2026 Eastern States Conference

Title: Track and save: the impact of medication dispense tracking software

Authors: Joshua Mercure, Mary Pat Thomas, Rachel Russ

Objective: At the conclusion of this presentation, audience members will be able to describe the impact of medication dispense tracking technology on inpatient medication re-dispensing rates, pharmacy workload, and associated costs.

Background/Objective: Evaluate the impact of medication tracking technology on inpatient medication re-dispensing. We hypothesize implementation will reduce missing medication requests, medication waste, and associated pharmacy workload and costs.

Methods: This retrospective pre–post study evaluates the impact of a medication tracking system on re-dispensing at a single academic medical center using EHR and pharmacy operational data (Aug–Oct 2024 vs Aug–Oct 2025). The study includes non-controlled, non-premixed, pharmacy-prepared medications dispensed to inpatient units. ADC-dispensed, continuous infusions, PRN, and patient-supplied medications were excluded. Re-dispenses were identified through monthly audits of missing medication messages. The primary endpoint is change in the percentage of missing medication messages and re-dispensed medications post-implementation. Secondary endpoints include estimated cost reduction, medication classes, and care areas associated with higher rates of re-dispenses. Costs were calculated using wholesale acquisition cost, excluding high-cost outliers.

Results: Implementation of medication dispense tracking software was associated with a significant reduction in medication re-dispenses related to missing medication requests in the post-implementation period. The rate of missing medication requests resulting in re-dispense decreased by 16% compared to the pre-implementation period (p < 0.001). Compliance with dispense tracking was 75% during the post-implementation period. Oral syringes demonstrated the greatest reduction in re-dispenses (23%), while acute care units experienced the largest decrease among inpatient care areas. Operational and financial analyses suggest reductions in costs associated with re-dispensing activities, although specific financial savings has yet to be determined.

Conclusion: Implementation of medication dispense tracking improved medication distribution efficiency and reduced operational burden associated with re-dispensing workflows. These findings support the use of tracking technology to improve medication accountability, reduce waste, and enhance inpatient pharmacy operations. Additional opportunities exist to optimize outcomes through improved compliance and continued workflow refinement.

Self-assessment question: A reduction in medication re-dispensing rates after implementation of dispense tracking software may suggest improvements in medication accountability and distribution workflow efficiency, though additional operational factors should also be considered.

Authors: Lillian Babbie, PharmD; Alem Mulat, PharmD, BCPS; Joanne Ondrush, MD; Candace Ly, PharmD, BCSCP; Millicent Deya, PharmD, MHA; Jonathan Meli, PharmD, MS
Learning Objective: Describe strategies pharmacists can employ to reduce intravenous pharmaceutical waste and subsequent carbon emissions in a community hospital setting.
Purpose: Expired medications contribute substantially to pharmaceutical waste, leading to both financial losses and environmental concerns. Few studies have examined how returns data can inform formulary management. This project evaluates whether a structured review of pharmaceutical returns, carbon emissions, and expiration data can reduce IV medication waste and optimize inventory management in a community hospital.
Methods: This prospective quality improvement study was conducted at UVA Prince William Medical Center following IRB approval. Baseline returns data were collected over a 6-month period (November 2024 through April 2025). A pharmacy workgroup, including clinical pharmacy specialists, a supply chain supervisor, and a clinical sustainability chair, then convened biweekly from January 2026 through May 2026 to review IV pharmaceutical returns data, focusing on non-creditable, high-expense, and expiratory-related medications. For each medication, usage trends, clinical necessity, published emission factors for pharmaceutical disposal, and cost were assessed. Interventions included formulary changes (removal or restriction), inventory adjustments (par-level changes), beyond-use-dating (BUD) changes, and staff education. The primary endpoint was reduction in IV pharmaceutical waste and carbon footprint emissions, measured as percent reduction of waste prevented during the intervention period compared to the equivalent dollar value of waste during the baseline period. Secondary endpoints included the proportion of reviewed medications requiring intervention and the type of interventions utilized.
Results: 59 IV medications were analyzed. Of the 59 medications reviewed, 29 had opportunity for at least one intervention. Opportunities included 7 BUD changes, 1 formulary change, 16 staff education sessions, 9 protocol changes, and 2 par level adjustments. Carbon footprint data (gCO2e) were calculated for 37 of 59 (62.7%) medications. Waste volume and carbon emission reductions were demonstrated across multiple high-cost IV medication categories following workgroup-directed interventions.
Conclusions: A structured biweekly pharmacy workgroup review of IV pharmaceutical returns data can identify actionable waste-reduction opportunities in a community hospital. Formulary modifications, education, and BUD changes represent scalable, pharmacist-led interventions to reduce pharmaceutical waste and environmental impact. Integrating carbon footprint calculations into formulary review positions pharmacy teams as active contributors to health-system sustainability goals.
Self-Assessment Question: What are some strategies that pharmacists in a hospital setting could employ to reduce IV pharmaceutical waste?

Title: Operational and financial impacts of backorders and shortages at Geisinger
Authors: Maxwell McGuire, PharmD; Bradley Dudeck, PharmD, BCPS; Sarah Siemion, PharmD, BCPS; Kristen Franklin, PharmD, BCCCP; Vanessa Markle, PharmD, BCPS
Objective: At the conclusion of the presentation, the participant will be able to describe a mixed-methods approach to evaluating the financial and operational impact of inpatient drug shortages and backorders within a health system.
Self-Assessment Question: Which metric best reflects the indirect operational burden of a medication shortage?
A) Staff hours spent managing shortage-related tasks
B) Contract purchase price
C) Annual drug spend alone
D) Inventory par level
Background: Drug shortages and backorders disrupt hospital operations, yet system-level data on financial and operational impact remain limited. Rural health systems face added risk from supply constraints. This study aims to quantify costs and labor burden.
Methods: A mixed-methods evaluation will be conducted. The financial analysis will review purchasing and inventory data from Aug 1, 2023, to Sep 1, 2025, to identify fulfillment delays, cost increases, alternative sourcing patterns, and the frequency and duration of backorders for high-impact inpatient medications. Descriptive and comparative analyses will estimate excess cost attributable to shortage periods. The operational analysis will use an anonymous survey distributed to pharmacy, nursing, providers, and operational leaders to assess time spent on shortage tasks, workflow disruptions, perceived burden, communication challenges, and role-specific impact. Reported labor time will be converted into personnel cost to quantify indirect workload. Findings will be compared across floors and departments to evaluate variation in operational burden.
Results: Over the 25-month study period, $7.7M was spent on shortage-affected inpatient medications; $0.7M (9%) represented incremental cost directly attributable to backorders, annualizing to $321,323.11 in direct spend. Leading incremental cost drivers were iron sucrose, liposomal amphotericin B, glucagon, insulin, and labetalol. Survey respondents (19/44) reported 5,326 labor hours per year managing shortages—led by pharmacy procurement (1,528 hrs) and providers (718 hrs)—annualizing to $448,970.30 in operational cost. 71% of respondents reported severe workflow impact, supporting the hypothesis that indirect operational burden substantially exceeds direct financial cost.
Conclusion: Drug shortages impose a substantial operational burden on health systems that far outweighs their direct financial footprint. These findings highlight the need to invest in proactive shortage-management infrastructure, standardized communication, dedicated procurement, and cross-disciplinary coordination, rather than focusing on drug acquisition cost alone. Hospital leaders can use this framework to justify staffing, prioritize mitigation strategies, and protect continuity of patient care.
  

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Title: Prescribing Trends and the Risk of Serotonin Syndrome in Patients Receiving Linezolid and Serotonergic Medications

Authors: Clara Bishay, PharmD, MSMEd; Eric Kowalek, PharmD, BCPS; Danielle Kuhn, PharmD, BCPS

Learning Objectives:
Audience members will be able to:

1. Identify the risk of serotonin syndrome (SS) based on the existing literature.
2. Describe the prescribing trends of the most commonly reported serotonergic agents (SAs) administered with linezolid and the associated risk of serotonin syndrome.
3. Outline key study limitations, clinical significance, and areas for future research.

Methods: This retrospective, descriptive cohort study utilized electronic health record data collected between January 1, 2021, and August 1, 2025. Adult patients admitted to inpatient services who received an order for linezolid within 16 days of serotonergic agent administration were included; pregnant patients were excluded. Serotonin syndrome was identified by documented ICD-10 diagnosis and/or cyproheptadine administration. Data was analyzed using descriptive statistics, including measures of central tendency, dispersion, and percentages.

Results: Primary outcomes showed 69% of linezolid–serotonergic agent (SA) co-administrations had no provider or pharmacist interventions. Providers most often held/switched/dose-reduced SAs (49%), followed by holding/switching linezolid (31%) or no change (20%). Pharmacists recommended SA modifications in 78% of cases, no change with documented low serotonin syndrome (SS) risk in 17%, and linezolid changes in 5%. Patients were on 1–5 SAs; most interventions occurred with 1 (61%) or 2 (31%) SAs. Apart from one case, pharmacist interventions increased with SA count. No SS cases or cyproheptadine use were observed.

Conclusions: Pharmacists and providers often held or modified SAs despite the low incidence of serotonin syndrome (SS) reported in the literature. Avoiding SS through prescribing changes may lead to unintended consequences, including suboptimal infection management, withdrawal or worsening of comorbid conditions, and prolonged interruption of SAs. These findings support considering continuation of linezolid with SAs. No patients in this cohort experienced SS, consistent with published evidence.

Self-assessment Question: True or False: Linezolid should be avoided at all costs in patients taking SAs due to a high risk of SS.

Title: Optimizing Anesthesia Controlled Substance Auditing through Control Check Implementation: A Performance Improvement Initiative  
Authors: Julianne Anderson, PharmD; Harshal Shukla, PharmD, BCPS, DPLA; Vicken Yaghdjian, PharmD
Learning Objective: At the conclusion of this presentation, the participants will be able to identify how automated auditing technology can reduce controlled substance discrepancies and improve accountability in the perioperative anesthesia setting.  
Background/Objective: Controlled substances (CS) in the operating room are high risk for diversion and documentation errors. This performance improvement imitative aims to reduce the CS discrepancy rate by 50% from baseline within our perioperative anesthesia areas.  
Methods: This performance improvement, pre–post interventional study was conducted in the perioperative anesthesia departments at Montefiore Moses and Jack D. Weiler hospitals. Retrospective manual audit data were compared with prospective data following implementation of the Control Check auditing process to evaluate changes in controlled substance discrepancy rates and resolution timelines. Outcomes were monitored at baseline and throughout Plan‑Do‑Study‑Act (PDSA) cycles, including percent change in discrepancy rate, average time to discrepancy resolution, and percent of unresolved discrepancies at 30 days.
Results: Baseline results show a 10.7% unreconciled rate at Jack D. Weiler Hospital (Weiler) and a 27.7% unreconciled rate at Moses Hospital. Of the reconciled discrepancies, the time to resolution were a median of 2 days (mean of 2.39 and 2.19 days at Weiler and Moses, respectively). At both campuses, resident physicians were the most likely to make a discrepancy and the reason for the discrepancy was that the administration was documented late. The results of the PDSA cycle are ongoing, but preliminary data suggests that adding a second mode of communication to providers yields a lower unresolved discrepancy rate and a shorter time to resolution. 
Conclusion: Implementation of an automated controlled substance auditing platform in the perioperative anesthesia setting improved oversight by standardizing discrepancy detection and accelerating resolution timelines. This performance improvement initiative demonstrates the potential for technology‑enabled auditing to enhance accountability, reduce risk of diversion, and support regulatory compliance while decreasing manual workload.
Self-assessment Question: True/False: Automated auditing technology improves controlled substance accountability by enabling standardized, real‑time identification and follow‑up of discrepancies in the perioperative setting.

Title: Evaluating Expired Waste Reduction Strategies for Controlled Substance Medications in the Hospital Pharmacy Setting

Authors: Allison Welsh, PharmD, MBA; Ashley Covert, PharmD, MBA, FACHE; Cecilia Costello, PharmD, MS; Lindsay Lutz, CPhT

Learning Objective: Evaluate the operational and financial impact of controlled substance repackaging and compounding practices to identify opportunities for cost reduction and workflow optimization.

Background: Controlled substance waste presents a significant challenge for health systems as it can lead to increased costs and potential risk of drug diversion. The American Society of Health System Pharmacists (ASHP) identifies minimizing controlled substance waste as a method to minimize opportunities for controlled substance diversion. In a 12-month lookback, Mary Hitchcock Memorial Hospital (MHMH) wasted approximately 13,000 units of controlled substances totaling over $90,000 (Wholesale Acquisition Cost). This cost does not include the time required to compound in house medications or repackage controlled substances into unit doses and syringes, which is believed to account for a significant cost that is not currently represented in the numbers.

Methods: A pre–post interventional study was conducted at MHMH to evaluate the cost and operational impact of controlled substance waste. Expired Schedule II through IV medication from in-house compounded, repackaged, and outsourced 503B products were evaluated for 3 month pre- and post-intervention phases. Interventions included PAR optimization, ADC removal, sourcing changes, compounding workflow adjustments, and formulary modifications. Primary outcomes included expired medication quantity and total waste cost (drug acquisition plus pharmacist/technician labor cost). Secondary outcomes included low-days and zero-days inventory events.

Results: Total expired controlled substance units decreased from the pre-intervention period to the post-intervention period, from 672 to 385 units respectively, representing a 42.7% reduction. Total waste costs decreased from $7,328 pre-intervention to $3,182 post-intervention with medication acquisition costs accounted for the majority of waste cost reduction (-$3,314). Labor-related waste costs also decreased $831, accounting for 21.8 hours of saved employee time. The largest reductions in waste cost were associated with converting compounded batch products to patient-specific preparation and PAR optimization interventions. Increased low- and zero-day inventory events were observed during the post-intervention period, though many were attributable to a single medication affected by manufacturing delays from a 503B outsourcing facility.

Conclusions: Targeted inventory optimization strategies substantially reduced expired controlled substance waste and associated costs in a hospital pharmacy setting. Ongoing refinement of PAR levels and sourcing strategies may further improve inventory efficiency while balancing stockout risk.

Self-Assessment Question:
Which of the following represents a potential unintended consequence of aggressive PAR level reduction interventions?
A. Increased medication acquisition cost
B. Increased zero-day (stock-out) inventory events
C. Increased controlled substance diversion risk
D. Increased expired medication waste