PSHP 2026 Residency Conference

Purpose: The purpose of this study is to evaluate current institutional practices related to initiation and dosing of pharmacological venous thromboembolism (VTE) prophylaxis.  


Methods: This retrospective, single-center, chart review evaluated 150 patients from January 1-June 30, 2025. Adult patients who received at least 48 hours of pharmacologic VTE prophylaxis with a length of stay between 3 to 28 days were included. Patients were excluded if they had a clear indication for VTE prophylaxis (recent trauma, surgery, or active malignancy). The primary endpoint is the number of patients appropriately initiated on pharmacologic prophylaxis based on a Padua Prediction Score of ≥4. Secondary endpoints include the number of patients with appropriately dosed thromboprophylaxis based on body weight or BMI, the incidence of adverse events, and the number of readmissions due to bleeding or clotting events. Data included patient characteristics, components of the Padua Prediction and HAS-BLED scores, medication regimens, adverse events, and readmissions. Descriptive analysis was utilized to interpret the data.  


Results: Fifty-eight patients (38.7%) with a Padua Prediction score of ≥4 were appropriately initiated on VTE prophylaxis. There were 125 patients (83.3%) initiated on VTE prophylaxis at an appropriate dose for their BMI/body weight. Of patients dosed inappropriately, the highest rate of dosing errors (88.3%) occurred in those with a low BMI/body weight.  Adverse events and readmissions related to clotting or bleeding were rare. One DVT (0.7%) and one episode of major bleeding (0.7%) occurred during admission. Two patients had readmissions (1.4%), one related to bleeding, and one related to clotting.  Enoxaparin was the agent used the most (56.7%) and had the greatest rate of inappropriate dosing among patients (11.3%). 


Conclusion: In patients without a clear indication for VTE prophylaxis, pharmacologic agents are frequently initiated unnecessarily. Patients with a low BMI/body weight demonstrated the highest rate of inappropriate dosing, highlighting the need for improved risk assessment and standardized protocols at our institution. Optimizing the initiation of thromboprophylaxis presents an opportunity to reduce unnecessary medication use and healthcare costs.  


(This study is IRB approved)

Purpose: 
This study aims to evaluate real-world enoxaparin dosing and anti-Xa levels among patients with obesity to assess whether dose reductions improved the proportion of therapeutic anti-Xa levels and reduced supratherapeutic exposure.
 
Methods: 
This single-center retrospective chart review at Penn State Health Milton S. Hershey Medical Center evaluated adults with body mass index ≥35 kg/m2 receiving therapeutic enoxaparin every 12 hours with at least one appropriately timed anti-Xa level between June 2023 and June 2025. Therapeutic enoxaparin included standard weight-based dosing (1 mg/kg) using actual body weight with institutional syringe rounding, continuation of home regimen, or empiric dose adjustments based on body mass index or prior anti-Xa levels. Data collected included demographics, enoxaparin doses, anti-Xa levels, and bleeding events. The therapeutic anti-Xa range was defined as 0.5-1 IU/mL. The primary outcome was the proportion of patients requiring dose reduction based on anti-Xa levels. Secondary outcomes included percent dose reduction and bleeding events. Descriptive statistics and subgroup analyses by dosing group and obesity class were performed.
 
Results: 
Among 174 patients, 56% had supratherapeutic, 41% therapeutic, and 3% subtherapeutic initial anti-Xa levels. Lower initial doses (<0.85 mg/kg) were associated with higher therapeutic rates (64-65%) and lower supratherapeutic rates (18-32%) compared with >0.95 mg/kg (35% therapeutic, 65% supratherapeutic). Patients receiving <0.75 mg/kg had significantly lower odds of supratherapeutic levels (OR 0.11, p<0.001). The mean therapeutic dose was 0.84 mg/kg among all patients, however 0.81 mg/kg among those with class 3 obesity. Repeat anti-Xa monitoring occurred in 16% of patients with therapeutic anti-Xa levels, with 71% remaining therapeutic. Bleeding occurred in 6% of patients, with 82% of events in those with supratherapeutic levels.
 
Conclusion:
Reduced enoxaparin dosing (<0.85 mg/kg) in patients with obesity was associated with improved therapeutic anti-Xa levels and significantly lower supratherapeutic anti-Xa levels compared with standard dosing (>0.95 mg/kg). Supratherapeutic levels were common and linked to most bleeding events. These results support lower initial dosing and more targeted anti-Xa monitoring in patients with obesity.

Purpose: 
To improve visibility, coordination, accountability, and sustainability of pharmacy initiatives by developing a program to centralize oversight of pharmacy quality efforts across inpatient, ambulatory, and retail settings
 
Methods: 
A quality needs assessment was conducted at the Hospital of the University of Pennsylvania, a 1,067-bed academic quaternary referral center with over 600 pharmacy staff. This assessment was carried out using an anonymous electronic survey distributed to pharmacists, technicians, and interns across all main practice areas, including inpatient, ambulatory, and retail settings. The survey assessed baseline perceptions of departmental quality priorities, preferred communication styles, awareness of and current involvement in quality initiatives, and perceived value of establishing a formal quality program. Quantitative Likert-scale responses and qualitative free-text answers were reviewed to identify major themes and opportunities for improvement for a structured governance model. Survey findings were used to refine and guide the program’s design and structure.
 
Results: 
A total of 150 responses were collected. Over half of respondents could not name a current pharmacy quality initiative, highlighting the limited awareness of ongoing work in the department. The most common barriers to participating in initiatives included lack of protected time or visibility of opportunities. Most respondents agreed or strongly agreed that time spent on quality work is a worthwhile investment. This suggests that while staff may feel disconnected from the process, they still recognize the value of quality improvement work. Staff strongly supported formal committee creation: 74% agreed or strongly agreed that a designated quality committee could improve visibility, coordination, and outcomes of pharmacy quality work.
 
Conclusion: 
Survey findings demonstrated strong departmental support and need for a centralized Pharmacy Quality Initiatives Program. Establishing a designated committee may reduce fragmented efforts, strengthen accountability, and create a sustainable framework for quality improvement. In the long term, a committee may enhance patient safety and operational efficiency while also highlighting pharmacy’s value across the health system. 
 
No IRB approval necessary.