PSHP 2026 Residency Conference: Full Schedule

Purpose: The purpose of this retrospective study is to evaluate the appropriateness and effectiveness of low-intensity pravastatin 20 mg daily in statin-naïve, kidney transplant recipients, according to the estimated baseline ASCVD risks.
Methods: The study includes a chart review of 296 subjects who underwent kidney transplants between September 1, 2023, and September 1, 2024, with at least 12 months of post-transplant follow-up. Baseline demographics that are pertinent to estimate ASCVD risk are included. Transplant data was collected, including transplant indication, lipid profiles, and incidence of delayed graft function. Goal statin intensity was extrapolated based on age, history of diabetes mellitus, chronic kidney disease, tobacco use, coronary calcium scores (when available), and calculated ASCVD scores. ASCVD risk scores were assessed using the American College of Cardiology online calculator. Pravastatin initiation and monthly continuation were recorded. If pravastatin discontinuation occurred within 12 months, timing, reason for discontinuation, and intensity changes were further assessed. Information on immunosuppressive therapy was also collected.
Results: A total of 296 patients were evaluated, and 60 patients were included for analysis. The 10-year ASCVD risk was estimated for 24 (40%) patients. Low-intensity pravastatin was appropriate in 35 (58%) patients. The median changes in LDL, HDL, and total cholesterol levels from day 30 to 365 post-transplant were 7.5 mg/dL, 1.5 mg/dL, and 10 mg/dL, respectively (all p-value>0.05). Approximately 51 (85%) patients continued pravastatin throughout one year post transplant. Four (6.7%) discontinued pravastatin due to reported intolerance or self-discontinuation; no patients met clinical criteria for hepatoxicity and rhabdomyolysis. One (1.7%) experienced non-fatal myocardial infarction (MI); however, no patients experienced ischemic stroke.
Conclusion: We estimated that more than a third of patients might be considered for a higher intensity statin based on baseline characteristics, estimated risk assessment, and ASCVD risk enhancers. Most patients remained on low-intensity pravastatin for up to one-year post-transplant. Changes in lipid profile from 30 days to 365 days were not significant. No major safety issues were observed, except for non-fatal MI.

Moderators

Shirley Bonanni, PharmD, BCPS

Assistant Director, Clinical Services, Thomas Jefferson University Hospital

Lauren Geerlof

Melissa Roselli

Speakers

Chi Truong

PGY1, Hospital of the University of Pennsylvania

I went to the University of Washington School of Pharmacy. I am the PGY-1 pharmacy resident at the Hospital of the University of Pennsylvania.

Tuesday May 19, 2026 9:00am - 9:20am EDT
Broad Hub EAST

Ambulatory Care

9:00am EDT

Risk Factors for PTT Prolongation in Patients Receiving Continuous Heparin

Tuesday May 19, 2026 9:00am - 9:20am EDT

Broad Hub WEST

Purpose
Evaluate the characteristics of patients started on intravenous heparin for a thrombotic indication that experienced PTT prolongation at Jefferson Einstein Philadelphia Hospital.

Methods
This study included patients at least 18 years old that received heparin for a thrombotic indication and had at least 48 hours of PTTs available in their chart. Prolonged PTT was defined by two or more PTT values greater than 112 seconds within 48 hours of heparin. If patients experienced a prolonged PTT, they were evaluated to determine if a bleeding event had occurred within 48 hours of heparin. Patients were excluded if they were pregnant at data collection. The primary endpoint was a multivariable analysis of characteristics that predisposed patients to prolonged PTTs, including hypertension, abnormal renal and/or liver function, previous stroke, history of bleed, baseline PTT 1.5 times the upper limit of normal, age, alcohol use disorder, body mass index, male sex, bolus on initiation, black race, and thrombolytic or anticoagulant use within 48 hours of heparin initiation. The secondary endpoint was the incidence of bleeding with prolonged PTT.

Results
Data was analyzed using GraphPad Prism 10.6.1. Out of 344 patients, 58 (16.9%) did not experience PTT prolongation. Baseline characteristics between both groups were similar. PTT 1.5 times the upper limit of normal (5.8, 95% CI [1.1-107], p=0.04) was the only variable associated with PTT prolongation. All other variables were considered statistically nonsignificant. Among the 286 patients (83.1%) that experienced PTT prolongation, 65 patients (22.7%) experienced a bleeding event within 48 hours of heparin initiation.

Conclusion/Summary
This study with 344 patients found that a baseline PTT 1.5 times the upper limit of normal is associated with PTT prolongation. Limitations include single-center, retrospective nature, and small sample size. Future steps include conducting a study using a nomogram with conservative heparin dosing in this cohort of patients with PTT prolongation at baseline and more frequent monitoring to prevent adverse outcomes.

Moderators

Matt Alspach, PharmD, BCPS

PGY1 RPD, Tower Health

Poonam Chhunchha

Brandi Thoma

Speakers

Christina Kim

PGY1, Department of Pharmacy, Jefferson Einstein Philadelphia Hospital

My name is Chrissy Kim. I graduated from Virginia Commonwealth University School of Pharmacy in 2025 and am a current PGY1 resident at Jefferson Einstein Philadelphia Hospital. Clinical interests include critical care, cardiology, and academia.

Tuesday May 19, 2026 9:00am - 9:20am EDT
Broad Hub WEST

Cardiology

9:00am EDT

Comparing Fentanyl Infusion Dosing Before and After Implementation of a Non-Weight-Based Approach in the Critical Care Unit

Tuesday May 19, 2026 9:00am - 9:20am EDT

a.Pavilion Hub EAST

Purpose: Evaluate the overall impact of transitioning from a weight-based to non-weight-based fentanyl infusion dosing strategy in critically ill, mechanically ventilated patients in the critical care unit.
Methods: Through a retrospective electronic medical record chart review, adult patients who were admitted to the critical care unit, were mechanically ventilated and receiving a fentanyl infusion were identified for inclusion. Exclusion criteria included patients not admitted to the critical care unit, not mechanically ventilated, did not receive a fentanyl infusion for more than 24 hours, received concomitant neuromuscular blockers and patients who underwent targeted temperature management. The patient population was characterized using descriptive statistics. Students’ T-test or Mann-Whitney U tests were used for continuous variables, and Chi-squared was used to measure the association between categorical variables. Power calculation determined that 100 patients would be included to evaluate study outcomes.
Results: One hundred patients were included in the final analysis. For daily fentanyl dose, there was no statistically significant difference between pre- and post-implementation groups (p-value: 0.391). There was a statistically significant difference between groups for the maximum fentanyl infusion dose (p-value = 0.007). The subset of patients with BMI 30 or greater showed no difference between groups for daily fentanyl dose (p-value: 0.411). The difference between subset groups for maximum fentanyl infusion dose was statistically significant (p-value: 0.006). For length of stay in the critical care unit and total time spent on mechanical ventilation, there was not a statistically significant difference between groups (p-value: 0.139).
Conclusion: Implementation of a non-weight-based fentanyl infusion dosing strategy did not significantly reduce mean daily fentanyl dose compared to weight-based dosing. However, it significantly reduced maximum infusion doses, including in patients with a BMI ≥30. No significant differences were observed in ICU length of stay or duration of mechanical ventilation. These findings suggest non-weight-based dosing may reduce peak opioid exposure without compromising clinical outcomes.

Moderators

Jesse Cheng

Gabrielle Grossman

Jennifer Sullivan

Speakers

Carmelina Branca

PGY1, Penn State Health - St. Joseph Medical Center

I have been working in the pharmacy field since 2015. I began as a certified technician and later became a pharmacy intern during my pharmacy school studies. Currently, I am almost finished with my PGY1 and plan to stay on Per Diem at my current hospital while I look for a full-time... Read More →

Tuesday May 19, 2026 9:00am - 9:20am EDT
a.Pavilion Hub EAST

Critical Care

9:00am EDT

Evaluating Early Transition from Intravenous to Oral Antibiotics for Adult Patients with Community Acquired Pneumonia

Tuesday May 19, 2026 9:00am - 9:20am EDT

a.Pavilion Hub WEST

Purpose:
To evaluate early transition (at day 3 or less) compared to late transition (after day 3) of intravenous (IV) to oral (PO) antibiotics on clinical outcomes.

Methods:
This study utilized retrospective chart review of patients treated for CAP within Lankenau Medical Center (LMC). Adult patients were included if they met CAP criteria published in the IDSA guidelines and received at least 3 days of antibiotic therapy. Patients were excluded if they did not meet criteria for transition to oral therapy in IDSA CAP guidelines, transferred from another inpatient facility, had concomitant infection treatment, or admitted to an intensive care unit on the day of antibiotic initiation. The primary outcome compared 30-day readmission rates between patients transitioned to PO before and after day 3 of antibiotics. Key secondary outcomes were compared between these groups and included 90-day all-cause mortality, hospital length of stay, total antibiotic days of treatment, and Clostridium difficile infection at day 90.

Results:
676 patients were screened for meeting criteria, of which 50 met inclusion criteria. Six of these patients met early transition criterion, with 44 qualifying for late transition. Baseline characteristics across the two treatment groups were similar in Charlston Comorbidity Index and Pneumonia Severity Index scores. Thirty-day readmission occurred in 8 (18.2%) of the late transition group, with no readmissions in the early transition group. One patient within the late transition group did have mortality at 90 days, while no patients within the early transition group met this criterion. Both treatment groups had a median length of hospital stay of 5 days.

Conclusion:
For patients meeting IDSA criteria, early transition to oral antibiotics in CAP patients was associated with decreased 30-day readmission rates as compared to late PO transition.

Moderators

Sara Groome

Adrienne Kroznuskie

Adrienne Terico

Speakers

Cole Anderson

PGY1, Main Line Health, Lankenau Medical Center

Cole is originally from Delran, NJ. He received his Doctor of Pharmacy from Philadelphia College of Pharmacy. Post PGY1 graduation, Cole hopes to practice as an emergency medicine pharmacist or a staff pharmacist, and precept pharmacy students.

Tuesday May 19, 2026 9:00am - 9:20am EDT
a.Pavilion Hub WEST

Infectious Diseases

9:20am EDT

Assessing the Effect of Pharmacist Intervention on Inappropriate Beta-Blocker Prescribing for Essential Hypertension

Tuesday May 19, 2026 9:20am - 9:40am EDT

Broad Hub EAST

Purpose
To evaluate the impact of a pharmacist-led intervention on inappropriate beta-blocker prescribing in adults with essential hypertension (HTN) without compelling indications
Methods
A prospective cohort study of adults with essential HTN who were prescribed a beta-blocker without a compelling indication was conducted across eight family medicine practices at our institution. A randomized convenience sample (N≈120) was identified from a prior medication use evaluation. After chart review, recommendations were sent to the primary care practitioner (PCP) to deprescribe the beta-blocker or switch to a guideline-preferred agent. Patients were excluded for resistant HTN, documented ASCVD, heart failure, recent myocardial infraction, arrhythmias, migraine, hyperthyroidism, intolerance to first-line agents, or cardiology-managed HTN. The primary endpoint was the recommendation acceptance rate. Secondary outcomes were absolute change in inappropriate beta-blocker use, time to implementation, predictors of acceptance, and documented adverse drug events. Descriptive statistics were used.
Results
A total of 25 patients met inclusion criteria. Eleven (44%) recommendations to deprescribe were accepted. Among accepted recommendations with follow-up (n = 6), 3 were implemented. Twelve (48%) recommendations were refused, and 2 (8%) received no response. The most common reason for refusal was that the beta-blocker had been initiated by a specialist (n = 11). Reported adverse drug reactions potentially related to beta-blockers (N = 26) consisted of fatigue (n = 14), bradycardia (n = 4), and sleep disturbances (n = 8). Male sex was associated with lower odds of recommendation acceptance (OR, 0.14; 95% CI, 0.02–0.84; P = 0.032).
Conclusion: to be presented at the conference

Moderators

Shirley Bonanni, PharmD, BCPS

Assistant Director, Clinical Services, Thomas Jefferson University Hospital

Lauren Geerlof

Melissa Roselli

Speakers

Toni Mikhael

PGY2 Ambulatory Care Pharamcy, Penn Medicine, Lancaster General Health

My name is Toni Mikhael, and I am a PGY2 Ambulatory Care Pharmacy Resident at Penn Medicine Lancaster General Health with a strong interest in cardiology and chronic disease management. I earned my pharmacy degree from Touro College of Pharmacy in New York City and completed my PGY1... Read More →

Tuesday May 19, 2026 9:20am - 9:40am EDT
Broad Hub EAST

Ambulatory Care

9:20am EDT

Comparing The Safety and Effectiveness of Venous Thromboembolism Prophylaxis with Unfractionated Heparin Versus Enoxaparin in Patients with Cirrhosis and Chronic Liver Disease

Tuesday May 19, 2026 9:20am - 9:40am EDT

Broad Hub WEST

Purpose: To compare the safety and efficacy of enoxaparin versus unfractionated heparin for venous thromboembolism prophylaxis in hospitalized patients with chronic liver disease by evaluating in-hospital bleeding and thromboembolic events.
Methods: This retrospective, single-center cohort study included adult patients (> 18 years) with a documented diagnosis of cirrhosis or chronic liver disease as identified by relevant ICD-10 codes from January 2020 to June 2025 that have received VTE prophylaxis with UFH or enoxaparin during hospitalization. The data collected includes baseline patient characteristics, admission diagnosis, prior to admission medications, important baseline laboratory values, MELD score, Child-Pugh score, VTE and bleed risk assessment tools, and VTE prophylaxis administered. The primary endpoint is the incidence of in-hospital bleeding events. Secondary endpoints include incidences of in-hospital International Society on Thrombosis and Haemostasis (ISTH) major and minor bleeding, in-hospital VTE events, drug discontinuations due to thrombocytopenia or anemia, and mortality. Data analysis was completed using descriptive statistics.
Results: A total of 82 patients were included (enoxaparin n=46; UFH n=36). Baseline demographics, laboratory values, and liver disease severity were similar, with median age 60 years and most patients classified as Child-Pugh C. All patients were high VTE risk by PADUA and IMPROVE scores. New bleeding events occurred in 8.6% with enoxaparin and 5.6% with UFH. Major bleeding occurred only with UFH (5.6%), while minor bleeding occurred only with enoxaparin (8.6%). VTE events were rare and comparable (2.2% vs 2.7%). Therapy discontinuation for non-bleeding events was more frequent with enoxaparin (32.6% vs 22.2%). In-hospital mortality was numerically lower with enoxaparin (6.5% vs 13.8%).
Conclusion: In hospitalized patients with cirrhosis requiring VTE prophylaxis, enoxaparin demonstrated similar efficacy to UFH in preventing thromboembolic events. Although bleeding occurred more often with enoxaparin, events were minor and did not require discontinuation of therapy, whereas fewer but more severe bleeding events were seen with UFH. These findings suggest that enoxaparin may be a safe alternative, though larger prospective studies are needed.

Moderators

Matt Alspach, PharmD, BCPS

PGY1 RPD, Tower Health

Poonam Chhunchha

Brandi Thoma

Speakers

Ahja Brown

PGY1, Penn Medicine Princeton Medical Center

A PGY1 pharmacy resident that graduated from Temple University School of Pharmacy with interests in ambulatory care and emergency medicine.

Tuesday May 19, 2026 9:20am - 9:40am EDT
Broad Hub WEST

Cardiology

9:20am EDT

Trends in Sedative and Paralytic Exposures in Critically Ill Pediatric Patients During Three Different Time Periods

Tuesday May 19, 2026 9:20am - 9:40am EDT

a.Pavilion Hub EAST

Purpose: This study compared the trends of total daily dose (TDD) of sedation and paralytic medications in intubated pediatric patients prior to and after the implementation of the State Behavioral Scale (SBS) and Cornell Assessment of Pediatric Delirium (CAPD).

Methods: This was an IRB-exempt single center retrospective chart review taking place during three different time periods in the pediatric intensive care unit (PICU) at Penn State Health Golisano Children’s Hospital (PSHGCH). Study periods were defined as follows: Stage 1, (January 1, 2017-December 31, 2018) prior to the implementation of both SBS and CAPD; Stage 2 (March 5, 2024-January 31, 2025), following SBS but prior to CAPD implementation; and Stage 3 (February 1, 2025-August 31, 2025), after implementation of both SBS and CAPD. In each cohort, TDD was calculated for all sedative, paralytic, and delirium agents. Daily sedation burden was calculated using the Pediatric Normalized sedation Index (PNSI), which provides an objective measure of sedation burden for the patient. The primary outcome of this study is to compare sedative and paralytic use before and after the implementation of SBS and CAPD. Data analysis was done using the Kruskal-Wallis test.

Results: 526 patients were screened with the inclusion of 134 patients in the final analysis. Baseline characteristics were well balanced across groups, with no meaningful differences observed except length of intubation (p = 0.0496). PNSI differed overall across all time points combined and changed differently overtime with an apparent increase in sedation use during Stage 2 and subsequent decrease in sedation use during Stage 3 (Group p <0.001; Interaction p <0.0010). PNSI on each individual day was not statistically significant except for day 1 (p < 0.001). Vecuronium use differed across all time points combined but did not distinctly change over time (Group p < 0.001; Interaction p = 0.1008).

Conclusion: Sedation use increased during Stage 2 following implementation of SBS scoring and subsequently decreased during Stage 3 with the implementation of CAPD scoring. Trends in paralytic use remained inconclusive and limited clinical interpretation. Larger future studies are needed to better evaluate these patterns and determine the clinically meaningful impact of SBS and CAPD on both sedation and paralytic use.

Moderators

Jesse Cheng

Gabrielle Grossman

Jennifer Sullivan

Speakers

Jess Wilcox

PGY1, Penn State Health Milton S. Hershey Medical Center

I am from Exton, PA, completed my undergraduate degree at Bloomsburg University and got my PharmD from Philadelphia College of Pharmacy. Next year, I will be staying at Hershey to complete PGY2 in Critical Care

Tuesday May 19, 2026 9:20am - 9:40am EDT
a.Pavilion Hub EAST

Critical Care

9:20am EDT

Impact of Preoperative Antibiotic Timing on Odds of Surgical Site Infection

Tuesday May 19, 2026 9:20am - 9:40am EDT

a.Pavilion Hub WEST

Purpose: Ideal timing of preoperative antibiotic administration in relation to incision time remains unclear. This study aims to evaluate optimal timing of preoperative antibiotic administration to mitigate the risk of surgical site infection (SSI).

Methods: This study was a retrospective, case-control trial evaluating 993 adult patients admitted to St. Luke’s University Health Network for a surgical procedure between January 2022 and December 2024. Patients were included at a 1:4 case-to-control, with cases defined as patients who developed a SSI, and controls defined as patients without subsequent SSI. Patients were excluded if they did not receive preoperative antibiotics, received preoperative antibiotics > 120 minutes prior to incision, underwent more than one procedure during index hospitalization, or had a preexisting infection at time and anatomical site of index procedure. The primary outcome was SSI rate by preoperative antibiotic administration time. Secondary outcomes included admission for SSI, hospital length of stay, readmission for SSI, and mortality at 30 and 90 days post-operation. SSIs were categorized based on National Healthcare Safety Network (NHSN) definitions.

Results: Cefazolin was the most frequent preoperative antibiotic administered (863 of 993 cases). Preoperative administration time was evaluated at 15-minute intervals, with time 0 being start of procedure. The SSI rate when cefazolin was administered before or at 45 minutes prior to procedure was significantly lower than the SSI rate when cefazolin was administered beyond 45 minutes (18.5% vs 44.4%, P = 0.005). The majority of patients presenting with a SSI were admitted for inpatient management (67.6%). In the subgroup analysis, cefazolin was associated with a significantly lower rate of SSIs compared to clindamycin (P = 0.013).

Conclusion: Cefazolin should be administered within 45 minutes of procedure initiation to best mitigate the risk of SSIs. Cefazolin was associated with a lower rate of SSIs compared to clindamycin, supporting its use as the preoperative antibiotic of choice.

IRB approval: yes

Moderators

Sara Groome

Adrienne Kroznuskie

Adrienne Terico

Speakers

Jovina Fager

PGY1, St. Luke's University Health Network

2025 graduate from Philadelphia College of Pharmacy at Saint Joseph's University. Current PGY1 resident at St. Luke's University Health Netowork. Pursing a PGY2 in infectious diseases at St. Luke's University Health Network.

Jovina Preoperative Antibiotics PSHP pptx

Tuesday May 19, 2026 9:20am - 9:40am EDT
a.Pavilion Hub WEST

Infectious Diseases

9:40am EDT

Characterization of Semaglutide and Tirzepatide Prescribing and Tolerability After Therapy Lapse

Tuesday May 19, 2026 9:40am - 10:00am EDT

Broad Hub EAST

Purpose:
This retrospective cohort study characterized approaches for resuming semaglutide or tirzepatide after at least two consecutive missed doses and evaluated tolerability in outpatient clinics at Penn Presbyterian Medical Center (PPMC).

Methods:
This study included adults who missed at least two consecutive doses of semaglutide or tirzepatide between October 2024 and November 2025 and reinitiated therapy at a non-starting dose. Exclusion criteria included patients who resumed at the lowest dose, those switching medications (except brand substitutions), or without follow-up data. Chart review captured demographics, indication, therapy duration before lapse, prior and resumed doses, and number of missed doses. The primary outcome was the tolerability associated with the dose step changes related to missed doses. Tolerability was defined as no patient-reported adverse drug reactions (ADRs), a dose increase or continuation. Intolerance was defined as any patient-reported ADR, a dose reduction, or discontinuation. Secondary outcomes included reasons for lapse and months saved by avoiding restart at the initial dose. Descriptive statistics were used.

Results:
Among 65 patients, the mean age was 46 years and 76.9% were female. Most were prescribed tirzepatide (46.2%) or semaglutide (38.5%) for weight loss. The median number of missed doses was 3 (IQR, 2 to 4), with a median dose step change of -1 (IQR, -2 to 0). A dose reduction occurred in 37 patients (57%), 24 patients (36.9%) had no change, and 4 patients (6.2%) had a dose increase. Overall, 95.4% of patients tolerated reinitiation. Access-related issues accounted for 87.7% of lapses. The median months saved by avoiding restart at the initial dose was 2 (IQR, 1 to 3). Additionally, tolerability remained high across missed-dose subgroups.

Conclusion:
Resuming semaglutide or tirzepatide at a non-starting dose after at least two missed doses was well-tolerated in most patients. Dose reductions were common with high rates of tolerability. This approach prevented titration delays typically caused by missed doses. Further studies should prospectively evaluate optimal reinitiation strategies, including the impact on long-term weight loss and glycemic control.

Moderators

Shirley Bonanni, PharmD, BCPS

Assistant Director, Clinical Services, Thomas Jefferson University Hospital

Lauren Geerlof

Melissa Roselli

Speakers

Ling Chen

PGY-2 Ambulatory Care Pharmacy Resident, Penn Presbyterian Medical Center

Ling Chen, PharmD completed a PGY-1 pharmacy residency at the Philadelphia VA Medical Center and is currently completing a PGY-2 residency in ambulatory care at Penn Presbyterian Medical Center. Her clinical interests are primary care and cardiology.

Tuesday May 19, 2026 9:40am - 10:00am EDT
Broad Hub EAST

Ambulatory Care

9:40am EDT

Assessing Inpatient Pharmacist Role In Optimizing Sodium-Glucose Cotransporter-2 (SGLT2) Inhibitor Use In Patients With Heart Failure Prior To Discharge

Tuesday May 19, 2026 9:40am - 10:00am EDT

Broad Hub WEST

Purpose: Evaluate the impact of inpatient pharmacist interventions on SGLT2 inhibitor initiation in hospitalized heart failure patients and compare pre- and post-intervention rates, pharmacist involvement, barriers, and 30-day readmissions.

Methods: This retrospective, pre- and post-quality improvement study included adult patients hospitalized with heart failure over two six-week periods. Data collected included demographics, heart failure classification, laboratory values, guideline-directed medical therapy (GDMT), pharmacist interventions, and 30-day readmissions. The intervention consisted of increased inpatient pharmacist involvement through chart review, documentation, medication recommendations, discharge counseling, and assistance with medication access. Statistical analyses included chi-square tests for categorical variables and t-tests for continuous variables.

Results: A total of 164 pre- and 170 post-intervention patients were included. Baseline demographics and clinical characteristics were similar between groups. Pharmacist interventions significantly increased from 7.3% pre-intervention to 21.3% post-intervention (p<0.001).

SGLT2 inhibitor use at discharge remained similar between groups (28.0% vs 27.2%, p=0.866), and initiation rates during hospitalization did not significantly change (12.2% vs 12.4%, p=0.949). Other GDMT utilization also showed no statistically significant differences.
However, 30-day readmission rates increased from 34.8% pre-intervention to 48.5% post-intervention (p=0.011). Barriers to SGLT2 inhibitor initiation were similar between groups (32.9% vs 30.8%).

Conclusion: Inpatient pharmacist involvement significantly improved documentation and intervention rates but did not result in increased SGLT2 inhibitor initiation. Despite enhanced pharmacist engagement, no reduction in 30-day readmissions was observed. These findings show persistent barriers to therapy initiation suggesting additional strategies beyond pharmacist intervention may be necessary to improve clinical outcomes in heart failure patients.

Authorship:
Katherine Ghattas, PharmD; James Helms, PharmD, BCPS; Bonny Brownstein, PharmD, BCPS, BCPPS

Moderators

Matt Alspach, PharmD, BCPS

PGY1 RPD, Tower Health

Poonam Chhunchha

Brandi Thoma

Speakers

Katherine Ghattas

PGY1, Tower Health - Reading Hospital

Current PGY-1 Pharmacy Resident that graduated from Chapman University School of Pharmacy in 2025, interested in critical care and pediatrics/NICU.

Tuesday May 19, 2026 9:40am - 10:00am EDT
Broad Hub WEST

Cardiology

9:40am EDT

Comparison of Heparin versus Bivalirudin Therapy for Anticoagulation in Patients Receiving Extracorporeal Membrane Oxygenation

Tuesday May 19, 2026 9:40am - 10:00am EDT

a.Pavilion Hub EAST

PURPOSE: The purpose of this study is to evaluate the safety and efficacy of bivalirudin versus heparin as anticoagulation for patients receiving either VA or VV ECMO.

METHODS: This single center, retrospective chart review evaluated patients at Temple University Hospital between June 1st, 2019 to June 30th, 2025 who were placed on either VA or VV ECMO and received anticoagulation with either heparin or bivalirudin for at least 72 hours. The primary composite endpoint for the efficacy of bivalirudin in the use of ECMO compared to heparin was the overall incidence of thrombosis occurrences including venous and arterial thromboembolism and/or circuit related thrombotic event occurring after anticoagulation initiation. Secondary outcomes included bleeding occurrences while on anticoagulation and ECMO and the average volume of blood products received. Data collection included patient demographics, baseline characteristics, and anticoagulant used while on ECMO. Demographic data was analyzed using descriptive statistics, categorical data was analyzed using Chi- square test, and continuous data was analyzed by Student T-test.

RESULTS: A total of 78 patients were included: median age 59, 69% male, and 60% received VV ECMO. The incidence of thrombotic events was similar between heparin and bivalirudin (10.2% versus 12.5%, p = 0.754). More patients who received heparin experienced a major bleeding event compared to those who received bivalirudin (28.2% versus 2.6%, p < 0.001). Additional analysis is ongoing.

CONCLUSION: Patients receiving bivalirudin for systemic anticoagulation on extracorporeal membrane oxygenation did not have an increased incidence of thrombotic events and had a significantly lower incidence of major bleeding events compared to heparin.

Moderators

Jesse Cheng

Gabrielle Grossman

Jennifer Sullivan

Speakers

Caitlin Maskornick, PharmD

PGY1, Temple Health, Temple University Hospital

Attended pharmacy school at Northeastern University, Boston, MACurrent PGY1 Resident at Temple University Hospital, Philadelphia, PAUpcoming PGY2 Solid Organ Transplant Resident at Temple University Hospital, Philadelphia, PA

Tuesday May 19, 2026 9:40am - 10:00am EDT
a.Pavilion Hub EAST

Critical Care

9:40am EDT

Effect of Inhaled Amikacin Liposome Dose Adjustments on Treatment Outcomes in Pulmonary Non-Tuberculous Mycobacteria Infections

Tuesday May 19, 2026 9:40am - 10:00am EDT

a.Pavilion Hub WEST

Purpose:
This study evaluates the impact of reduced-dose amikacin liposome inhalation suspension (ALIS) on treatment outcomes in patients with pulmonary nontuberculous mycobacteria (NTM) infections who may experience treatment intolerance.

Methods:
This was a retrospective, descriptive study. Eligible patients started ALIS therapy from September 1, 2018-June 30, 2024, and filled ALIS through the health system specialty pharmacy. Patients must have completed at least 6 months of ALIS therapy by June 30, 2025. Data was sourced through the pharmacy software system, and data collection was conducted through chart review. Patient adherence was quantified by a percentage of days covered (PDC), calculated based on refill history. The primary outcome was prevalence of negative cultures with various dosing strategies. Secondary outcomes included the incidence of culture reconversion up to one year after the first negative culture conversion or at the end of the study period, new culture resistance, number of patients with reduced ALIS dosing strategies, reasons for ALIS dose adjustments, and total duration of ALIS treatment. Descriptive statistics were used to report outcomes.

Results:
30 patients were included in this study and 17 (56%) were considered adherent to daily dosing based on a PDC of >80%. Overall, 24 (80%) patients achieved culture conversion, with 12 of 17 patients in the >80% PDC group and 12 of 13 in the <80% PDC group. Median time to culture conversion was 178.5 (117-216.5) days. Median time to culture conversion in the >80% PDC group was 201 (105-247.25) days vs.146 (122.5-210.75) days in the <80% PDC group. There were 12 (20%) patients with culture reconversion, with 6 of 17 patients in the >80% PDC group and 6 of 13 in the <80% PDC group. One patient (3.3%) developed new resistance to amikacin. There were several reasons for dose adjustment, with the most frequent reason being adverse effects.

Conclusion:
Dose adjustments of ALIS did not appear to influence the rate of culture conversion in this study. There was a limited impact on resistance or duration of ALIS treatment. This suggests dose adjustment strategies may be an option for patients with adverse effects; however, further research is needed.

Moderators

Sara Groome

Adrienne Kroznuskie

Adrienne Terico

Speakers

Shaleen Ghosh

PGY1, Penn Medicine, Hospital of the University of Pennsylvania

Dr. Shaleen Ghosh is a graduate of the University of North Carolina Eshelman School of Pharmacy in Chapel Hill, NC. She is originally from Akron, OH and received her bachelor’s degree in biology from The Ohio State University. Her professional interests include ambulatory care... Read More →

Tuesday May 19, 2026 9:40am - 10:00am EDT
a.Pavilion Hub WEST

Infectious Diseases

10:00am EDT

Comparison of Appropriate Lipid Panel Monitoring in Patients Managed by Pharmacists and Non-Pharmacists at Temple University Health System (TUHS)

Tuesday May 19, 2026 10:00am - 10:20am EDT

Broad Hub EAST

Purpose:
The purpose of this study was to compare the number of patients who had appropriate lipid panel follow-up/monitoring at TUHS divided by management type: managed by pharmacy (Rx-managed) and not managed by pharmacy (Non-Rx-managed).

Methods:
This study was conducted at the Temple Internal Medicine Associates (TIMA) clinic at TUHS from 07/01/2024 to 06/30/2025. Inclusion criteria were age ≥18 years, TIMA patients, ≥2 in-person visits (≥3 months apart), and ≥1 lipid panel during the study period. Exclusion criteria included ESRD, palliative care, pregnancy, TSH >4.5 mIU/L, or TG >400 mg/dL. Patients were categorized as Rx-managed (≥2 pharmacist visits) or Non-Rx-managed (managed exclusively by non-pharmacist clinicians). The primary endpoint was the number of lipid panels. Secondary endpoints included mean LDL-C, number of patients achieving LDL-C <100 mg/dL and <70 mg/dL, and number of patients receiving lipid-lowering therapy. Due to group size differences, 1:4 propensity score matching was performed using age, sex, race, T2DM, and ASCVD. Continuous variables were analyzed using the Wilcoxon rank-sum test, and categorical variables using Fisher’s exact or Chi-square tests.

Results:
Baseline characteristics were similar between groups after 1:4 matching. A greater proportion of patients in the Rx-managed group had more than one lipid panel compared with the Non-Rx-managed group (39.7% vs 27.1%, p=0.006). Mean LDL-C was numerically lower in the Rx-managed group (86.6 vs 88.4 mg/dL), though not statistically significant. The proportion of patients achieving LDL-C goals was similar between Non-Rx-managed and Rx-managed groups (<100 mg/dL: 67.1% vs 70.2%; <70 mg/dL: 34.3% vs 38.8%). Use of lipid-lowering therapy was comparable between groups. This study used real-world data and propensity matching to improve comparability; however, it was limited by its retrospective, single-center design and lack of baseline lipid values.

Conclusion:
Patients in the Rx-managed group were more likely to receive additional lipid monitoring than those in the non-Rx- managed group. Although not statistically significant, the Rx-managed group showed trends toward lower LDL-C and greater goal attainment. Future studies with longer follow-up and baseline lipid values are needed to better evaluate longitudinal lipid outcomes and the clinical impact of pharmacist-led management in lipid management.

Moderators

Shirley Bonanni, PharmD, BCPS

Assistant Director, Clinical Services, Thomas Jefferson University Hospital

Lauren Geerlof

Melissa Roselli

Speakers

Jiwoo Lee, PharmD

PGY-2 Ambulatory Care Pharmacy Resident, Temple University School of Pharmacy

I am a PGY-2 Ambulatory Care Pharmacy Resident at Temple University School of Pharmacy. I am interested in academia and clinical practice. My clinical interests include primary care and chronic disease management.

Tuesday May 19, 2026 10:00am - 10:20am EDT
Broad Hub EAST

Ambulatory Care

10:00am EDT

Evaluation of Initial Management for Acute Blood Pressure Control in Intracerebral Hemorrhage

Tuesday May 19, 2026 10:00am - 10:20am EDT

a.Pavilion Hub EAST

Purpose:
To evaluate the proportion of patients with spontaneous intracerebral hemorrhage (ICH) achieving institutional systolic blood pressure (SBP) targets within 60 minutes of head computed tomography (HCT).

Methods:
This retrospective cohort study included adult patients with spontaneous ICH admitted to entities within the University of Pennsylvania Health System between January 1, 2025, and November 30, 2025. Patients were stratified by presenting SBP (<220 mmHg vs >220 mmHg), corresponding to institutional protocol targets. For patients presenting with SBP greater than 220 mmHg, the initial goal is to reduce SBP to less than 180 mmHg within the first hour. For patients presenting with SBP between 180–220 mmHg, the target range is 130–150 mmHg. The primary outcome was achievement of protocol-defined SBP target within 60 minutes of HCT confirmation. Secondary outcomes included antihypertensive medication regimen, time to target SBP, SBP variability during the first six hours after HCT , neurologic outcomes , incidence of hematoma expansion or ischemic stroke, mortality, and safety outcomes including hypotension and bradycardia.

Results:
A total of 39 patients met inclusion criteria (SBP <220 mmHg: n=23; SBP >220 mmHg: n=16). Achievement of target SBP within 60 minutes occurred more frequently in patients presenting with SBP > 220 mmHg (39.1% vs 93.8%, p<0.01). Nicardipine was utilized in all patients and was initiated within 30 minutes of HCT confirmation in 69.6% and 75% of patients with SBP <220 mmHg and >220 mmHg, respectively. In-hospital mortality occurred in 8.7% of patients with SBP <220 mmHg and 6.3% with SBP >220 mmHg (p=1.00). The incidence of ischemic stroke was 8.7% versus 25.0%, respectively (p=0.21). Hypotension occurred in one patient (4.3%) in the SBP <220 mmHg group (p=1.00). No cases of bradycardia were observed.

Conclusion:
Patients with SBP >220 mmHg were more likely to achieve protocol-defined SBP targets within 60 minutes compared with those <220 mmHg. Despite rapid blood pressure reduction, rates of hypotension and bradycardia were low. These findings suggest that early SBP control in patients with moderately elevated SBP may reflect differences in clinical attention and management intensity, highlighting a potential need for more optimized titration strategies.

Moderators

Jesse Cheng

Gabrielle Grossman

Jennifer Sullivan

Speakers

Elizabeth George

PGY2 Critical Care, Penn Medicine, Penn Presbyterian Medical Center

Liz completed her PGY-1 at St. Luke’s University Health Network and is currently completing a PGY-2 in critical care at Penn Presbyterian Medical Center.

Tuesday May 19, 2026 10:00am - 10:20am EDT
a.Pavilion Hub EAST

Critical Care

10:00am EDT

Treatment Outcomes in Patients with Fungal Infections After Implementation of Weight Based Micafungin Dosing at a Large Academic Medical Center

Tuesday May 19, 2026 10:00am - 10:20am EDT

a.Pavilion Hub WEST

Purpose: Given the opportunity to optimize micafungin therapy in obese patients, our institution established a new protocol that recommends high doses for patients > 125 kg. We aimed to evaluate the outcomes associated with this new protocol.

Methods: This is a retrospective cohort study of patients at Thomas Jefferson University Hospital Inc locations from December 2024 to March 2026. Patients were included if they were 18 years or older, had documented invasive candidiasis, and received micafungin for 3 or more days. Patients were excluded if they had a concomitant infection within 7 days, were given empiric combination antifungal therapy, or had Candida species isolated from the genitourinary tract. Outcomes will be compared between patients weighing ≤ 125kg, patients weighing > 125kg on standard dose micafungin, and patients weighing > 125kg on high dose micafungin. The primary outcome is a composite of all–cause 90-day mortality, microbiologic and clinical cure, and incidence of recurrent infections within 30 days. The secondary outcomes are 30-day infection related readmission, duration of micafungin treatment, hospital and ICU length of stay and duration of candidemia.

Results: A total of 318 positive Candida cultures were identified and of those, 271 patients were removed to meet the exclusion criteria. Therefore, the study cohort included a total of 42 patients with 40 patients in the ≤ 125kg group, 1 patient in the > 125kg with standard micafungin dose group, and 1 patient in the > 125kg with high micafungin dose group. No difference was seen with the primary composite outcome between the cohorts (p=0.448). Due to low enrollment, exploratory analysis was performed utilizing binomial linear regression. When including mg/kg dosing as a continuous variable and analyzed it with other impactful and confounding variables, we did not find that it added significantly to the model.

Conclusion: Our results from a very limited data set suggest that increased micafungin dosing in obese patients was not associated with improved clinical outcomes for invasive candidiasis. Exploratory analysis did not suggest that higher micafungin dosing (measured in mg/kg) provided additional benefit. Our institution will continue to collect data, in hopes of generating a greater sample size. Larger studies are required to confirm these results.

Moderators

Sara Groome

Adrienne Kroznuskie

Adrienne Terico

Speakers

Jane McNoble

PGY2 Infectious Diseases Pharmacy Resident, Thomas Jefferson University Hospital

Jane is a PGY2 Infectious Diseases resident at Thomas Jefferson University Hospital. She completed her PGY1 training at NYU Langone Hospital - Brooklyn. Once she completes her training, she aims to become a board-certified ID pharmacist and continue her practice at a large academic... Read More →

Tuesday May 19, 2026 10:00am - 10:20am EDT
a.Pavilion Hub WEST

Infectious Diseases

10:30am EDT

Safety and Efficacy of Alpha-2 Agonists in the Setting of Fentanyl and Medetomidine Withdrawal

Tuesday May 19, 2026 10:30am - 10:50am EDT

Broad Hub WEST

Purpose
The purpose of this study was to characterize and assess the safety and efficacy of alpha-2 agonist utilization in the setting of fentanyl and presumed medetomidine withdrawal at a tertiary academic medical center in Philadelphia, PA.

Methods
This retrospective, single-center chart review evaluated patients admitted to an academic medical center between 1/1/2025 and 10/31/2025 with fentanyl and suspected medetomidine withdrawal and received an alpha-2 agonist(s) for withdrawal management. Patients were excluded if they received mechanical ventilation or vasopressors, experienced severe alcohol withdrawal, or underwent surgery during their withdrawal management. The primary objective was to characterize alpha-2 agonist use, including agent, dose, frequency, and route. Secondary objectives assessed safety and efficacy. Safety endpoints included incidence of hemodynamic instability and ICU disposition. Efficacy endpoints included incidence of ICU escalation and patient-directed discharge and the change in maximum Clinical Opiate Withdrawal Scale (COWS) scores within 72 hours of admission.

Results
There were 100 included patients: 53 in the ICU and 47 on general medicine floors. All patients received clonidine, largely as oral tablets; 18% received tizanidine and 52% dexmedetomidine. The median maximum total daily dose of clonidine was 1.2 mg [IQR 1-1.6] for a median duration of 108.9 hours [IQR 72.7-159.7]. Dexmedetomidine had a median maximum infusion rate of 1.2 mcg/kg/hr [IQR 1-1.5] and a median of 27.3 hours [IQR 18.6-42]. Clonidine was held in 65% of patients (bradycardia). A heart rate <60 bpm occurred in 51% and a systolic blood pressure <90 mmHg in 5% of patients. The median COWS by day 2 had decreased from 22 [IQR 16.5-26] to 6 [IQR 4-8]. Many patients (58%) were discharged on clonidine, and 27% had self-directed discharge.

Conclusions
Alpha-2 agonists improved COWS scores over 72 hours and were well tolerated, with bradycardia being the most common adverse effect. Clonidine was the most frequently used alpha agonist, with dexmedetomidine reserved for ICU-level patients. Overall, these findings support the use of alpha-2 agonists for fentanyl with presumed medetomidine withdrawal management with careful hemodynamic monitoring and individualized dosing and tapering strategies.

This study was approved by the University of Pennsylvania Institutional Review Board (Protocol #859692).

Moderators

Nikitha Patel

Sarah Tobin

Kiyo Yoda

Speakers

Julia Keating

PGY1 Pharmacy Resident, Penn Medicine, Penn Presbyterian Medical Center

Julia Keating, PharmD, is a graduate of the University of South Carolina College of Pharmacy and is currently completing a PGY1 Pharmacy Residency at Penn Presbyterian Medical Center (PPMC). She will continue her postgraduate training at PPMC as a PGY2 Emergency Medicine Pharmacy... Read More →

Tuesday May 19, 2026 10:30am - 10:50am EDT
Broad Hub WEST

Addiction Medicine/Pain Management

10:30am EDT

Evaluation of Guideline-Recommended Weight-Based Initial Vancomycin Dosing in Septic Patients and the Effects on Therapeutic Level Achievement and Clinical Outcomes

Tuesday May 19, 2026 10:30am - 10:50am EDT

a.Pavilion Hub WEST

Abstract Title: Evaluation of Guideline-Recommended Weight-Based Initial Vancomycin Dosing in Septic Patients and the Effects on Therapeutic Level Achievement and Clinical Outcomes
Purpose: This study was designed to evaluate guideline-recommended weight-based initial vancomycin dosing of 25 mg/kg in septic patients and the effects on therapeutic level achievement and clinical outcomes.
Methods: Institutional Review Board approval was obtained for this retrospective observational chart review. Patients were identified based on the order set utilized by providers for vancomycin loading dose. The order set used prior to September 2023 allowed providers to order a maximum loading dose of 1,500 mg, while the new sepsis order set guides providers to order 25 mg/kg loading doses with a maximum dose of 3,000 mg. Data was collected from March 1^st 2023, through March 31^st, 2025. The primary outcome is to determine if sufficient loading doses of vancomycin in septic patients result in faster achievement of therapeutic levels. Secondary outcomes include the rate of patients who experienced nephrotoxicity, time to administration of loading doses, length of stay, 30-day mortality, critical care admission, and the rate of MRSA bacteremia. Data analysis was completed with descriptive statistics, Wilcoxon Sum Rank test and Chi-squared test.
Results: Initial vancomycin doses of 25 mg/kg, based on total body weight, in septic patients results in faster therapeutic achievement (p-value 0.000004) and lower rates of acute kidney injuries (p-value 0.005). The time from order to administration of initial vancomycin doses in the post-implementation group was about 25 minutes faster than the pre-implementation group and was almost one day shorter for the average length of stay compared to the pre-implementation group. In the pre-implementation group, the average loading dose was 15.5 (SD of 3.1) and the average AUC was 365.3 mg/h/L (SD of 122.6). In the post-implementation group, the average loading dose was 20.1 (SD of 4.4) and the average AUC was 419.9 (SD of 95.2).
Conclusion: Increased initial vancomycin doses resulted in faster therapeutic achievement and lower rates of acute kidney injury. There were no statistically significant differences between 30-day mortality, admission to critical care unit, MRSA bacteremia, time from order to administration and length of stay. Results support updating non-sepsis vancomycin order sets to increase the initial dose, as well as promoting batching larger vancomycin doses.
Authorship: Paige de Fremery, PharmD; Miranda Cason, PharmD, BCPS; Troy Albrecht, PharmD, BCPS, BCIDP

Moderators

Meghin Haines

Samantha Macko, PharmD

Advanced Clinical Pharmacist, Thomas Jefferson University Hospital

Alyssa Polotti, PharmD, BCCCP

Clinical Pharmacy Specialist - Emergency Medicine/Trauma, St Mary Medical Centr - Trinity Health

Speakers

Paige de Fremery

PGY1, Penn State Health St. Joseph

Graduated Ohio Northern University in 2025. Currently a PGY1 Pharmacy Resident at Penn State Health St. Joseph. Interested in emergency medicine, infectious disease and pain and palliative.

Tuesday May 19, 2026 10:30am - 10:50am EDT
a.Pavilion Hub WEST

Critical Care

10:30am EDT

Implementation of a Pharmacist-Driven Protocol for Ceftriaxone IV to PO Step-down in Hospitalized Patients with an Uncomplicated or Complicated Urinary Tract Infection

Tuesday May 19, 2026 10:30am - 10:50am EDT

a.Pavilion Hub EAST

Purpose: To implement a pharmacist-driven protocol which allows for the step-down of IV ceftriaxone to PO antibiotics for hospitalized patients with uncomplicated and complicated urinary tract infections to help improve transition time.
Methods: A prospective study will be conducted from February 23, 2026 to May 12, 2026, using data collected from EPIC. The included patients will be age 18 and older with a UTI diagnosis, presence of stones, obstruction, strictures, TURP, prostatitis, stents, associated bacteremia, indwelling urinary catheters, pregnancy and before/after genitourinary procedure. Patients will be excluded if they have asymptomatic bacteriuria, secondary diagnosis for another infection, renal abscess, or are immunocompromised.
The primary endpoint is transition time from IV to PO antibiotics. Secondary endpoints include length of stay, 30-day UTI readmission rates, total length of therapy, antibiotic selection and dosing. The endpoints will be compared to a retrospective analysis from May 1, 2025, to June 30, 2025, to assess if a pharmacist-driven protocol allowed for a timely transition to oral antibiotics and/or a reduction in any of the secondary endpoints.
Results: TBD
Conclusion: TBD
IRB Approval: IRB approval is not required as this research is categorized as a process improvement project.

Moderators

Rebecca Buckler

Alex Matika

Infectious Diseases Clinical Pharmacy Specialist / RPD PGY-2 ID Pharmacy Residency, St. Luke's University Health Network

Hinal Patel

Speakers

Rachel Molino

PGY1, Main Line Health, Paoli Hospital

My name is Rachel Molino and I am a PGY1 resident at Paoli Hospital. I earned my undergraduate degree in chemistry from Elizabethtown College and received my Doctor of Pharmacy degree from Thomas Jefferson University College of Pharmacy. I am interested in infectious diseases and... Read More →

Tuesday May 19, 2026 10:30am - 10:50am EDT
a.Pavilion Hub EAST

Infectious Diseases

10:30am EDT

Evaluation of Implementation of an Agitation Protocol in an Emergency Department

Tuesday May 19, 2026 10:30am - 10:50am EDT

Broad Hub EAST

Purpose
This study evaluates the implementation of an ED agitation protocol on the reduction of repeat sedative doses within 1 hr in agitated adults, leading to safer, more effective agent selection and evidence-based pharmacologic management.
Methods
This multi-center retrospective chart review evaluated electronic medical records of adult ED patients across all LVHN sites who were treated with at least one dose of sedative medication for agitation. Patients treated from 7/1/2022–7/1/2023 and 10/1/2023–10/1/2024 were identified, stratified by study period, and randomly selected to be included for analysis. Patients who were not treated for acute agitation, had alternative indications for benzodiazepines, (Ex. CIWA benzodiazepines), or had a pre-administration SPO₂<92% or SBP< 90 were excluded from analysis. Variables collected included medication selection, times of medication administration, ED LOS, patient disposition, and safety data. A sample size of 169 patients per group was calculated to detect 15% differences in repeat sedative use (49% vs 34%) using a two-tailed chi-square test (α=0.05, power=80%).
Results
Baseline characteristics were similar amongst groups. Agent treatment selection was similar pre- and post-protocol implementation. The proportion of patients requiring an additional sedative within 1 hour significantly decreased post-protocol implementation (8.9% vs 17%, p=0.025). ED length of stay was significantly reduced (20 h vs 25 h, p=0.00006). The proportion of patients requiring 1:1 monitoring before and after implementation was (31% vs 39%, p=0.096), a reduction in 8%. Restraint use decreased by 13% post-implementation (31% vs 43%). ICU admission rates did not differ between groups (p=0.769). Adverse events were infrequent, limiting conclusions. Diphenhydramine use was not associated with ED LOS.
Conclusion
Adoption of a standardized ED agitation protocol was associated with fewer repeat sedative doses within one hour and a reduction in emergency department length of stay. These improvements occurred without increases in ICU admission, monitoring needs, or adverse events. Protocol-driven, evidence-based medication selection enhances initial agitation control, reduces restraint use, improves patient safety, and promotes more efficient care delivery.

Moderators

Jessica Clancy

Nicholas Ferraro, PharmD, BCPS

PGY1 RPD & Clinical Pharmacy Specialist: IM/TOC, Temple University Hospital - Main Campus

Speakers

Zachary Balodis

PGY1, Lehigh Valley Health Network - Cedar Crest

Zachary Balodis attended pharmacy school at Thomas Jefferson University in 2025. He is now completing a PGY1 at Lehigh Valley Health Network - Cedar Crest in Allentown, PA. His major areas of clinical interest include emergency medicine, critical care, and transplant. After completion... Read More →

Tuesday May 19, 2026 10:30am - 10:50am EDT
Broad Hub EAST

Medication Safety/Quality Improvement

10:50am EDT

Assessment of Pharmacy Resident Education on Opioid with Suspected Adulterants Withdrawal Clinical Practice

Tuesday May 19, 2026 10:50am - 11:10am EDT

Broad Hub WEST

Purpose: The purpose of this project is to evaluate the current treatment practices in the critical care units for complex withdrawal and organize formal education surrounding a high priority clinical topic.

Methods: The study will use a newly implemented protocol in the medical intensive care unit and pharmacy resident education to screen current treatment practices and assess gaps in knowledge. An anonymous survey was developed and consisted of questions regarding experience treating complex withdrawal and self-reported confidence in the management in clinical practice. Data will be collected including the attendees professional practice setting. The education and the survey will be presented to the appropriate departments and afterwards survey results will be used to assess changes in knowledge and confidence with future adherence to the implemented protocol. The primary endpoint is the improvement in healthcare professional knowledge regarding the management of complex withdrawal, measured by completed survey results. Secondary endpoint includes change in confidence pre and post-educational sessions.

Results: Approximately ~75 healthcare professionals were given formal education, and a total of 40 were able to complete the survey due to access at time of presentation. Self-reported confidence in the treatment of opioid with suspected adulterant withdrawal increased from 42% to 78% after education was given. Two clinical questions regarding the presentation of medetomidine withdrawal were asked and 30% and 63% of responders were “not confident” in their answer choices. When asked to report confidence in using the presented material 78% and 96% of responders were confident in applying the material to clinical practice. Even though not every participant was able to take the pre- and post-surveys the reminders for close monitoring and proactive care has reinforced different specialties their importance in managing complex withdrawal.

Conclusion: Implementation of a standardized complex withdrawal management protocol, along with educational sessions was found to improve self-reported confidence and knowledge in managing complex withdrawal. Ongoing monitoring of protocol use and interdisciplinary support to promote long-term adherence to the newly implanted protocol. Future evaluation may include clinical outcomes, such as length of hospital stay, length of intensive care unit stay and incidence of withdrawal-related complications

Moderators

Nikitha Patel

Sarah Tobin

Kiyo Yoda

Speakers

Erin Torrance

PGY1, Philadelphia VA, Corporal Michael J. Crescenz VA Medical Center

Current PGY-1 pharmacy resident at the Philadelphia VA, who graduated from Temple University's School of Pharmacy May 2025. Interests include pain management, addiction medicine and substance use disorder. Plans to stay at the Philadelphia VA to complete the PGY-2 in pain management... Read More →

Tuesday May 19, 2026 10:50am - 11:10am EDT
Broad Hub WEST

Addiction Medicine/Pain Management

10:50am EDT

Evaluation of the impact of anti-Xa monitoring for the prevention of venous thromboembolism (VTE) in trauma patients

Tuesday May 19, 2026 10:50am - 11:10am EDT

a.Pavilion Hub WEST

Purpose:
The purpose of this study is to evaluate the impact of prophylactic anti-Xa monitoring on rates of venous thromboembolism (VTE) events and bleeding in trauma patients at a level one trauma center.

Methods:
This retrospective cohort study includes patients admitted to the trauma surgery service from January 2019 – July 2025 treated with enoxaparin for VTE prophylaxis. Exclusion criteria includes patients who spent 48 hours or more at a referring facility before transfer or an anti-Xa level collected before 3.5 hours of after 6.5 hours from last enoxaparin dose. Patients were identified via an Enterprise Information Management report, data was extracted from the electronic health record using REDCap, and statistical analysis was completed using Microsoft Excel. The primary outcome is rate of thromboembolic events, and secondary outcomes include rates of bleeding, units of red blood cells transfused, ICU and hospital length of stay (LOS). Categorical data is compared using a chi-squared test, and continuous data is reported using descriptive statistics. The study is IRB exempt by the institutional review board at the study site.

Results:
A total of 196 patients are included in the study; 91 received anti-Xa monitoring and 105 patients did not. No statistically significant differences in rates of VTE events were observed between patients who received anti-Xa monitoring compared with those who did not (9.9% vs 7.6%, p-value 0.573). Rates of bleeding were higher in the anti-Xa monitoring group (44.0% vs 26.7%, p-value 0.01). Patients who received anti-Xa monitoring were more likely to have missed doses of enoxaparin (56.0% vs 41.0% p-value 0.03) and had a longer median ICU LOS (13.6 days vs 6.3 days). In patients receiving anti-Xa monitoring, 48/91 (52.7%) patients had an initial anti-Xa within the goal range, and only 3/91 (2.2%) had an anti-Xa above the goal range.

Conclusion:
Anti-Xa monitoring did not result in a difference in VTE events and was associated with higher bleeding rates. However, the anti-xa monitoring group had more missed doses of enoxaparin and longer ICU length of stay, which are risk factors for VTE events. This suggests that patients who received anti-xa monitoring likely had a greater severity of illness, leading to higher rates or bleeding, despite not having supratherapeutic anti-xa levels.

Moderators

Meghin Haines

Samantha Macko, PharmD

Advanced Clinical Pharmacist, Thomas Jefferson University Hospital

Alyssa Polotti, PharmD, BCCCP

Clinical Pharmacy Specialist - Emergency Medicine/Trauma, St Mary Medical Centr - Trinity Health

Speakers

Brady Wisniewski

PGY-2 Critical Care Pharmacy Resident at Penn State Health Milton S. Hershey Medical Center, Penn State Health Milton S. Hershey Medical Center

Current PGY-2 critical care pharmacy resident at Penn State Health Milton S. Hershey Medical Center

Tuesday May 19, 2026 10:50am - 11:10am EDT
a.Pavilion Hub WEST

Critical Care

10:50am EDT

Incidence of Piperacillin/Tazobactam Reactions in Patients with Reported Beta-Lactam Reactions in a Community Hospital Setting

Tuesday May 19, 2026 10:50am - 11:10am EDT

a.Pavilion Hub EAST

Purpose: Despite structural dissimilarity between penicillins and piperacillin/tazobactam (P/T), the incidence of cross-reactivity is unknown. This project evaluated the incidence of P/T reaction in patients with documented β-lactam reactions.

Methods: This was a retrospective single-center cohort analysis evaluating patients with reported β-lactam reactions who received P/T from July 2022 to June 2025. Patients were included if they received at least one dose of P/T during this time and had a previously reported β-lactam reaction. Patients were excluded if they were less than 18 years old, the P/T order was not administered, or there was insufficient quality of data. The primary outcome was the compared incidence of P/T reactions between patients with documented penicillin class reactions versus patients with reactions to all other β-lactams and β-lactamase inhibitors. Secondary outcomes were the incidence of P/T reactions in the following subgroups: subclass of previous β-lactam reaction, previous reaction type classification, P/T duration, and number of previously reported reactions. Results were analyzed using a Chi-squared analysis and descriptive statistics.

Results: Of 183 patients screened for analysis, 164 were included. Previously reported β-lactam reactions were classified as IgE-mediated (30%), non-IgE-mediated (18%), adverse reactions (23%), and unknown (29%). There were 21 (13%) patients with multiple β-lactam allergies. Potential reaction to P/T occurred in 0/87 (0%) patients with penicillin class reactions and 1/77 (1.3%) patients with non-penicillin β-lactam reactions (p=0.286). The patient with a documented reaction to P/T had a history of developing hives to cefuroxime. The median [IQR] length of treatment for patients who received multiple doses in an encounter was 2 [1-3.5] days, with the most common reason for discontinuation being targeted antimicrobial therapy (47%).

Conclusion: In patients labeled with a β-lactam reaction, there was minimal incidence of P/T reactions, with 1/164 patients (0.6%) experiencing a documented reaction. These results support the hypothesis that cross-reactivity would be low based on structural dissimilarity, including penicillin class allergies. Further research is warranted to further elucidate the safety of administering P/T in this patient population.

Moderators

Rebecca Buckler

Alex Matika

Infectious Diseases Clinical Pharmacy Specialist / RPD PGY-2 ID Pharmacy Residency, St. Luke's University Health Network

Hinal Patel

Speakers

Brigid Hurst

PGY1, Penn Medicine, Penn Medicine Doylestown Health

Brigid is a graduate of the Philadelphia College of Pharmacy at Saint Joseph's University and the current PGY1 pharmacy resident at Penn Medicine Doylestown Health. Her career interests include antimicrobial resistance, LGBTQIA+ health and advocacy, pharmacokinetics, and critical... Read More →

Tuesday May 19, 2026 10:50am - 11:10am EDT
a.Pavilion Hub EAST

Infectious Diseases

10:50am EDT

Assessing High-Risk Behaviors in Veterans at the CMCVAMC through a Behavioral Health Initiative for Distributing Fentanyl Test Strips

Tuesday May 19, 2026 10:50am - 11:10am EDT

Broad Hub EAST

Purpose:
Harm reduction minimizes negative outcomes associated with substance use. Fentanyl test strips are distributed as a strategy due to its presence in local supply. The primary goal is to assess impact of test strips on high-risk behaviors.

Methods:
Retrospective chart reviews were conducted using the Veterans Health Administration (VHA) Computerized Patient Record System (CPRS) to collect data on 129 veterans who received fentanyl test strips from behavioral health teams between 10/02/2024 to 09/08/2025. Veterans receiving outpatient care aged 18 and older with active opioid and/or stimulant use disorder were included in our review. Veterans with significant cognitive impairments or acute psychiatric instability that prevent informed consent were excluded. A prospective component was planned but will not be reported due to insufficient enrollment.

Results:
Among veterans offered fentanyl test strips, the majority accepted, with only a small percentage declining. A subset of veterans accepted additional fentanyl test strip kits when re-offered. Additionally, many veterans who accepted the fentanyl test strips already had naloxone on hand, or received it concurrently.

Conclusion:
Fentanyl test strip acceptance, including repeated offer acceptances, suggest potential utilization and perceived benefits by veterans. However, further evaluation is warranted to determine whether use leads to reduction in high-risk behaviors. Additionally, ensuring naloxone access alongside fentanyl test strip distribution further supports harm-reduction efforts to protect veterans who are at risk for opioid overdose.

Moderators

Jessica Clancy

Nicholas Ferraro, PharmD, BCPS

PGY1 RPD & Clinical Pharmacy Specialist: IM/TOC, Temple University Hospital - Main Campus

Speakers

Han Trinh

PGY1, Corporal Michael J. Crescenz VA Medical Center

Han Trinh is one of the PGY1 Pharmacy Residents at Corporal Michael J. Crescenz VA Medical Center for the 2025-2026 year. She entered the program with an interest in ambulatory care, which has been further strengthened through her rotations in the outpatient cardiology clinics and... Read More →

Tuesday May 19, 2026 10:50am - 11:10am EDT
Broad Hub EAST

Medication Safety/Quality Improvement

11:10am EDT

Impact of a Two-Part Training Program to Support Naloxone Education and Community Outreach: Outcomes of the NAME Initiative

Tuesday May 19, 2026 11:10am - 11:30am EDT

Broad Hub WEST

Purpose:
North Philadelphia is disproportionately affected by opioid use disorder and related deaths. The objective of this study is to evaluate the effectiveness of a community-centered opioid harm reduction education program for pharmacy students.

Methods:
This is a prospective, quasi-experimental, pilot study evaluating outcomes of the Naloxone Access and Medication Education (NAME) Initiative. The study was conducted at a single ACPE-accredited school of pharmacy in Philadelphia, Pennsylvania. The program consisted of a two-hour training course followed by a two-hour community outreach Introductory Pharmacy Practice Experience (IPPE). Students completed pre- and post-surveys to assess their knowledge of opioid overdose recognition and response using the validated Opioid Overdose Knowledge Scale (OOKS) and confidence to engage meaningfully in community service using the validated Community Service Self-Efficacy Scale (CSSES). The primary endpoint was the change in OOKS scores pre- and post- didactic training. The secondary endpoint was the change in CSSES scores from pre- to post-IPPE. Pre- and post-survey data were analyzed using paired t-tests.

Results:
A statistically significant improvement of 0.91 points (SD ± 3.0) was seen in OOKS scores after students received didactic training (p=0.049). Significant improvement was primarily seen in the “Action” domain of the OOKS score (p=0.01). Seventy percent (31/44 students) completed the post-CSSES. Of those completed the survey, an improvement of 3.5 points (SD± 8.4) was observed; however, this was not statistically significant (p=0.053).

Conclusions:
Utilization of a didactic training program followed by a community outreach IPPE led to improvement in pharmacy student knowledge of opioid harm reduction and management and may increase perceived self-efficacy with educating community members.

Moderators

Nikitha Patel

Sarah Tobin

Kiyo Yoda

Speakers

Sarah Thomas, PharmD

PGY-2 Internal Medicine Pharmacy Residency, Temple University School of Pharmacy

Sarah Thomas is currently a PGY-2 Internal Medicine Pharmacy Resident at Temple University School of Pharmacy. She previously completed her PGY-1 at Penn Presbyterian Medical Center and received her PharmD degree from Rutgers University. Her career interests include transitions of... Read More →

Tuesday May 19, 2026 11:10am - 11:30am EDT
Broad Hub WEST

Addiction Medicine/Pain Management

11:10am EDT

Assessment of Bradycardia with Dexmedetomidine Use for Sedation in Non-Cardiac Intensive Care Units

Tuesday May 19, 2026 11:10am - 11:30am EDT

a.Pavilion Hub WEST

PURPOSE: This study evaluates the incidence of bradycardia following dexmedetomidine initiation in critically ill patients and identifies clinical predictors and dosing patterns to inform monitoring and optimize sedation practices.
METHODS: This retrospective chart review included critically ill adult patients who received a dexmedetomidine infusion for greater than 2 hours admitted to a non-cardiac intensive care unit (ICU) from November 1st, 2024 to November 1st, 2025. The primary outcome was the incidence of bradycardia defined as less than 60 beats per minute (bpm) following dexmedetomidine initiation. Secondary outcomes included incidence of severe bradycardia (less than 40 bpm or requiring clinical action), incidence of hypotension, time to first bradycardic event, dose and duration of infusion, liver function on ICU admission, body mass index (BMI) at time of infusion initiation, and concomitant use of vasoactive or rate-controlling medications. Descriptive statistics were used to summarize primary and secondary outcomes, and a binary logistic regression was performed as an exploratory analysis to identify predictors of bradycardia.
RESULTS: Seventy patients were included, with bradycardia occurring in 25 patients (35.7%). Severe bradycardia occurred in 2 patients (2.9%). Median time to first bradycardic event was 6.33 hours [2.93, 10.45]. Median infusion duration was 28.1 hours [14.6, 72], and mean infusion rate was 0.99 ± 0.48 mcg/kg/hr. Hypotension occurred in 41 patients (58.6%), and vasopressor therapy was continued or initiated in a subset of patients during infusion. In a binary logistic regression, higher heart rate on hospital admission was associated with increased odds of bradycardia [p=0.013, (OR 1.046, 95% CI 1.010-1.084)], while higher heart rate at dexmedetomidine initiation was associated with decreased odds of bradycardia [p=0.004 (OR 0.936, 95% CI 0.896-0.979)].
CONCLUSION: Bradycardia occurred in over one-third of critically ill patients receiving dexmedetomidine. Baseline heart rate predicted bradycardia risk, with effects varying based on when it was measured, as higher heart rate on hospital admission increased risk while higher heart rate at dexmedetomidine initiation was associated with lower risk. These findings highlight the need for patient-specific assessment and close monitoring during therapy.
IRB Approval: iRISID-2026-0188

Moderators

Meghin Haines

Samantha Macko, PharmD

Advanced Clinical Pharmacist, Thomas Jefferson University Hospital

Alyssa Polotti, PharmD, BCCCP

Clinical Pharmacy Specialist - Emergency Medicine/Trauma, St Mary Medical Centr - Trinity Health

Speakers

Christina Wallace

PGY2 - Critical Care, Jefferson Health, Thomas Jefferson University Hospital

I am currently the PGY2 Critical Care Pharmacy Resident at Thomas Jefferson University Hospital, where I also completed by PGY1 training. My clinical interests include sedation and analgesia management (PADIS) and the pharmacokinetic and pharmacodynamic alterations seen in critically... Read More →

Tuesday May 19, 2026 11:10am - 11:30am EDT
a.Pavilion Hub WEST

Critical Care

11:10am EDT

Evaluation of Carbapenem Therapy for Extended Spectrum β-Lactamase producing Enterobacterales (ESBL-E) Bloodstream Infections in Patients with and without Hypoalbuminemia

Tuesday May 19, 2026 11:10am - 11:30am EDT

a.Pavilion Hub EAST

Purpose:
The aim of this study was to evaluate the impact of albumin status on clinical and microbiological outcomes of patients treated with ertapenem or meropenem for ESBL-E bacteremia, and to identify factors associated with treatment failure.

Methods:
We conducted a dual-center, retrospective cohort study of adult patients admitted between October 1, 2022, and October 1, 2025, who received ertapenem or meropenem for the treatment of ESBL-E bacteremia (ceftriaxone-resistant Escherichia coli, Klebsiella spp. (non-aerogenes), or Proteus spp.). Patients were stratified by albumin status (L-Alb: serum albumin < 2.5 mg/dL or N-Alb: serum albumin ≥ 2.5 mg/dL) and carbapenem selection. The primary outcome was a composite of treatment failure: death, readmission for related infectious causes, recurrent infection, or absence of clinical improvement by day 14. Secondary outcomes included 30-day all-cause mortality and evaluation of clinical characteristics hypothesized to be associated with treatment failure. Categorical variables were compared using chi-square or Fisher’s exact tests. A multivariable logistic regression was performed to identify factors independently associated with outcomes.

Results:
Among 203 patients with a median age of 63 years, 23.6% had L-Alb, and 49.8% were immunocompromised. Bacteremia was primarily caused by E. coli (57.6%) from urinary or intra-abdominal sources, and the 30-day all-cause mortality rate was 14.3%. The primary outcome occurred in 24.6% of the cohort. Treatment failure was higher in patients with L-Alb versus N-Alb (47.9% vs 17.4%, P < 0.01) and with ertapenem in relation to albumin status (42.3% vs 12.9%, P < 0.01), but not with meropenem (54.5% vs 35.5%, P = 0.17). On multivariable analysis, L‑Alb (OR 2.76, 95% CI [1.26-6.04]) and lack of source control (OR 4.45, 95% CI [1.77-11.22]) independently predicted treatment failure, while ertapenem did not appear to (OR 0.42, 95% CI [0.19–0.93]).

Conclusion:
Our study presents medically complex patients with ESBL-E bacteremia not limited by infectious source. While prior literature cautions against ertapenem in patients who are critically ill and/or with L-Alb, our data suggests that poor ertapenem efficacy is multifactorial. Although failure rates were higher in patients with L-Alb receiving ertapenem, ertapenem did not appear to be associated with increased failure after adjusting for confounders.

Moderators

Rebecca Buckler

Alex Matika

Infectious Diseases Clinical Pharmacy Specialist / RPD PGY-2 ID Pharmacy Residency, St. Luke's University Health Network

Hinal Patel

Speakers

Thomas Hyson

PGY2 Infectious Diseases, Penn Medicine, Penn Presbyterian Medical Center

Thomas Hyson, PharmD is the current PGY-2 Infectious Diseases Pharmacy Resident at Penn Presbyterian Medical Center. Dr. Hyson completed his pharmacy education at the Jefferson College of Pharmacy in Philadelphia, PA and completed his PGY-1 Pharmacy Residency at Penn Presbyterian... Read More →

Tuesday May 19, 2026 11:10am - 11:30am EDT
a.Pavilion Hub EAST

Infectious Diseases

11:10am EDT

Impact of IV Push Antibiotics Administered in the Emergency Department in Patients with Sepsis and Septic Shock

Tuesday May 19, 2026 11:10am - 11:30am EDT

Broad Hub EAST

Purpose: The primary objective was to compare administration times of intravenous push (IVP) compared to piggyback (IVPB) antibiotics in the emergency department (ED) in patients with sepsis and septic shock.

Methods: This retrospective, single-center, IRB-exempt, chart review conducted at Jefferson Einstein Philadelphia Hospital (JEPH) included ED patients with sepsis or septic shock who received either IVP or IVPB ceftriaxone or daptomycin. Patients with sepsis were identified by ICD-10 code and sepsis alert, and septic shock patients had vasopressor requirements. Patients were excluded if transferred from outside hospital. To account for institution-wide process changes due to drug shortages, IVPB antibiotics were evaluated from January 1, 2024 to September 30, 2024, and IVP antibiotics were evaluated from November 1, 2024 to July 31, 2025.

Results: Patients assessed for eligibility included 76 patients in the IVP group and 51 patients in the IVPB group. No patients who were administered daptomycin met inclusion criteria. There was no difference in median time to administration between the two groups (IVPB 40.8 min vs IVP 39.2 min. p=0.99). In patients with sepsis, 34/46 patients (73.9%) and 51/72 patients (70.8%) in the IVPB and IVP group received antibiotics within 3 hours, respectively. In patients with septic shock, 1/5 patients (20%) and 2/4 patients (50%) in the IVPB and IVP group received doses within one hour, respectively. Similar rates of in-hospital mortality were seen in septic shock patients, and no patients experienced a type-1 hypersensitivity reaction.

Conclusion: Results showed no difference in administration times between IVP and IVPB ceftriaxone. Post-intervention IVP times to administration in prior studies were comparable to pre-intervention IVPB times to administration at JEPH. Future research should aim to evaluate potential factors that may contribute to delays in time to administration of antibiotics in sepsis and septic shock.

Moderators

Jessica Clancy

Nicholas Ferraro, PharmD, BCPS

PGY1 RPD & Clinical Pharmacy Specialist: IM/TOC, Temple University Hospital - Main Campus

Speakers

Jenna Kim

PGY-1, Jefferson Einstein Philadelphia Hospital

My name is Jenna Kim, and I am currently a PGY-1 pharmacy resident at Jefferson Einstein Philadelphia Hospital. I graduated from Saint Joseph's University Philadelphia College of Pharmacy in 2025, and my current interests include internal medicine, ambulatory care, and critical c... Read More →

Tuesday May 19, 2026 11:10am - 11:30am EDT
Broad Hub EAST

Medication Safety/Quality Improvement

11:30am EDT

Evaluation of a Pharmacist Driven Naloxone Protocol on Inpatient Naloxone Prescribing: A Retrospective Chart Review

Tuesday May 19, 2026 11:30am - 11:50am EDT

Broad Hub WEST

Purpose: This study was designed to evaluate whether a standardized inpatient pharmacist-driven naloxone protocol increased the number of naloxone prescriptions dispensed to patients at risk for opioid induced respiratory depression (OIRD).
Methods: This was a retrospective, single-center, cohort study where a pharmacist-driven naloxone protocol was implemented directing pharmacists to identify patients prescribed an opioid and at high risk for OIRD. A report was developed to standardize identification of at-risk patients from April 2025 to June 2025. Pharmacist then counseled on the importance and use of naloxone, communicated with providers, and pended naloxone prescriptions. Patients included were those at risk for OIRD and expected to take opioids at discharge or have a diagnosis of opioid use disorder. Patients excluded were those less than 18 years old and those discharged to a rehabilitation or skilled nursing facility. Patients were characterized into either a pre- or post-protocol group based off the discharge date. Dispensing of the naloxone prescription was then confirmed with the affiliated outpatient pharmacy. This study was approved by the institutional review board.
Results: Those included in the pre- and post-protocol groups were 54 and 42, respectively. The median age was 44 (range, 39 to 55), median BMI was 24 (range, 20 to 30) and median outpatient MME per day per patient was 180 (range, 45 to 564) in the pre-protocol group. The median age was 42 (range, 36 to 51), median BMI was 25 (range, 22 to 34) and median outpatient MME per day per patient was 94 (range, 46 to 360) in the post-protocol group. The total number of orders pended in the post-protocol group was 9 out of 42 (21%) and common reasons for not pending were either not documented (43%) or already had naloxone (28%). The number of naloxone prescriptions dispensed outpatient in the pre- and post-protocol groups are pending.
Conclusion: The most common risk factors identified for OIRD were active smoking, diagnosis of opioid use disorder, and concomitant sedative/hypnotic use. The most common outpatient opioids prescribed were methadone, oxycodone, and buprenorphine/naloxone. Results on the impact on naloxone dispensing are pending.

Moderators

Nikitha Patel

Sarah Tobin

Kiyo Yoda

Speakers

Amanda Northup

PGY1 pharmacy resident, Penn Medicine, Hospital of the University of Pennsylvania

My name is Amanda Northup, and I am a current PGY-1 pharmacy resident at the Hospital of the University of Pennsylvania. I am originally from Rochester, NY and received my PharmD from Binghamton University School of Pharmacy and Pharmaceutical Sciences. My career interests include... Read More →

Tuesday May 19, 2026 11:30am - 11:50am EDT
Broad Hub WEST

Addiction Medicine/Pain Management

11:30am EDT

Impact of a Pharmacist-Driven Antimicrobial Stewardship Initiative on Time to Targeted Therapy for Enterobacterales Bacteremia

Tuesday May 19, 2026 11:30am - 11:50am EDT

a.Pavilion Hub EAST

Objective: The purpose of this study was to evaluate the impact of a pharmacist-driven antimicrobial stewardship (ASP) initiative using rapid diagnostic testing (RDT) on de-escalation of antipseudomonal antibiotic therapy for Enterobacterales bloodstream infections (BSIs).
Methods: This was a multi-center, retrospective, comparative cohort study was approved by the institutional review board review (IRB) and included a sample of adult patients with Enterobacterales bacteremia who received empiric antipseudomonal therapy. Treatment was compared pre- and post- implementation of RDT. The primary outcome was time (hours) to de-escalation of antipseudomonal coverage. Secondary outcomes included days of antipseudomonal antibiotic therapy, 30-day mortality, and incidence of Clostridioides difficile infection (CDI). A subgroup analysis was also conducted to evaluate the use of anti-methicillin resistant Staphylococcus aureus (MRSA) therapy. Antimicrobial stewardship activities were also evaluated in the post-implementation group.
Results: This study included 44 patients in the pre-implementation group and 60 patients in the post-implementation group. Baseline characteristics were comparable between both groups. The median time (hours) to de-escalation of antipseudomonal coverage for Enterobacterales bacteremia was found to be significantly lower in the post-implementation group (9.3 vs 50.5, p < 0.001). Median days of therapy was also found to be lower in the post-implementation group (2 vs 4 days, p < 0.001). The 30-day mortality rate, CDI events, and days of anti-MRSA therapy were not statistically different between groups.
Conclusion: This study demonstrated that a pharmacist-driven antimicrobial stewardship initiative was successful in reducing time to targeted therapy in hospitalized patients receiving treatment for Enterobacterales bacteremia.

Moderators

Rebecca Buckler

Alex Matika

Infectious Diseases Clinical Pharmacy Specialist / RPD PGY-2 ID Pharmacy Residency, St. Luke's University Health Network

Hinal Patel

Speakers

Emily Pinto

PGY2 Infectious Diseases Pharmacy Resident, Jefferson Abington Hospital

Graduated from Fairleigh Dickinson University School of Pharmacy and Health Sciences with a doctorate in pharmacy. Later completed a PGY1 pharmacy residency at St. Joseph's University Medical Center. Currently, a PGY2 infectious diseases pharmacy resident at Jefferson Abington Hospital... Read More →

Tuesday May 19, 2026 11:30am - 11:50am EDT
a.Pavilion Hub EAST

Infectious Diseases

11:50am EDT

Lunch & Networking with Exhibitors

Tuesday May 19, 2026 11:50am - 1:00pm EDT

Franklin Square (13th Floor Downstairs)

Grab your lunch and network with exhibitors

Tuesday May 19, 2026 11:50am - 1:00pm EDT
Franklin Square (13th Floor Downstairs)

Event

1:00pm EDT

Panel Discussion: From Residency Training to Practice Success

Tuesday May 19, 2026 1:00pm - 2:00pm EDT

Forum (13th Floor Downstairs)

Panel Discussion with Residency Program Directors & New Practitioners. Open to all attendees. Justin Miller (St. Luke's University Health Network), Jeff Sivik (Penn State Hershey), Emily Casey (Hospital of the University of Pennsylvania), Samantha Macko (Thomas Jefferson University Hospital), Matt Alspach (Tower Health), Anthony Trono (Main Line Health), Moderated by Jill Rebuck (PSHP)

Moderators

Jill Rebuck

Executive Director, PSHP

Speakers

Jeff Sivik, PharmD, BCOP

PGY2 Oncology RPD & Adult Oncology Clinical Pharmacy Supervisor, Penn State Health Milton S. Hershey Medical Center

Matt Alspach, PharmD, BCPS

PGY1 RPD, Tower Health

Justin Miller, PharmD

PGY1 RPD & Emergency Medicine Clinical Pharmacist, St. Luke's University Health Network

Samantha Macko, PharmD

Advanced Clinical Pharmacist, Thomas Jefferson University Hospital

Tuesday May 19, 2026 1:00pm - 2:00pm EDT
Forum (13th Floor Downstairs)

General Session

2:00pm EDT

Clinical Pearl: Emerging Therapies in Lipid Lowering

Tuesday May 19, 2026 2:00pm - 2:20pm EDT

a.Pavilion Hub EAST

0.25 contact hour continuing education

Moderators

Morgan Gerber

PGY2 Critical Care, Milton S. Hershey Medical Center

Completed PGY1 at Milton S. Hershey Medical Center and am a current PGY-2 Critical Care Resident at Milton S. Hershey Medical Center. Have accepted a position as an Emergency Medicine/Critical Care pharmacy specialist at Milton S. Hershey Medical Center.

Speakers