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. 

 To compare PACU recovery time, opioid use, and postoperative outcomes in adults undergoing general laparoscopic/robotic surgery managed with dexmedetomidine versus standard therapy without dexmedetomidine.


This is a retrospective cohort study conducted at Penn Medicine Princeton Medical Center. Medical records of adult patients (≥18 years) undergoing laparoscopic/robotic procedures in the surgery center between July 1, 2024, and June 30, 2025. General laparoscopic/robotic surgeries were predominantly abdominal and gastrointestinal cases. Patients were stratified by dexmedetomidine use in the anesthesia care plan. Primary outcome was total PACU recovery time from admission to discharge. Secondary outcomes included postoperative nausea/vomiting occurrence, opioid administration converted to morphine milligram equivalents (MME), and postoperative pain scores. Data collected included demographic, comorbidities, and anesthetic details including anesthesia minutes, use of inhaled gases and sedatives. Statistical analyses applied were independent t-tests for independent variables and Chi-square tests for categorical outcomes. 


A total of 1,475 patients were included (222 dexmedetomidine; 1,253 control). Median PACU length of stay was not statistically significant with dexmedetomidine (98.4 minutes [IQR 77.5-129.5] versus 92.1 minutes [IQR 81.9-117.8]), along with the median anesthesia duration (158 minutes vs 174.3 minutes). Reduced sevoflurane exposure was statistically significant (68.1 minutes vs 109.8 minutes). Although not statistically significant, the median opioid requirements were lower in the dexmedetomidine group compared to control (MME 7.5mg versus 11.8mg) but had more PACU opioid use (57.7% versus 50.8%), with moderate-to-severe pain being less frequent in the dexmedetomidine group with a median of 2 patients vs 7 patients.


In this retrospective study, dexmedetomidine use in general laparoscopic/robotic procedures did not significantly improve PACU recovery time compared to standard anesthesia. However, it reduced anesthesia exposure and sevoflurane use. Patients receiving dexmedetomidine reported lower rates of moderate-to-severe postoperative pain and required less total opioid use, suggesting a reasonable addition to standard of care with comparable outcomes.

Purpose
The primary objective of this study is to assess Pennsylvania Community pharmacist awareness of SOC regulatory models. The secondary objective is to determine pharmacist perception on SOC regulation change in Pennsylvania.


Methods
This mixed-methods study will explore pharmacists’ awareness and perceptions of SOC using survey questions guided by the Consolidated Framework for Implementation Research (CFIR).
The survey will be conducted via Qualtrics. Eligible participants include pharmacists who are licensed and practicing in a community pharmacy in Pennsylvania. A flyer for the research project survey was distributed to pharmacies via email, in-person, and direct messaging.
Each qualifying participant will have the option to enter a drawing. Participant responses to the survey will not be linked to their raffle entry. Twenty (20) participants will be randomly selected to each receive a $50 gift card. Survey results will be exported, and descriptive statistics will be utilized to assess results of both the primary and secondary objectives.


Results
Findings presented represent ongoing preliminary data from 32 respondents as of 4/15/26. Respondents were across chain (36%), grocery/mass merchant (55%), and independent (9%) settings. Most reported limited familiarity with SOC (48% slightly familiar, 33% not at all). Following educational material, respondents viewed SOC favorably. 85% agreed it would improve patient satisfaction, 85% supported updating the current regulatory model, and 81% considered SOC an important initiative. Most expressed confidence in their ability to follow SOC guidelines (88%) and their willingness to advocate for it (72%). Top barriers included workflow constraints and staffing requirements (50% each), policymakers (47%), and training requirements (44%).


Conclusions
Preliminary findings suggest strong pharmacist support for SOC regulatory models, with most recognizing their importance and potential to improve patient care. Key barriers reflect systemic challenges requiring stakeholder collaboration. As data collection continues, these trends may inform targeted strategies to advance pharmacist-led SOC advocacy and adoption.


Approved by Temple University Institutional Review Board (IRB).

Purpose: Uninsured patients face long hospital stays for IV antibiotics. This study evaluated cost savings and length of stay for patients discharged after receiving dalbavancin via patient assistance programs compared to standard IV antibiotics.


Methods: The patient population included those who received a dose of inpatient dalbavancin from a patient assistance program for treatment of a gram-positive infection. De-identified data in this retrospective evaluation were collected from the electronic medical record and included demographics, microbiological results, admission/discharge dates, and inpatient antibiotic therapies. The analysis compared actual length of hospital stay prior to dalbavancin administration with projected inpatient duration with a full course of standard IV antibiotics. Estimates for prolonged inpatient stay were derived from treatment plans and antimicrobial practice guidelines. Hospital costs were calculated with cost-per-day estimations and drug costs for inpatient antibiotics. Investigators evaluated cost impact of dalbavancin compared to standard antibiotics and assessed potential implications for expanding access to patients with limited insurance coverage.


Results: Twelve patients were included in the study population. Actual length of hospital stay prior to dalbavancin was compared to the projected inpatient duration had the patient received a full course of standard antibiotics. Length of stay (LOS) cost was determined using an approximation of $800 per day. The early discharges saved a cumulative 355 inpatient days, with cost savings of $284,000.00. The cost of inpatient antibiotic therapy was estimated using hospital acquisition costs. Dalbavancin was acquired at no cost through the patient assistance program. Total projected cost of standard therapy was $5,229.00, compared to actual cost of $3,665.00 with early discharge. The total cost savings afforded to the hospital amounted to $349,877.46.


Conclusion: Compared to standard inpatient IV antibiotics, early discharge with dalbavancin resulted in reduced costs and shortened length of stay. Through patient assistance programs, access to outpatient IV antibiotics can be expanded to include patients without insurance coverage or with high out-of-pocket costs. The significant cost savings and benefits of early discharge support the value of incorporating dalbavancin into clinical practice.


IRB Approval: The IRB reviewed your project and determined that it is not human subjects research per the federal 
regulations found at 45 CFR 46.102(l). 

Open to all residents and preceptors. Choose the networking session most of interest.

Purpose: 
To evaluate enteral nutrition (EN) practices and tolerance in critically ill patients receiving ≥2 vasopressors and to inform evidence-based feeding recommendations for this high risk population. 
Methods: 
This single center, retrospective chart review included adult ICU patients receiving ≥2 vasopressors between September 2024 and September 2025. The primary outcome was incidence of clinically significant EN intolerance, defined as abdominal pain, distention, nausea/vomiting, diarrhea, or interruption/discontinuation of feeds. Secondary outcomes included EN route, initial and maximum EN rates, and vasopressor requirements quantified as norepinephrine equivalents. 
Results: 
286 patients were screened, while only 29 patients were included, with only 2 (6.9%) who had documented EN intolerance, recorded as regurgitation and fecal intolerance. 
EN was most commonly delivered via nasogastric (NG) and orogastric (OG) tube (72.4%), followed by percutaneous endoscopic gastrostomy (PEG) (27.6%). Vital AF 1.2 Liter® was the most frequently used formula (58.6%), with other formulas used less commonly. Patients were managed across multiple ICUs, reflecting consistent feeding practices. 
Septic (38%) and cardiogenic (37%) shock were most prevalent. At EN initiation, the mean norepinephrine equivalent dose was 0.3 [0.34] mcg/kg/min, with most patients receiving moderate to high vasopressor support. EN was initiated conservatively 20 [35] cc/hour and advanced as tolerated to a mean maximum of 45 [30] cc/hr. 
Conclusion: 
Despite frequent mechanical ventilation and continuous renal replacement therapy (CRRT) use, EN intolerance was uncommon evidenced by continued feeding until tolerating food by mouth or discharge. Institutional practice demonstrated a tendency to discontinue tube feeds when patients escalate to three vasopressors or high vasopressor doses. EN was typically initiated at trophic rates and advanced cautiously. 
These findings suggest that EN may be tolerated in select critically ill patients receiving multiple vasopressors, particularly at low infusion rates. However, feeding practices remain conservative, highlighting the need for further research to define safe and standardized thresholds for EN initiation and continuation in this population. 

To evaluate the safety and effectiveness of a standardized phenobarbital protocol for alcohol withdrawal syndrome in a mixed ICU at a community hospital compared to benzodiazepine based management. 


This retrospective cohort study evaluated adults admitted to a mixed ICU at a community hospital with alcohol withdrawal (AWS) between May–November 2024 and May–November 2025. Adults with a diagnosis of AWS and critical care admission who received phenobarbital through a standardized weight-based protocol, or benzodiazepines through the medical AWS order set were included. Exclusion criteria consisted of mechanical ventilation before medication initiation, use of phenobarbital or benzodiazepines prior to admission based on the home medication list or dispense history, or benzodiazepine-treated patients who received phenobarbital. The primary outcome was incidence of escalation to continuous sedation or intubation within 72 hours, with secondary outcomes assessing safety, medication use, symptom control, adjunctive sedative use, and length of stay (LOS).


Of 230 patients reviewed, 170 met inclusion criteria (phenobarbital n=90; benzodiazepine n=80). The primary outcome occurred in 18 phenobarbital patients and 24 benzodiazepine patients. Phenobarbital was associated with lower odds of escalation (20% vs 32.5%); however, this was not statistically significant (OR 0.59, 95% CI 0.29–1.19; p=0.14). Median ICU LOS (2.1 vs 2.9 days; p=0.008), hospital LOS (4 vs 5 days; p=0.032), and as needed benzodiazepine use (1 vs 38.5 milligrams; p≤0.001) were significantly lower with phenobarbital. Adverse respiratory events were more frequent with phenobarbital (13.3% vs 0%; p≤0.001), while seizures (1.1% vs 10%; p=0.013) and delirium tremens (0% vs 83.8%; p≤0.001) were more frequent with benzodiazepines.


Although the primary outcome was not statistically significant, the findings suggest potential clinical benefit. A standardized phenobarbital protocol was associated with reduced ICU and hospital LOS and decreased incidence of seizure and delirium tremens when compared to benzodiazepine based management. Further studies with larger populations are needed to confirm these findings.

Purpose: To evaluate whether ketamine-based sedation is associated with a difference in duration of mechanical ventilation compared with standard sedation strategies in mechanically ventilated medical intensive care unit patients. 


Methods: A single center retrospective study of patients admitted to the medical intensive care unit at a community teaching hospital between January 2023 and July 2025 was conducted. Patients administered continuous sedation with or without ketamine for at least 6 hours while mechanically ventilated for at least 24 hours were identified. The primary outcome was duration of mechanical ventilation. Secondary outcomes included mortality, intensive care unit and hospital length of stay, CAM-ICU results, and fentanyl requirements. Patients on adjunctive ketamine were compared to those on standard sedation regimens. Baseline characteristics were collected and compared between groups. Continuous variables were analyzed using medians with interquartile ranges and compared using Mann-Whitney U. Categorical variables were compared using chi-square or Fisher’s exact tests. The study was IRB approved.


Results: Twenty-eight patients were included with 14 in each arm. Patients in the ketamine arm received adjunctive sedation with propofol, dexmedetomidine, or midazolam compared to patients sedated with at least two of the previously mentioned agents. Median duration of mechanical ventilation did not differ between the ketamine and standard sedation groups (10.6 days vs 8.4 days, p=0.603). Mortality was lower in the ketamine group (7.1% vs 50%, p=0.012). Hospital and intensive care unit length of stay were similar between groups. Patients receiving ketamine required higher median fentanyl doses (200 mcg/hr vs 100 mcg/hr, p=0.007).


Conclusion: Ketamine-based sedation was not associated with reduced duration of mechanical ventilation compared with standard sedation strategies. However, ketamine use was found to have a lower observed mortality. Larger prospective studies are needed to further evaluate the role of ketamine in intensive care unit sedation regimens.

Purpose: To evaluate the frequency and address any contributing factors associated with inappropriate empiric antibiotic prescribing in the Emergency Department (ED) based on national and institutional guidelines.
Methods: A retrospective record review was conducted at St. Mary Medical Center of electronic patient health records from January 1, 2025- June 30, 2025. Adults aged 18-89 years presenting to the ED with suspected or confirmed pneumonia (PNA) or urinary tract infection (UTI), who received pre-identified broad-spectrum antibiotics were included. The primary outcome looked at frequency of inappropriate empiric broad-spectrum antibiotic prescribing in the ED. Secondary outcomes included post ED antimicrobial course, hospital length of stay (LOS), and subgroup analyses of patients who met SIRS criteria and those with multidrug-resistant organism (MDRO) risk factors. Safety endpoints included adverse drug reactions and mortality. Initial treatment strategy was assessed based on the 2019 American Thoracic Society pneumonia guidelines, and 2010 Infectious Diseases Society of America UTI guidelines with local resistance pattern guidance.  
Results: Of the 166 patients included, 98 (59%) received antibiotics for PNA and 68 (41%) for UTI. Overall, 108 (65%) received inappropriate empiric antibiotics. In the inappropriate group, 71 (66%) met SIRS criteria, of which 1 (0.9%) had septic shock. Anti-MRSA antibiotics were discontinued in 57 (53%) patients, and antipseudomonal therapy was narrowed in 54 (50%) patients. Vancomycin was administered to 89 (54%) patients, despite only 16 patients meeting criteria for empiric MRSA coverage. Common MDRO risk factors were IV antibiotic use within 90 days and prior MDRO positive cultures within 1 year. The inappropriate group also had a longer mean LOS by 57 hours. Acute kidney injury occurred in 7 (6%) patients, and 3 (3%) patients died. 
Conclusion: Inappropriate empiric treatment was associated with providing unnecessary gram positive and gram-negative coverage, indicating a pattern of reflexive broad-spectrum prescribing. Targeted education on current national and institutional practice guidelines may reduce unnecessary broad-spectrum antibiotic use and reduce antimicrobial resistance. 

Purpose: Evaluate the impact of provider education on the initial selection of medications used to treat patients with escalating agitation in acute care settings to ensure staff and patient safety.
Methods: A two-phase retrospective chart review study evaluated the impact of provider education on medication selection for agitated patients aged 18 and older who required an institutional agitation alert and received stat medications for agitation. Phase one retrospectively identified these patients during a six-month period prior to the intervention. In phase two, providers received an educational presentation detailing the recommendations from an algorithm collaboratively created by clinical pharmacists and psychiatric providers for treatment of acutely agitated and violent patients. Post-education in phase two, a second retrospective chart review was conducted. The primary endpoint was the percentage of administered medications that were adherent to the algorithm. Secondary endpoints included percentage of medications considered first-line and second-line agents, and percentage of patient encounters that required a repeat agitation alert.
Results: A total of 88 agitation alerts from phase one and 30 from phase two were included in this study. The percentage of medications administered that were adherent to the institution’s guideline was 85.2% (109/128) in phase one and 89.5% (34/38) in phase two. In phase one, 63.3% (69/109) of these adherent medications were considered first line recommended agents, and 61.8% (21/34) in phase two. Of the medications that were adherent to the algorithm, 36.7% (40/109) were considered second line recommended agents in phase one, and 38.2% (13/34) in phase two. The percentage of repeat agitation alerts that met inclusion criteria per patient encounter in phase one was 20.5% (18/88) and 3.3% (1/30) in phase two.
Conclusion: Provider education did not affect the percentage of medications administered adherent to the algorithm or on medications considered first or second line. The percentage of repeat agitation alerts decreased following provider education. The findings are limited by minimal direct pharmacist input on medication selection. Future studies may explore the impact that pharmacists can make by providing real-time interventions during agitation alerts.

Purpose: This study aims to evaluate the effectiveness and safety of ketamine-propofol compared with propofol alone for procedural sedation in adult patients undergoing orthopedic reductions.
Methods: This single-center retrospective observational study included adults (≥18 years) undergoing orthopedic reductions with ketamine-propofol or propofol in the emergency department between September 2024 to September 2025. Patients were identified via electronic medical records. The primary endpoint was sedation efficacy, defined as successful first-attempt reduction confirmed by imaging without additional sedation. Secondary endpoints included site-specific reduction success, recovery time, emergency department length of stay, total weight-based sedative dose, and incidence of respiratory, cardiovascular, and rescue interventions. Continuous variables were analyzed using t-test or Mann-Whitney U test; categorical variables using chi-square or Fisher’s exact test (α=0.05).
Results: A total of 72 patients were included (ketamine-propofol n=14; propofol n=58). Propofol was associated with a higher first-attempt reduction success rate compared with ketamine-propofol (89% vs 64%, p=0.01). Site-specific reduction success was similar for shoulder (66.7% vs 88.0%, p=0.35), hip (66.7% vs 100%, p=0.33), or ankle reductions (100% vs 100%, p>0.9). Emergency department length of stay did not differ between groups (562 vs 429 minutes, p=0.26). Ketamine–propofol required a higher total sedative dose (2.3 vs 1.5 mg/kg, p=0.04). Procedural success rat

0.25 contact hour continuing education

0.25 contact hour continuing education

0.25 contact hour continuing education

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.

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. 

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.  

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.

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.  

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.

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.
 

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.

0.25 contact hour continuing education

0.25 contact hour continuing education

0.25 contact hour continuing education