Manuscript Library
2025 Manuscripts
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Amanda Jeppesen, PharmD |
Implementation of Pharmacist Counseling for Inpatient Chemotherapies Studies have demonstrated that pharmacist medication counseling improves patient adherence, reduces adverse reactions, increases patient understanding and satisfaction, and ultimately improves patient outcomes. The majority of antineoplastic treatment and pharmacist counseling occurs in the ambulatory setting. Inpatient chemotherapy is also a key component in the cancer care process, but pharmacist counseling is less common in the inpatient setting. As a result, the benefits of pharmacist counseling are less established for hospitalized patients. Historically, at Renown Regional Medical Center, inpatient chemotherapy education has consisted of general sessions with registered nurses. Renown Regional Medical Center’s pharmacy department has implemented a pharmacist counseling program for new-start inpatient chemotherapies. The goal of this project is to evaluate the pharmacist counseling program for newly initiated chemotherapy regimens.
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Aljay Denzel Manez, PharmD VA Southern Nevada Healthcare System |
Facility-level initiation of empagliflozin during hospitalization and at discharge for eligible patients admitted for acute decompensated heart failure The 2022 AHA/ACC/HFSA guidelines for acute decompensated heart failure (ADHF) recommend sodium glucose transporter 2 inhibitors (SGLT2i) as part of the guideline-directed medical therapy (GDMT) to improve outcomes and reduce hospitalizations. The VA Southern Nevada Healthcare System (VASNHS) has empagliflozin as its formulary SGLT2i. Limited data is available on the utilization of empagliflozin in our facility. The primary outcome is the initiation of empagliflozin for patients admitted with ADHF during hospitalization and at discharge. The secondary outcome is the rate of clinical pharmacist practitioner (CPP) interventions resulting in the initiation of empagliflozin for patients admitted with ADHF.
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Jack Vo, PharmD |
Comparison of IV Epinephrine and IV Norepinephrine in Cardiac Arrest Patients with Return of Spontaneous Circulation Out-of-hospital cardiac arrest (OHCA) affects approximately 350,000 individuals annually in the United States, with a low survival rate of around 9.1%. Post-resuscitation shock following return of spontaneous circulation (ROSC) is a common occurrence, characterized by vasoplegia, myocardial dysfunction, and hypovolemia. Epinephrine, the historically preferred vasopressor, may worsen myocardial oxygen demand and increase arrhythmia risk. Norepinephrine, which has stronger alpha-adrenergic activity and fewer beta-adrenergic effects, may offer improved outcomes with fewer complications.
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2024 Manuscripts
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Ben Chiarolanza, PharmD |
Evaluation of Clinical Pharmacist Review of Discharge Prescriptions in a Tertiary Medical Center Medication discrepancies at discharge from the hospital have been associated with adverse drug events (ADEs). Clinical pharmacist involvement with medication reconciliation at discharge has been associated with a decrease in medication discrepancies and ADEs. In January 2023, a new process was implemented for clinical pharmacists to prospectively evaluate high-impact discharge prescriptions prior to outpatient pharmacy electronic transmission. The medications initially considered for review encompassed pediatric prescriptions (for individuals under 18 years of age), insulins, oral anticoagulants, and antimicrobials. The purpose of this study is to determine the impact of prospective review of discharge prescriptions on medication safety.
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Cassandra Dilibero, PharmD |
Percentage of CABG and/or Valvular Surgery Patients Discharged on Amiodarone Post-operative atrial fibrillation (POAF) is the most common arrhythmic complication following cardiac surgery, with the highest incidence 48 to 72 hours post-operation. The 2023 AHA/ACC/HRS guideline on atrial fibrillation (AF) recommend beta-blockers as first-line therapy for the treatment of POAF, unless contraindicated. . Despite these recommendations and significant adverse effects of amiodarone, patients are still regularly initiated on amiodarone for management of POAF. Furthermore, amiodarone initiated while inpatient may be unnecessarily continued upon discharge.
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Benjamin Mossholder, PharmD |
Necessity of ED-Based Outpatient Infusion Services as a Stewardship Program Infusion centers provide longitudinal chronic disease management of numerous conditions. Emergency departments have experienced patient visits for receipt of normally infusion-center based care. The purpose of this study was to assess the necessity and feasibility of implementing an outpatient infusion service within the emergency department (ED) for when the institution’s outpatient infusion center is unavailable.
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2023 Manuscripts
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Ricardo Aguirre-escobar, PharmD |
Evaluation of a pediatric ceftriaxone dose rounding protocol on time to administration in an emergency department Pediatric doses utilize weight-based dosing, which results in doses not available in commercially available products. Dose rounding can round doses to commercially available products, which may be stored in patient care areas and thereby expedite acquisition time. These commercially available products may then be prepared in a patient care area and prepared for administration. In the emergency department (ED), antibiotics are regularly administered empirically. At the Renown Regional Medical Center (RRMC) ED, ceftriaxone is used as a broad-spectrum cephalosporin for the empiric coverage of various infections. Doses of ceftriaxone were prepared at bedside if the dose was available commercially. Otherwise, doses were prepared in the pharmacy IV room and given as an infusion. Workflow is more intense for doses prepared in the IV room, as this utilizes pharmacy technician hours, a double-pharmacist check on the compounded product, and then delivery of the patient specific dose to the patient care area.
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Steven Burgos, PharmD |
Pharmacy-Led Continuous Sedation Stop Procedure Affect On Ventilation Days The use of sedation medications in intensive care units (ICUs) has been common practice to alleviate patient stress and prevent agitation-related harm. Current guidelines prioritize pain management before sedation and recommend light sedation levels, spontaneous awakening trials (SATs), and limited use of benzodiazepines for better outcomes. This study aims to assess the impact of reinforcing SATs and utilizing a multifaceted approach involving analgesic and anxiolytic medications on mechanical ventilation duration in the ICU.
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Sabrina Curtis, PharmD |
Evaluation of optimal care provided to a patient with third- or fourth-degree frostbite presenting to a level II trauma center emergency department Frostbite is a cold injury that occurs when patients are exposed to cold temperatures for a prolonged period of time. The Wilderness Medical Society has published clinical practice guidelines for the prevention and treatment of frostbite. Severe frostbite is uncommon and requires prompt attention. The purpose of this study was to evaluate the incidence of guideline concordant care of third- and fourth-degree frostbite presenting within 48 hours to an emergency department.
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Megan Farrell, PharmD |
The impact of a pharmacist on conversion of intravenous to subcutaneous insulin in cardiac surgery patients In 2009 the Society of Thoracic Surgeons (STS) published guidelines for perioperative glucose management in cardiac surgery.1 Per STS, continuous insulin infusion is recommended for perioperative glucose control; it is additionally recommended that infusion be initiated intra-operatively and continued for ≥ 24 hours postoperatively in diabetic patients. Perioperative hyperglycemia is an independent predictor of mortality in adults undergoing cardiac surgery, regardless of diabetic status.2,3,4 Maintaining blood glucose levels ≤ 180 mg/dL perioperatively decreases overall mortality and reduces length of hospital stay in both diabetic and non-diabetic patients. Once past the initial 24-48 hours postoperatively patients may be transitioned to subcutaneous insulin. In order to standardize the transition from intravenous to subcutaneous insulin and increase the amount of time in goal glucose range in cardiac surgery patients at Dignity Health - St. Rose Dominican Hospital, a pharmacy-driven protocol was created. This protocol allowed pharmacists to transition adult cardiac surgery patients from intravenous insulin to subcutaneous insulin once blood glucose has stabilized in the post-operative period.
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Sarah Forrest, PharmD |
Continuation of Atypical Antipsychotics Initiated in the Trauma ICU at Hospital Discharge Poor transitions of care have been known to cause delays in appropriate treatment, additional primary care and emergency department visits, and increased adverse events. Atypical antipsychotics (AA) have been identified as medications often continued unnecessarily at transitions of care. The Impact of a Hospital Protocol in Neonates at Risk for Neonatal Abstinence Syndrome
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Victoria Pang, PharmD, MBA |
The Impact of a Hospital Protocol in Neonates at Risk for Neonatal Abstinence Syndrome In the midst of the opioid epidemic, neonatal abstinence syndrome (NAS) has become one of the leading causes of extended-stay admissions among neonates nationwide1 . Within the last 2 decades, the use of controlled substances in adults, including pregnant women, have nearly quadrupled2 . Patients diagnosed with NAS typically stay an average of 22 days in the hospital3 . The “Eat, Sleep, Console” (ESC) protocol was designed to maximize non-pharmacological measures to reduce symptoms of NAS, as well as dependence on one or more substances. If pharmacologic treatments are deemed necessary despite non-pharmacological therapy, ESC utilizes a daily morphine taper to slowly reduce dependence on these controlled substances4 . Although not well understood, it is hypothesized that implementing protocols such as ESC can decrease length of hospital stay, as well as reduce the usage of morphine and other rescue treatments by nearly 50 percent according to a paper published by Grossman et al. With that in mind, this protocol was implemented at St. Rose Hospital – Siena Campus in September of 2021 to establish a standard of care within the facility, as well as to understand the impact the ESC protocol has on neonatal patients.
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Denise Truong, PharmD, BCPS |
Antifungal Prophylaxis in Adults Receiving Parenteral Nutrition Candidemia is a serious infection associated with high mortality and prolonged hospital length of stay. Antifungal prophylaxis is warranted in patients with composite risk factors including but not limited to recent intra-abdominal surgery, immunocompromised status, receiving total parenteral nutrition (TPN), having a central venous catheter, and prolonged antibiotic therapies. With a low overall reported incidence of candidemia of approximately 3% in high-risk populations, prophylaxis in general hospitalized patients is likely to be unnecessary. Inappropriate antifungal therapy is associated with higher healthcare cost and unwanted adverse events. The goal of this project is to compare the incidence rates of candidemia in non-abdominal surgical patients receiving parenteral nutrition with and without antifungal prophylaxis to determine if therapy is warranted in this patient population.
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