have made an unhealthy choice but keep the lines of communication open. “Your job is to treat the patient and make them better, not ridicule what they were doing that brought them in,” added Dr. Mays, an ASHP member for the past 10 years.
  • Put your message in terms relative to adolescents. Dr. Reinert’s cessation curriculum discusses the financial, health and psychosocial ramifications of nicotine use at a level appropriate for adolescents, not adults or younger children.
  • Offer resources for quitting. Educate adolescents that, similar to cigarettes, it’s hard to quit cold turkey, Dr. Mays noted. Encourage them to seek appropriate help through their pediatrician or another primary care provider, and work with them to develop a plan.
  • Try to talk to the patients without their parents. Patients may not want to fully admit to using these products, especially if their parents are present, Dr. Mays said.
  • Keep current on your knowledge. People tend to think JUUL devices are the e-cigarette of choice for teens, but new ones are popping up all the time, said Dr. Mays. “You have to stay trendy with what’s going on in a teenager’s mind,” he added.

Patient impact

Vaping devices essentially are nebulizers that deliver a drug, Dr. Novak said. But they haven’t yet been adequately studied to determine what products should go in them, what the safety margins are, or if chemicals put into them are altered by heat that the devices generate. Hopefully, with time, she said, the medical community will learn better safety information about these devices and their related products.

Meanwhile, pharmacists should stay involved, such as working with ASHP to advocate for more regulation around vaping and nicotine products. “The more we can do this on an individual level, whether in our own institutions, providing education or working with poison centers, we can make a pretty positive impact wherever our patients are,” said Dr. Novak.

 

By Karen Blum

 

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November 12, 2020

ASHP’s Standardize 4 Safety Initiative Helps Pharmacists Reduce Medication Errors

Nathaniel Sims, M.D.

ASHP released its recommended list of concentrations and dosing units for intravenous continuous medications for pediatric patients in November 2020, representing the culmination of a multi-year, multidisciplinary effort to improve medication safety for children and adults nationwide.

The Standardize 4 Safety (S4S) initiative, funded by the U.S. Food and Drug Administration (FDA) and helmed by ASHP, is the first national, interprofessional effort to standardize medication concentrations to reduce errors resulting from confusion over non-standardized drug concentrations and errors that result from concentration differences when patients transition their care from one setting to another. Expert committees with the program previously released two lists—standardized concentrations for adult continuous infusions and compounded oral liquids.

ASHP standardization leadership

Many health care systems have developed their own local standardized concentrations, or formularies, for how drugs are mixed or compounded for administration, and have shared these widely, said Nathaniel Sims, M.D., a cardiac anesthesiologist and medical device developer at Massachusetts General Hospital (MGH) in Boston. Dr. Sims served on the expert committee to develop the MGH intravenous continuous medications for pediatric patients. However, the S4S initiative is “special in that it arose as a project of the FDA,” he said. Because the FDA does not have authority to mandate such lists, it partnered with ASHP and other entities with high credibility. “The S4S initiative is exceptionally well-positioned to influence clinical practice,” Dr. Sims said.

For over a decade ASHP has supported the creation of nationally standardized drug concentrations for adult and pediatric medications, but the work began in earnest in 2015, when the FDA awarded ASHP a three-year contract to develop and implement lists of such concentrations for intravenous and oral liquid medications. That contract, which was later renewed, was part of the FDA’s Safe Use Initiative—an effort to reduce preventable harm from medications by fostering and facilitating public and private collaborations within the healthcare community.

Through these efforts, ASHP gathered a variety of pharmacist, physician, and nurse experts from across the care continuum and partnered with national patient safety organizations such as the Pediatric Pharmacy Association, the Institute for Safe Medication Practices (ISMP), and the Association for the Advancement of Medical Instrumentation, as well as regional and local health care organizations.

Although additional lists are planned, finalization of the first three lists is timely. Concurrent with many hospitals launching ambitious initiatives to integrate drug infusion pumps with their clinical information systems for automatic programming. Dr. Sims noted that since smart IV pumps will not accept auto programming instructions unless there is a perfect match between the concentration in the pump’s drug library and the pharmacy order, hospitals including MGH are working hard to create compatible systems using the ASHP standard lists as a benchmark.

Benefits of standardization

Standardization is helpful in many ways, said Rachel Meyers, Pharm.D., B.C.P.S., B.C.P.P.S., F.P.P.A., a pediatric pharmacy specialist at Saint Barnabas Medical Center in Livingston, N.J., who served on the committee for the pediatric continuous infusion list. It can simplify medication ordering for providers; enhance efficiency for pharmacies, who can then purchase less stock; and streamline production and allow for the formulation of premixes.

Rachel Meyers, Pharm.D., B.C.P.S., B.C.P.P.S., F.P.P.A.

“It might sound meaningless, caring what concentrations other hospitals use,” said Dr. Meyers, also a clinical associate professor of pharmacy practice administration at Rutgers University’s Ernest Mario School of Pharmacy. “But it’s actually really important, because we often transfer our patients between hospitals. It helps a lot if we’re all using the same concentrations.”

Having a standardized library for syringe pumps also is beneficial, she noted. “When you think about smaller hospitals who might not have a pediatric pharmacist on staff, then when they get a pediatric patient admitted to the Emergency Department, they’ll have a syringe pump ready to go already programmed with the appropriate concentrations,” Dr. Meyers said. “It just makes this whole process that much safer for the patient, so we can fully utilize tools at our disposal to their maximum effect.”

In the pediatric population, wide variations of weight range, dosing units, and fluid tolerance need special consideration, Dr. Sims cautioned. These factors may require multiple concentrations. Out of about 43 unique drugs in the ASHP pediatric concentration list, approximately 10 have three recommended standard concentrations and 30 have two recommended standard concentrations.

The key benefits of ASHP’s lists are several-fold, Dr. Sims said. The ASHP standard concentrations were created by many health care system experts using a disciplined consensus process informed by best practices for all patient groups, from “micro-preemies” in the neonatal intensive care units to adults. They also include stability data and other information essential to validate the safety of these standard concentrations. ASHP can use its broad network to publicize the lists, as well as additional educational materials, including an online course directed by Dr. Sims. Launched in November, it covers a comprehensive overview of syringe pumps and considerations for use at low flow rates. The online course offers free continuing education credits for pharmacists, nurses, and physicians, emphasizing the importance of ASHP’s standard concentrations for the safe use of infusion pumps.

Pharmacists at the helm

Pharmacists, as the “original safety champions for drug safety,” are primed to help lead efforts to adopt these lists at their home institutions, said Jared Cash, Pharm.D., M.B.A., B.C.P.S., F.P.P.A., director of pharmacy at Intermountain Primary Children’s Medical Center, in Salt Lake City. “Pharmacists are both the production crew as well as the clinical crew involved with communication of medication information and assuring the correct dose.”

Jared Cash, Pharm.D., M.B.A., B.C.P.S., F.P.P.A.

Pharmacists can employ various strategies to help push for adoption of these lists at their hospitals and health systems, Dr. Sims said. For example, they can leverage a “sentinel safety event” to convene a discussion about adoption of S4S.

A second approach is to combine a discussion about the ASHP standards with a local initiative, such as a planned revision of infusion pump drug libraries. Additionally, pharmacists can create a multidisciplinary initiative within a hospital or health system to validate and benchmark the ASHP standard concentrations against what they already are doing. They could use the ASHP lists as a prompt to “spring clean” the infusion pump drug libraries, Dr. Sims suggested, or run queries in electronic medical record systems to capture utilization of each of the medications, and learn the range of real-world dose rates clinicians program into infusion pumps to see whether resulting flow rates match patient needs.

“Be aware of the lists as you’re reviewing your formularies and EMR product selections,” Dr. Cash added. “Many places are already compounding these items and to change their compounding to the specific concentration is strongly encouraged.”

Process improvements

Some hospitals have already adopted a list of standard concentrations for neonatal drug infusions that was published several years ago by the Vermont Oxford Network, a nonprofit voluntary group of healthcare professionals, and the ISMP, Dr. Meyers said, so there is a precedent. ASHP’s working group was conscientious to include considerations of that previous list in their own work, Dr. Cash noted.

“The ASHP list is bigger, and I think it’s important for pharmacists to stress the safety of standardizing those concentrations,” Dr. Meyers said. “It not only makes transfer between hospitals easier, but if you’re part of a health system, it can help make all processes of care safer, from your EMR to your syringe pumps.”

Experts working on the S4S standards hope that the work may motivate drug manufacturers to produce some of the recommended standard concentrations, Dr. Meyers added.

“One thing we really struggle with in pediatrics is we have to compound so many of these medications,” she said. “By making this list and selecting standards, we’re hoping some drug manufacturers will pick up on this and say it may be worth it to make these items, because we know that commercially available products are safer.”

While pediatrics may have the most to gain from standardized lists, Dr. Cash said, there is still a lot of medication safety the lists can improve for adults, too. “The amount of compounding within the adult population is more significant than people recognize, and having standardized concentrations for any of that compounding reduces risk,” he said.

 

By Karen Blum

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Tips for Students: Getting the Most Out of the 2020 Midyear Meeting

Marissa Chow, a fourth year Pharm.D. candidate at St. Louis College of Pharmacy

WITH SOME ADVANCE PLANNING AND PREPARATION, students will find this year’s virtual Midyear Clinical Meeting as enlightening and productive as the in-person meetings of previous years. The meeting is loaded with student programming, so attendees like Marissa Chow, a fourth year Pharm.D. candidate at St. Louis College of Pharmacy, are getting down to work preparing for a few jam-packed days of education, networking, and interviews.

“Since in-person meetings will most likely not happen due to safety concerns during the COVID-19 pandemic, it will be even more important to chat with the right people at this year’s Midyear,” said Chow.

Preparation is key

Her preparation includes looking through the ASHP Midyear’s student-specific programming, which will be offered both in on-demand and simu-live formats. Residency-focused student sessions will cover all aspects of residency applications and interviews, ranging from navigating the PhORCAS application system to understanding the Match Algorithm. Professional development student sessions will aim to help students of all classes explore post-graduate opportunities and personal success topics like branding and financial guidance.

As with every year, the ASHP virtual residency showcase will give students a chance to interact with residency programs, learn more about what they have to offer, and narrow down their options prior to applications. Additionally, the Personnel Placement Service (PPS), free to all fourth-year student registrants through advance sign up, will provide an opportunity for dedicated interviews and one-on-one time.

Chow said she is already researching programs that are participating in this year’s residency showcase and writing down criteria and questions ahead of time to help her evaluate programs.

Advice for first-timers

One piece of advice Chow had for students attending the Midyear for the first time is to map out where they want to go ahead of time and to read and learn about the virtual platform prior to the meeting, “so you aren’t scrambling to find the next item to attend and there are no technical errors.”

“And consider finding a “Midyear Buddy” to support each other for meetings, residency talks, and even PPS,” Chow said.

Elizabeth King, Pharm.D.

Students should also work with their preceptors and professors ahead of time to make sure they can dedicate time to the meeting, said Elizabeth King, Pharm.D., who graduated from pharmacy school in 2018 and is now a hematology/oncology pharmacist at Mayo Clinic, Rochester, Minnesota.

“When we attend in person, there is a natural separation from other responsibilities so we can focus on the meeting, but this may not be the case in the virtual setting,” Dr. King said.

Students should carve out a time and space with minimal distractions and dress as if they were attending the conference in person, “to get yourself in the right mindset,” she recommended. “And just like in person, you will need breaks so don’t be afraid to walk away from the screen,” she added.

Although the meeting is chock-full of student programming, Dr. King suggested attending at least one new practitioner session and one pharmacist session.

“If students have a clinical area they’re interested in, it’s a great idea to attend some of the clinical sessions on that topic to hear about how clinical practice is changing,” she said, noting that the virtual format means attendees can spend more time viewing posters and listening in on sessions and less time “shuttling between locations.”

Another reason to venture outside of student programming is to get a better sense of the faculty at an institution where one might apply for a residency, Dr. King said.

“You can get an idea of what the people you will be learning from are like and what their academic passions are, which also gives you talking points for interviews,” she said.

Dr. King recommended actively participating in sessions by asking questions. If there are private messaging options, contacting others to network can help you connect with people who have similar interests, she added. “Also make sure also to build up your profile on ASHP and PPS so that others can find you based on your interests and reach out to you,” Dr. King said.

Residency search

Younger students interested in learning about the residency process should attend the PhORCAS session to find out what programs are looking for in residency candidates, Dr. King said.

“Knowing this can help you set your priorities so that you end up getting to where you want to be academically,” Dr. King said. “The earlier you can start thinking about and preparing for residency, the better.”

For residency applicants, it’s a good idea to formulate a set of criteria that can help decide on a program and also to formulate questions tailored to that specific institution, Dr. King advised.

Nelly Adel, Pharm.D., BCOP, BCPS, supports her student during an ASHP Midyear meeting poster presentation.

“These questions can help you understand the culture of the institution, the educational offerings they have, or explore key non-negotiable items that you want in a residency,” she said.

As a residency recruiter herself, Nelly Adel, Pharm.D., BCOP, BCPS, chair of the department of pharmacy practice and associate professor in oncology, Touro College of Pharmacy, New York, appreciates when residency candidates distinguish themselves from others in the candidate pool.

“Ask questions that are not answered on the program’s website,” she recommended. “For example, I like to be asked about projects that I have worked on with students or residents and that have made a difference.”

Dr. Adel also recommended highlighting co- and extra-curricular activities and volunteer work. “I speak with 20-30 candidates a day and it’s sometimes hard to remember each one.  This can help to separate you from your peers,” she said.

Virtual etiquette

One thing Dr. Adel emphasized is to approach the Midyear with professionalism. “Even though the meeting is virtual, the same rules as in-person meetings hold,” she said. She encouraged students to wear professional attire, find a room without visual distractions in the background, smile when speaking to others or presenting a poster, and to not be “sitting or lounging at your bed.”

“There’s also no reason to be late for a meeting or a presentation, particularly when it’s virtual,” she said. “So become familiar with the platforms you’ll be using by playing around with them ahead of time. This could help avoid technical glitches and delays.”

Having attended and hosted numerous virtual meetings herself, Dr. Adel said student presenters and residency applicants should look straight into their computer’s camera rather than at the picture on the monitor.  “This helps you connect better with the person in front of you,” she said. Another technical consideration to keep in mind is the possible lag time during remote conversations, Dr. Adel added.

“Avoid interrupting the other person by waiting for the end of their sentence,” she said. “If you want to interject, find the right moment and know how to interrupt without being offensive. That holds true whether it’s a live or a virtual meeting.”

Despite the checklist of considerations that students should keep in mind prior to this year’s Midyear, Chow, the student pharmacist, is enthusiastic about the potential of the meeting.

“I’m excited to attend this year’s meeting!” she said. “Although this is not the traditional format or the format that most people would have wanted for the Midyear, as the pharmacy profession as a whole has shown, we are good at adapting to change.”

 

By David Wild

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