2026 Eastern States Conference

Authors:
Cassidy Cox1, PharmD, Deepika Sivakumar1,2, PharmD, MS, Patricia Hernández2, MD, Bryan Hayes, PharmD1,2, Marianna Hernandez1, PharmD Candidate 
1Department of Pharmacy, Massachusetts General Hospital, Boston, MA 
2Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA 
 
Background:
Ketamine is used for procedural sedation in the emergency department (ED) for its analgesic and dissociative properties. It remains unclear whether substance use disorder (SUD) is associated with higher ketamine doses during procedural sedation. 
Objective: To evaluate if ketamine doses for procedural sedation differed between patients with and without various SUD. 

Learning Objective:  
Evaluate the impact of substance use disorder on dosing of ketamine for procedural sedation in the emergency department. 

Methods:  
This was a single-center, retrospective cohort study of patients receiving ketamine for procedural sedation in the ED from March 2018 to May 2025. Patients with SUD were identified using ICD-10 codes and matched 1:1 by age and weight using coarsened exact matching. SUD types included use of alcohol, opioids, cannabis, sedatives, cocaine or other stimulants, hallucinogens, nicotine, inhalants, or other psychoactive substances. The primary outcome was time-averaged ketamine dose as the cumulative dose in mg divided by sedation duration in minutes. Secondary outcomes included weight-based time-averaged ketamine dose as dose in mcg divided by weight in kg divided by documented sedation duration in minutes, and administration of additional sedative agents such as propofol and midazolam. The Student’s t-test was used for continuous data for analysis of means, the Mann-Whitney U test was used for continuous data for analysis of medians, and the Chi-squared test was used for categorical data. 

Results:  
92 patients were included in analysis, with 44 in the SUD group and 48 in the non-SUD group. Time-averaged ketamine dose (mg/min) did not significantly differ between the SUD group and non-SUD group (2.17 versus 3.09; p=0.062). Weight-based, time averaged ketamine dose (mcg/kg/min) also did not significantly differ between groups (29.5 versus 40.5; p-value 0.059). A total of 63 patients (68%) received additional sedatives, with no significant difference between SUD and non-SUD groups (72.7% versus 60.4%; p-value=0.212). There was no significant difference in propofol use (66% vs 46% in SUD and non-SUD groups, respectively; p=0.056). However, a higher mean propofol doses in mcg/kg/min were used in the SUD group (48.2 versus 22.7; p=0.009). 

Conclusion and Relevance:  
Patients with SUD did not require higher doses of ketamine for procedural sedation in the ED. Patients with SUD were also not more likely to require additional sedatives but did receive higher doses of propofol when administered in addition to ketamine. While not significant, patients with SUD were sedated almost 15 minutes longer than patients without SUD, possibly due to higher doses of concomitant propofol. Future studies should evaluate dosing by SUD type and sedation-related adverse events. 

Authors: Jennifer Gronski PharmD; Alyssa Robertson, PharmD, BCPS, BCCCP, BCEMP; Matthew Walbrown PharmD
Learning objective: Identify common etomidate doses used by physicians for rapid sequence intubation and procedural sedation.
Self-Assessment Question: True or False, the most common dose of etomidate used for rapid sequence intubation is 0.3 mg/kg.
Background/Objective: Etomidate is a short acting anesthetic agent used for rapid sequence intubation and procedural sedation with lack of literature showing which etomidate dose is preferred for each. The hypothesis of this survey is that there will be variability in dosing of etomidate.
Methods: This is a national survey that will be sent out through WellSpan York Hospital Emergency Medicine residency program alumni network, emergency medicine director network, and emergency medicine residency program director networks for physicians to complete. This survey aims to obtain information including hospital geographic location, trauma center designation, and annual emergency department volume. There are also questions about etomidate such as indication, dosing, adverse events, type of body weight used, dose-capping practices, and adjunctive therapy. The survey will be open for responses for four weeks, with all responses being included for analysis at the time of survey closure. 
Results: To be determined 
Conclusion: To be determined 

Title: 
Impact of pharmacist participation on timeliness of blood pressure management in spontaneous intracerebral hemorrhage 
 
Authors:  
Andy Bryan, Haijing Tran, Andrea D’Souza, DeAngelo Price, Imran Chughtai 
 
Objectives: 
At the conclusion of this presentation, the participants will be able to describe the impact of pharmacist participation on the timeliness of acute blood pressure management in patients with spontaneous intracerebral hemorrhage. 
 
Self-Assessment Question:  
Which blood pressure target is recommended for patients with mild to moderate spontaneous intracerebral hemorrhage and an initial SBP of 150–220 mmHg?  
A. SBP <180 mmHg  
B. SBP 160–180 mmHg
C. SBP 140 mmHg, maintained between 130–150 mmHg
D. SBP <120 mmHg
 
Background: 
Early systolic blood pressure (SBP) reduction improves outcomes in spontaneous intracerebral hemorrhage. Guidelines recommend rapid lowering to a target of 140 mmHg (maintain 130–150 mmHg). This study evaluates pharmacist impact on timeliness of BP control. 
 
Methods: 
This interventional cohort study includes adults aged 18 years or older presenting to a single emergency department with spontaneous intracerebral hemorrhage confirmed by non‑contrast computed tomography and an initial systolic blood pressure of 150 to 220 millimeters of mercury. The intervention consists of implementation of a standardized antihypertensive treatment protocol, targeted education for physicians and nurses, pharmacy‑based alerting at diagnosis, expedited access to antihypertensive agents, and pharmacist participation in early identification and response. Primary outcomes include time from emergency department arrival to first antihypertensive medication administration and time to achievement of target systolic blood pressure. Secondary outcomes include time to medication order entry, modified Rankin Scale score at discharge, intensive care unit length of stay, and hospital length of stay. Descriptive and inferential statistics will be used for analysis. 
 
Results: 
TBD 
 
Conclusion: 
TBD

Title: Bacterial vaginosis positivity among emergency department patients diagnosed with sexually transmitted infections 
 
Authors: Kaitlyn Czupryn, PharmD, BCCCP, Christiane Messerli, PharmD, Johnna Ball, PharmD, Brian Burton, MS  
 
Learning Objective: Evaluate the prevalence of BV co-infection among patients diagnosed with Chlamydia trachomatis and/or Neisseria gonorrhoeae, and assess associated clinical outcomes, including recurrence and need for antibiotic regimen modification. 
 
Background: Limited evidence describes the rate of BV co-infection among patients diagnosed with chlamydia and/or gonorrhea. This study evaluates the prevalence of BV in patients with chlamydia or gonorrhea and assesses associated outcomes. 
 
Methods: This retrospective study included adult female patients diagnosed with chlamydia, gonorrhea, or both who were evaluated and discharged from three Charleston Area Medical Center (CAMC) emergency departments (EDs) between August 1, 2022, and June 31, 2025, and had a vaginitis panel obtained. Patients younger than 18 years were excluded. The primary outcome was the proportion of patients with chlamydia and/or gonorrhea, who also tested positive for BV. Secondary measurements included 7-day ED revisits, pelvic inflammatory disease (PID) diagnosis, infection recurrence ≥ 4 weeks, and post-ED contact for antibiotic adjustment. 
 
Results: Among 212 patients included, most were nonpregnant (76.9%) and tested positive for chlamydia (85.4%). Overall, 68.4% tested positive for BV. No significant differences were observed in PID diagnoses or 7-day ED revisits. Patients with BV were more likely to experience infection recurrence ≥ 4 weeks (37.9% vs 20.9%, p = 0.0138) and require post-ED contact for antibiotic adjustment (83.8% vs 16.2%, p <0.0001).  
 
Conclusion: BV was frequently identified among patients diagnosed with chlamydia and/or gonorrhea and associated with higher rates of infection recurrence and antibiotic adjustments. Concurrent BV evaluation may support more targeted therapy and reduce recurrent infections. 
 
Self-Assessment Question: True or False: Untreated BV co-infection may increase the risk of recurrent STIs or complications.

Title: Clinical and patient reported outcomes with an emergency department meds to beds program in an integrated health system

Authors: Lindsey Kieffer, PharmD; Jamie Kerestes, PharmD, BCCCP, BCEMP; Angela Slampak-Cindric, PharmD, BCPS, BCCCP, FCCM; Alysa Adams, PharmD, Kent Strohecker, MS, MHSA, CRCR

Objective: Define the impact of an emergency department Meds to Beds (M2B) program within an integrated health system.

Self-Assessment Question: What percentage of prescriptions are not filled after a patient is discharged from the ED when M2B is not used?

Background/Objective: After ED visits, a significant proportion of prescriptions go unfilled. This program aims to increase fill rates for acute medications and reduce 30-day revisits for infectious diagnoses or acute VTE.

Methods: This multi-center single health system retrospective and prospective cohort study took place from March 2025 through April 2026. Patient satisfaction scores for the ED M2B program were collected from February 2026 through April 2026. Adult patients presenting to the ED diagnosed with an infectious cause or an acute VTE were included. Outcomes for M2B vs non-M2B discharges included claims-based fill compliance, 30-day ED return for the same ICD-10 diagnosis, survey-based satisfaction, and revenue per prescription. De-identified data were shared with Bucknell collaborators supporting a collaborative economic analysis.

Results: From the original data extraction, 849 encounters were screened and 815 included in the primary analysis. Of the 815 included encounters, 35.0% used Meds to Beds, 44.9% filled prescriptions at external pharmacies, and 30.9% did not fill external prescriptions (p <0.0001). Differences in patient race, ethnicity, and hospital location were observed between M2B and external pharmacy groups. Thirty‑day readmission rates were numerically lower with Meds to Beds compared with external pharmacy encounters (6.0% vs 7.9%). Hospital location varied among encounters with and without 30‑day readmission. Among 52 survey respondents, satisfaction with Meds to Beds was uniformly high, and 48.1% reported difficulty obtaining medications without ED dispensing.

Conclusion: An ED Meds to Beds program was associated with similar 30-day readmission rates compared with external pharmacy use, with clinically meaningful trends toward fewer readmissions. High patient satisfaction and reported difficulty obtaining medications without ED dispensing highlight the program’s potential to improve access to care at ED discharge.

Authors: 
Josephine Gresko, PharmD  
Tammy Nguyen, PharmD  
Savanna Scott, PharmD, BCEMP  
Katie Smithwick, PharmD, BCPP, BCPS  
 
Learning Objective: 
Audience members will compare and contrast efficacy and safety outcomes for droperidol and haloperidol when used for acute agitation in the emergency department (ED).   
 
Background/Objective: 
The objective of this quality improvement project was to characterize and compare droperidol versus haloperidol for agitation in the ED at VCU Medical Center.  
 
Methods: 
This quality improvement project consisted of a single center retrospective medical record review. The primary outcome was proportion of patients requiring additional medications for agitation within 15 minutes of initial droperidol or haloperidol administration. Secondary outcomes characterized the total antipsychotic dose, concomitant medications, and time to redosing any medication for agitation. Additional safety outcomes included patients requiring intubation, electrocardiogram monitoring, and proportion of patients experiencing extrapyramidal symptoms. All adult patients who received droperidol or haloperidol for acute agitation in the ED between October 11, 2024 and October 11, 2025 were included. Patients who received droperidol or haloperidol for any other indication were excluded. Descriptive statistics were used for demographic data. Continuous data was analyzed using t-test and categorical data using Fisher's exact or chi-square.   
 
Results: 
Of the 758 patients reviewed, 429 were excluded. Of those included, 59 received droperidol and 270 received haloperidol. Baseline characteristics were similar, except adults over 65 years were more likely to receive haloperidol (p=0.001). There was no statistically significant difference in the percentage of patients who required additional medications for agitation within 15 minutes of initial droperidol (24%) or haloperidol (16%) administration (p=0.224). The median doses used were 2.5 mg for droperidol and 5 mg for haloperidol. Time to redosing medications was similar between groups.  Haloperidol was more often given with concomitant lorazepam (p=0.012) or diphenhydramine (p=0.029). No other significant differences in outcomes were found. 
 
Conclusions: 
Droperidol and haloperidol had similar rates of treatment failure for agitation in this patient sample. However, lower doses of droperidol were given compared to published literature. Both antipsychotics demonstrated similar adverse effect profiles. Next steps include optimizing educational strategies for VCU Health ED providers surrounding use of droperidol in agitation, as regimens used do not reflect American College of Emergency Physicians’ recommendations, nor previous literature.  
 
Self-Assessment Question: 
True or false: Based on this retrospective review, droperidol is more effective at treating agitation in the ED compared to haloperidol.   
(False)  
 

Authors: Samantha Harper PharmD, Jesse Dorchak PharmD, BCPS

Learning Objective: At the conclusion of this presentation, audience members will be able to list the steps required to implement a pharmacist-administered IV medication protocol

Background: Due to increased demands on ED staff, a protocol allowing pharmacists to administer IV medications in the ED was created and implemented. We hypothesize ED pharmacists can safely administer IV medications.

Methods: This is a clinical process improvement project. PA laws regarding pharmacist medication administration were reviewed to create the written protocol. An exception to 28 Pa. Code § 107.64 (administration of drugs) was granted by the PA Department of Health. The protocol was approved by the appropriate committees at Conemaugh Memorial Medical Center (CMMC). Pharmacists must meet the following criteria to participate: active PA pharmacist license; active PA license to administer injectable medication; professional liability insurance; BLS, ACLS, and pediatric advanced life support certification; documented competency for comprehensive medication administration by a nurse educator. Pharmacist medication administration is limited to the scenarios and medications in the written protocol and only apply to practice in the ED. Administrations are documented as a clinical intervention and a data point in the CMMC's quality assurance and performance improvement within REDCap.

Results: This is an ongoing project that will be reassessed periodically. The approval process of a new written protocol will be discussed in detail. Data on safe medication administration and nursing satisfaction is ongoing at the time of submission. 

Conclusion: This project demonstrates a successful path to expand pharmacists' scope of practice in the ED. Early data on safe medication administration will be presented at the conference.

Self-Assessment Question: What steps must be taken to get a pharmacist-administered medication protocol approved?

Title: Time to first dose antibiotics administered IV push versus IV piggyback in sepsis in the emergency department 
 
Authors: Maya Smith, PharmD; Randi Jenkins, PharmD, BCPS 
 
Learning Objective: At the conclusion of this presentation, audience members will be able to explain the effect of antibiotic administration method on time to first dose of antibiotics in sepsis and cost considerations. 
 
Background/Objective: A shorter time to initial antibiotic administration is associated with reduced mortality in sepsis. The purpose of this investigation is to determine the difference in time to first dose antibiotics when administered IV push versus IV piggyback for sepsis in the emergency department. 
 
Methods: This retrospective review was conducted at a 397-bed community medical center before and after the administration of ceftriaxone, cefepime, cefazolin, and piperacillin-tazobactam was switched from IV piggyback to IV push in 2023. This study included patients aged 18 years and above who presented to the emergency department, had documentation of sepsis via ICD-10 code in their electronic health record, and received ceftriaxone, cefepime, cefazolin, and/or piperacillin-tazobactam. The IV piggyback cohort included patients treated between 1/1/2023-6/1/2023 and the IV push cohort included those treated between 1/1/2024-6/1/2024. Patients who were transferred from an outside hospital or had an antibiotic ordered but not administered were excluded. The primary outcome was the time to first dose of antibiotic. Secondary outcomes included time to first dose of second antibiotic when applicable and cost of administration.  
 
Results: A total of 719 patients were assessed for eligibility; 714 met the prespecified inclusion criteria. Of those included, 339 patients received IV piggyback antibiotics and 375 patients received IV push antibiotics. The median time to first dose of antibiotic was 115 minutes in the IV piggyback group and 119 minutes in the IV push group. The median time to first dose of second antibiotic from administration of first antibiotic was 58 minutes in the IV piggyback group and 32 minutes in the IV push group. A student’s t-test will be used to determine statistically significant differences between groups relative to each outcome. An approximation of the cost associated with each method of administration will be made using standard market prices. 
 
Conclusion(s): The preliminary results of this study suggest that there is not a notable difference in time to first dose of antibiotic between IV piggyback and IV push administration. However, IV push antibiotic administration appears to be associated with a reduced time to first dose of second antibiotic. Assessing the difference in cost of administration will provide useful information to further determine which of these methods may be preferred in an emergency department setting.  
 
Self-Assessment Question:
Based on the results of this study, which of the following statements is true?

1. IVP antibiotic administration is associated with improved outcomes comparedto IVPB administration 
2. There is no significant cost difference between IVP and IVPB antibioticadministration 
3. IVP antibiotic administration is associated with a significantly shorter time to1st dose of 2nd antibiotic 
4. IVPB antibiotic administration is associated with a significantly shorter time to1st dose of antibiotic 

Learning objectives: Audience members will be able to determine if Balfaxar or KCentra is superior in achieving hemostasis in different types of bleeds; brain, gastrointestinal, and other.
Authors: Allison Carmean, PharmD, Jesse Dorchak, PharmD, BCPS; Thomas Simunich, MS, MBA; Jacob Allenbaugh, DO; Lauren DeLong, DO; Shawna Morrissey, DO
Background: Limited research exists on the efficacy of 4-factor Prothrombin complex concentrates (4F-PCCs) to reverse bleeds caused by Warfarin and DOAC use. This study aims to compare the efficacy of Balfaxar or KCentra to reverse various types of bleeds.
Methods: This study is a retrospective study comparing pre/post measures for patients who received KCentra from February 2022 to February 2024 and Balfaxar from March 2024 to March 2026 at CMMC. Initial fixed dosing for both agents consisted of 2,000 units for DOACs and 1,500 units for Warfarin. Supplemental dosing used actual body weight and patients that received supplemental doses have been excluded. Hemostasis will be defined on the CT scan after Balfaxar or KCentra is given to ensure bleeding has stopped and if the lab values below return to normal. Lab values for hemostasis included INR less than 1.5, PT 11-13 seconds, aPTT 25-40 seconds, platelets 150,000-300,000, Hgb > 7, and fibrinogen 200-400. A 6 hour post CT scan was also used to ensure hemostasis was achieved. The analysis of the statistics will be processed and presented at Eastern States.
Results: Results will be presented at Eastern States.
Conclusion: Conclusion will be presented at Eastern States.

Title: Retrospective evaluation of desmopressin administration on hematoma expansion in traumatic intracranial hemorrhage in patients with suspected platelet dysfunction
Authors: Sadie Keener, PharmD; Olivia Iskaros, PharmD, BCCCP; Gene Berkovich, MD; Samuel Hawkins, MD; Ilana Gimelbrand, PharmD, BCCCP
Learning Objective: At the end of the presentation, the audience will be able to assess the impact of desmopressin administration on hematoma expansion in patients with traumatic intracranial hemorrhage at our institution.
Self-Assessment Question: What patient characteristics or conditions may contribute to platelet dysfunction?
1. Antiplatelet agents
2. Uremia
3. Liver Dysfunction
4. All of the above
Background: Limited evidence exists on the efficacy of desmopressin administration for platelet dysfunction in traumatic intracranial hemorrhage. The purpose of this study is to assess the effect of desmopressin on hematoma expansion upon repeat imaging in this patient population.
Methods: This is a retrospective cohort study of adult patients presenting to the emergency department with traumatic intracranial hemorrhage (ICH) and presumed platelet dysfunction at NYU Langone Hospital - Brooklyn from January 2020 to March 2025. Patients were stratified based on receipt of desmopressin versus no desmopressin. Patients were excluded if they had a secondary cause of ICH, no repeat brain imaging within 24 hours, neurosurgical intervention prior to repeat imaging, chronic therapeutic anticoagulation, Glasgow Coma Scale < 5, or catastrophic injury deemed nonsurvivable based on early clinical findings. The primary outcome is hematoma expansion upon repeat imaging defined by any hematoma expansion from baseline or a new hematoma not present on initial image. Secondary outcomes include hemostatic efficacy and survival to hospital discharge. Safety outcomes include ischemic stroke, venous thromboembolism, or hyponatremia within 7 days of desmopressin administration.
Results: TBD
Conclusion: TBD
  

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