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?

Authors: Shannon Hogarty, PharmD; Molly Walbrown, Pharm.D., BCPS, CACP, CDE; Theresa Langeheine, PharmD, BCPS 
 
Learning Objective: This study evaluates the frequency of newly initiated insulin at hospital discharge in insulin-naive adults with type 2 diabetes and hemoglobin A1c (HbA1c) 6.5–10%, assesses potential eligibility for glucagon-like peptide-1 receptor agonist (GLP-1RA) therapy, and examines associated clinical outcomes, including 30-day all-cause readmissions, emergency department visits, and urgent care visits. 

Self-Assessment Question: When are GLP-1 receptor agonists (GLP-1RAs) appropriate for hospitalized insulin-naive adults with type 2 diabetes and hemoglobin A1c 6.5–10% who are discharged on insulin, and how might this choice affect 30-day readmission rates? 

Background/Objective: Guidelines favor GLP-1RAs over insulin in type 2 diabetes and a HbA1c under 10%. Studies show these patients are often discharged on insulin, although GLP-1RAs give similar glycemic control and cardiovascular, renal, and weight loss benefits. 

Methods: This retrospective chart review included adults 18 years or older with type 2 diabetes discharged home from WellSpan hospitals, HbA1c 6.5–10%, and no insulin prior to admission. Exclusion criteria included type 1 diabetes, gestational diabetes, latent autoimmune diabetes in adults, pregnancy, insulin or GLP-1RA on home medication list, and insulin orders from the (diabetic ketoacidosis/hyperosmolar hyperglycemic state) DKA/HHS order-set. The primary outcome was potential GLP-1RA therapy eligibility. Secondary outcomes included frequency of insulin-naive patients discharged on an insulin regimen and 30-day all-cause readmissions and emergency department or urgent care visits.

Results: Among 193 patients, 91.2% met criteria for potential GLP-1RA therapy eligibility. Regarding discharge practices, 12 patients were discharged on an insulin regimen while 181 were not. Among those discharged on insulin, 4 patients (33.3%) experienced a 30-day all-cause readmission. In comparison, 37 patients (20.4%) not discharged on insulin were readmitted within 30 days. Emergency department or urgent care visit rates followed a similar trend, with higher utilization observed in the insulin-discharge group. Overall, a large proportion of patients were eligible for GLP-1RA therapy, while discharge on insulin was less frequent but associated with higher short-term healthcare utilization.

Conclusions: Most patients were eligible for GLP-1RA therapy, and few were discharged on insulin. Differences in 30-day readmissions and acute care utilization were observed between groups, though interpretation is limited by small sample size. These findings highlight an opportunity to optimize discharge processes within transitions of care and support guideline-concordant outpatient diabetes management, including greater consideration of GLP-1RA therapy when clinically appropriate.

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?

Authors: Laura Proshek, PharmD; Chelsea Kim, PharmD, BCPS; Zachary Harris, PharmD; Meagan Freel, PharmD, BCACP, CDCES
Learning Objective: Audience members will be able to evaluate and quantify the change in specialty pharmacy service utilization before and after implementation of targeted provider education within the health system.
Background/Objective: Increase transplant provider utilization of the health-system specialty pharmacy for immunosuppressant prescriptions through targeted provider education.
Self-Assessment Question: Which of the following statements best explains the significance of the quality improvement project results?
Methods: This single-center quality improvement study within a health-system specialty pharmacy transplant program aimed to increase the proportion of immunosuppressant prescriptions sent to the specialty pharmacy by transplant providers. During a 1-month pre-intervention period, baseline data were collected to determine the proportion of prescriptions for commonly prescribed immunosuppressants sent to the specialty pharmacy relative to all prescriptions written for these agents. A targeted provider education session was conducted using prior internal data demonstrating improved outcomes in specialty pharmacy transplant patients. Post-intervention data were collected over 1 month using the same methodology. All transplant patients receiving immunosuppressants during the study periods were included. The primary outcome was the change in prescribing proportion pre- and post-intervention.
Results: A total of 1168 immunosuppressant prescriptions were evaluated in the pre-intervention period compared with 1036 in the post-intervention period. The proportion of immunosuppressant prescriptions sent to the specialty pharmacy increased from 27.5% to 34.8%, demonstrating a 7.3% increase following educational intervention. This improvement was observed despite a lower overall prescription volume in the post-intervention period. Overall, the increase in specialty pharmacy utilization among transplant providers suggests a favorable shift in prescribing behavior after targeted provider education.
Conclusion: This quality improvement project demonstrated increased specialty pharmacy utilization for immunosuppressant prescribing after a targeted provider education session. These findings suggest that education may improve utilization of specialty pharmacy services among transplant providers. Further evaluation is needed to assess the sustainability of prescribing changes and their impact on clinical outcomes in transplant patients.

Title: Reducing cangrelor use in the intensive care unit  
Authors: Maliha Akter, PharmD; Nadia Ferguson PharmD, BCPS, BCCCP; Pooja Kumar, PharmD, BCCCP
Learning Objective: At the conclusion of my presentation, the participant will be able to evaluate inappropriate cangrelor prescribing in the intensive care unit (ICU).
Background: Reduce the proportion of ICU cangrelor orders exceeding 0.75 mcg/kg/min by 50% within six months of implementation.
Methods: Create a clinical pharmacist led multidisciplinary intervention to optimize cangrelor use. Establish criteria for ongoing use beyond institutional protocols for PCI and neurointerventional stenting, and for antiplatelet bridging in high-risk patients. Pharmacist-led stewardship activities included daily prospective review of active orders providing recommendations for initiation, de-escalation, or discontinuation of inappropriate orders. With future plans for next steps standardization of algorithm to implement EMR guidance for appropriate timing and dosing of oral P2Y12 inhibitor continuation.
Results: TBD
Conclusion: By creating standardized use criteria and EMR-based decision support, this initiative seeks to mitigate the risks and costs associated with off-label cangrelor use while ensuring safe transitions to oral antiplatelet therapy in high-risk ICU populations.
Self-Assessment Question: What role can pharmacists have in managing inappropriate orders of cangrelor?

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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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: Improving staff engagement in medication therapy management services at Johns Hopkins outpatient pharmacies
Authors: Kaitlyn Gelb, PharmD; Taylor Southers, PharmD; Amy Nathanson, PharmD, BCACP; Kurt Henke, PharmD; Abiodun Igandan, PharmD; Jason Katcoff, PharmD; Punam Patel, PharmD
Objective: At the conclusion of the presentation, the audience will be able to describe the impact of implementing a standardized workflow and creating resources on pharmacy staff engagement in MTM services.
Self Assessment Question: True or False: Implementing standardized MTM completion goals, developing workflow guidance, and creation of training resources can increase MTM case completion in outpatient pharmacy settings.
Background: This project aims to improve pharmacy team engagement in online MTM services by implementing standardized goals and expectations, creating resources to support the pharmacies, and evaluating pharmacy team satisfaction with the created resources.
Methods: This study will be a prospective multicenter study conducted at Johns Hopkins Outpatient Pharmacies (JHOP). The 8 pharmacies included in the study have access to the online MTM platform. Individual meetings will be conducted with each Clinical Pharmacy Manager (CPM) to create tailored action plans for integrating MTM into workflows. Resources to support MTM case completion will be created and stored on a centralized page for easy access by pharmacy staff. Monthly goals for CMR and TIP completion will be implemented at each pharmacy and communicated to pharmacy teams through a centralized page. Data collected will include number of cases attempted and number of cases completed monthly and will be analyzed using an excel sheet and reports from the online MTM platform. An internal survey will be used to assess staff satisfaction with resources created as well as an acknowledgment survey to track review of resources.
Results: TBD
Conclusion: TBD

Title: Optimizing rabbit anti-thymocyte globulin dosing in kidney transplant patients in a tertiary care transplant center
Authors: Kiera Chibuzor, PharmD; QingXiang Mo, PharmD, BCTXP; Angelly Joy Miane, PharmD; Dhara Shah, PharmD, BCPPPS
Learning Objective: Audience will be able to evaluate the financial impact of switching rabbit anti-thymocyte globulin (rATG) dosing from actual body weight to ideal body weight based
Self-Assessment Question: What body weight do you use when dosing rabbit anti-thymocyte globulin?
Background: rATG is vital for kidney transplant induction immunosuppression. Studies challenge lower exposure to rATG due to risk of infection and malignancy. Some centers adapted ideal body weight dosing as rATG has limited distribution into adipose tissue.
Methods: This performance improvement initiative included adult kidney transplant recipients who received rATG for induction therapy from 3/1/2025-8/31/2025 and 10/1/2025-3/31/2026. Patients transplanted in 9/2025 were excluded due to center's transition from actual to ideal body weight-based rATG dosing during this period. Exclusion criteria included retransplant, positive crossmatch, ABO incompatibility, graft loss, or patient death during index admission. Data collected will include number of rATG vials used per patient pre and post-transplant, donor specific antibodies, percentage of patients with delayed graft function, percentage on dialysis after the first month, kidney biopsy frequency, biopsy-proven acute rejection rate, infection rate, patient survival, and graft survival 6 months post-transplant. The study aims to assess whether ideal body weight-based dosing of rATG is effective for induction while limiting overexposure and cost compared to the actual body weight-based strategy.
Results: A total of 66 patients were included in the pre-transition cohort dosed by actual body weight. On average, each patient used 11 vials of rATG. However, if ideal body weight-based dosing had been applied to this cohort, the average vials used would have decreased to 9 vials per patient, corresponding to an estimated cost savings of $132,000.
Conclusion: While the use of ideal body weight dosing for anti-thymocyte globulin does demonstrate significant cost-saving opportunities, the clinical significance are yet to be determined by comparing the pre- and post-transition cohort.

Title:
Reducing falls among Veterans in Home-Based Primary Care (HBPC) on antidepressants and/or benzodiazepines: a pharmacist-led intervention
Authors:
Kylie Thompson, Pharm.D.; Meghan Hamm, Pharm.D., BCPS; Lauren A. Stutzman, Pharm.D. BCGP
Objective:
The primary objective is to determine if mailed patient education reduces subsequent falls among HBPC Veterans prescribed antidepressants and/or benzodiazepines. The secondary objective is to determine if deprescribing antidepressants and benzodiazepines reduce the risk of falls among HBPC Veterans. Audience members will be able to outline the development and implementation process of pharmacist-led interventions designed to reduce falls within this targeted population.
Background:
Falls are a leading cause of injury and mortality in older adults. This project aims to reduce falls in HBPC Veterans through deprescribing and patient education, leveraging pharmacists' efforts to prevent medication-related falls.
Methods:
This is a single-centered prospective quality improvement project. Veterans were included if they were enrolled in the HBPC program at the Coatesville Veterans Affairs Medical Center, experienced a fall between January 1st, 2025, and April 1st, 2025, and had an active prescription for either an antidepressant and/or benzodiazepine. Veterans in hospice care or deceased prior to intervention were excluded. Chart reviews were completed; each review assessed the patient's current medication regimen, medical history, recent clinical assessments, and potential risks versus benefits of continued therapy. Antidepressant deprescribing recommendations were based on most current PHQ scores and duration of clinical stability. Prescribers were contacted if Veterans prescribed benzodiazepines/antidepressants qualified for deprescribing measures.  Additionally, all Veterans taking these medications were sent a patient education handout via mail highlighting the associated fall risks and providing strategies to mitigate these risks. Falls were assessed 90 days after implementing the patient education handout intervention.
Results:
During the review period, 30 patients who experienced a fall were prescribed an antidepressant and/or benzodiazepine. All patients that were taking a benzodiazepine were also taking an antidepressant. After applying exclusion criteria, 17 patients were included in the final analysis; 8 were eligible for antidepressant tapering and 3 were eligible for benzodiazepine tapering. Of 8 patients eligible for antidepressant tapering, 4 patients agreed. After recommendations sent to providers, 2 were accepted but 1 patient reconsidered, leaving 1 patient who successfully completed taper prior to end of review period. Of 3 patients eligible for BZD tapering, 1 patient agreed and recommendation was accepted by provider however the patient later reconsidered during follow-up therefore no patients were tapered off benzodiazepines prior to the end of the review period. 12 patients did not have a subsequent fall 90 days after patient education handouts were mailed, while 5 patients did experience another fall.
Conclusion:
After patient education handouts were sent by mail, the incidence of subsequent falls among HBPC Veterans who were prescribed antidepressants and/or benzodiazepines were reduced. Additionally, half of the tapering recommendations to providers were accepted. For recommendations that were declined, providers shared clinical reasons for why tapering was not appropriate at the time. Pharmacist-led interventions demonstrated value in efforts of deprescribing high-risk meds and reducing falls. Increased pharmacist-patient discussions about medication risks were well-received by Veterans and can support future deprescribing efforts. Providing tailored education on fall risks and reinforcing this information throughout care may improve outcomes. Enhanced collaboration between pharmacists and providers, as well as obtaining consistent depression assessments are valuable for ensuring patient-centered recommendations.
Self-Assessment Question:
What role can pharmacists have to reduce fall risk in the HBPC population?

Title: Optimizing Peri-Operative Management of SGLT-2 Inhibitors
Authors: Michele Mathew, PharmD; Jennifer Premus, PharmD; Elaena Quattrocchi, BS, PharmD, FASHP, CDC; Preethi Samuel, PharmD, BCACP, AAHIVP 
Self Assessment Question:
Which of the following best describes the recommended peri-operative management of SGLT-2i to reduce the risk of EDKA?
A. Continue therapy until the morning of surgery
B. Hold the medication 24 hours before surgery
C. Hold the medication at least 72 hours prior to surgery or procedures requiring anesthesia
D. Discontinue therapy only after surgery is completed
Learning Objectives:  
At the conclusion of this presentation, participants will be able to: 
Explain how SGLT-2i contribute to EDKA development in surgical patients
Describe the mechanism of EDKA associated with SGLT-2i use in the peri-operative setting
Evaluate the adherence to institutional SGLT-2i management guidelines
 
Background/Objective: SGLT-2i improve cardiovascular and renal outcomes but their use has been linked to an increased risk of EDKA. Generally, SGLT-2i are held for at least 72 hours prior to surgery or procedure. Currently, there are limited studies evaluating SGLT-2i use in the preoperative setting. By addressing this gap in the literature, the study aims to clarify whether adherence to institutional policies can reduce the rate of EDKA and improve preoperative safety for patients taking SGLT-2i. 
 
Methods: This is a single-center retrospective chart review evaluating adherence to institutional preoperative SGLT-2i protocols and the incidence of EDKA in surgical patients at Staten Island University Hospital. Subjects for inclusion were identified from the electronic medical record as adult patients >18 years who had a procedure or surgery requiring anesthesia between February 22, 2024 - October 1, 2025. Eligible patients must have been prescribed a SGLT-2i prior to surgery or procedure. Exclusion criteria include patients <18 years and pregnancy. The primary outcome will be the percentage of patient's adherent to SGLT-2i institutional preoperative management guidelines. Secondary outcomes will include incidence of EDKA in adherent versus non-adherent patients, patient or surgery-related risk factors associated with EDKA, and clinical outcomes such as hospital length of stay and in-hospital mortality.

Results: Among 517 patients evaluated, only 212 patients (41%) appropriately adhered to Northwell Health’s peri-operative SGLT-2 inhibitor management policy. Policy non-adherence occurred in 305 patients (59%), with the primary reason being unknown SGLT-2 inhibitor hold duration in 288 patients (94.4%), followed by inappropriate medication hold in 17 patients (5.6%). Missing EDKA diagnostic laboratory values were present in 266 patients (87.2%). Mean SGLT-2 inhibitor hold duration was 4.12 ± 1.4 days. No confirmed cases of EDKA were identified in either the appropriately held or non-adherent groups, median hospital length of stay was 2 days (IQR 1–5), and mortality was low at 0.2% (1 patient).

Conclusion: The primary barriers to compliance were largely related to documentation deficiencies, incomplete medication reconciliation, and unclear preoperative hold durations rather than deliberate inappropriate prescribing. Although no confirmed cases of EDKA were identified, the high frequency of missing diagnostic laboratory values likely limited accurate event detection and may underestimate complete incidence. These findings suggest that while institutional guidelines provide an important for reducing perioperative EDKA risk, policy implementation alone is insufficient without effective interdisciplinary education and consistent provider awareness,

Authors: Simran Kaur, PharmD; Jeffrey Hare, PharmD; Brianna Schafer, PharmD, BCPPS; Sewit Araia, PharmD 
Objective: At the conclusion of this presentation, the participant will be able to describe the incidence of severe adverse effects associated with intravenous iron dextran compared with iron sucrose in pregnancy
Pre-assessment question: Which IV iron formulation is associated with a higher risk of severe AE in pregnancy? (A. Iron sucrose B. Iron dextran C. Both have similar risk D. Not sure) 
Background: Intravenous iron is used when oral therapy is inadequate; however, comparative safety data among formulations are limited. This study compares the incidence of severe adverse effects between iron dextran and iron sucrose in pregnant women. 
Methods: This retrospective cohort study included pregnant women of any gestational age who received intravenous iron dextran or iron sucrose within the Geisinger Health System during the iron sucrose shortage from March 25, 2024, to February 20, 2025. Patients were identified using electronic health record medication and diagnosis codes. The primary outcome was the incidence of severe adverse effects, including anaphylaxis, circulatory failure, shock, etc. occurring within 24 hours of iron administration. Secondary outcomes included pre-treatment medications, emergency department admission, hospital admission, and administration of rescue medications. Adverse effects were categorized using Common Terminology Criteria for Adverse Events grading. Primary and secondary outcome incidence rates were compared using fisher’s exact test. 
Results: Data from 150 patients per group were analyzed. Median age was 27 years, with gestational age 33 weeks (iron dextran) and 32 weeks (iron sucrose). Inpatient administration was less frequent with iron dextran (1.33%) vs iron sucrose (9.33%). Adverse events occurred in 2.7% of iron dextran patients and 0% with iron sucrose (p=0.1225). In the dextran group, 38% received premedication, with one ED visit (p=1), no hospitalizations, and 4 patients requiring rescue medications (p=0.1225).
Conclusion: In conclusion, Iron sucrose had zero incidence of adverse events, and they were more often observed in the patients that received iron dextran, however severe adverse events were uncommon. Iron dextran can be considered a safe alternative treatment for iron deficiency anemia in pregnancy when iron sucrose is not readily available as the preferred agent

LEARNING OBJECTIVE: 

1. Learners will be able to recognize opportunities to improve antibiotic prescribing for SSTIs in a community hospital emergency department

BACKGROUND/OBJECTIVE:  This study aims to characterize and evaluate the appropriateness of antibiotic prescribing for skin and soft tissue infections (SSTI) in patients who are discharged from either Cambridge Health Alliance emergency departments (ED).

METHODS: A retrospective chart review will evaluate adult patients (≥18 years of age) discharged from our institution’s emergency departments with a primary chief complaint of cellulitis or abscess. Exclusion criteria include inpatient admission, concomitant or deep tissue infections, bone and joint infections, infections of the mouth, head, neck, or foot, those involving a bite, surgical site, or underlying hardware, or re-presenting within 72 hours of the index admission for the same infection. Treatment data collected includes incision and drainage and antibiotic agent, dose, and duration. Patients will be categorized by wound purulence and IDSA-defined infection severity (mild, moderate, severe). The primary outcome will be adherence of antibiotic agent, dose, and duration prescribing to 2014 IDSA guidelines. Secondary outcomes include readmission within 30 days of the index ED encounter and documented adverse reaction to antimicrobial therapy. 

RESULTS: 200 patients were included in the analysis. Appropriateness was defined as being in compliance with IDSA 2014 guidelines in respect to antibiotic agent, dose, and duration. 32.1% of purulent and 18.8% of nonpurulent infections were prescribed antibiotic regimens in compliance with guideline recommendations. Of these, 56.5% and 71.9% of purulent and nonpurulent infection antibiotics, respectively, were deemed inappropriate due to the duration of therapy. Antibiotic therapy was inappropriate due to broadened coverage in 26.2% and 56.3% of purulent and nonpurulent infections, respectively. In 3.5% and 6.3% of antibiotic regimens, the prescribed dose was below recommended ranges. All cause 30-day readmission was 16.1% and 25% with two documented adverse reactions.

CONCLUSION: It is anticipated that this quality improvement project will provide insight into prescribing practices for SSTIs at our institution’s EDs and opportunities for improvement. Based on these results, the authors plan to propose interventions to the ED which may include additional clinical decision-making support and/or providing departmental education.

SELF ASSESSMENT QUESTION: Which of the following findings is the most appropriate target for an antimicrobial stewardship intervention in adult patients discharged from the ED with SSTIs at our institution?