Ben Chiarolanza, PharmD Background: 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. Percentage of CABG and/or Valvular Surgery Patients Discharged on Amiodarone Cassandra Dilibero, PharmD Background: 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. Necessity of ED-Based Outpatient Infusion Services as a Stewardship Program Benjamin Mossholder, PharmD Background: 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. |