Department of Pharmacy Earns $50,000 Award for Excellence in Medication Safety

The American Society of Hospital Pharmacists Foundation and the Cardinal Health Foundation honored a team of UNC pharmacist for their successful efforts to address rare and serious complications resulting from blood thinners.

Department of Pharmacy Earns $50,000 Award for Excellence in Medication Safety click to enlarge The UNC Department of Pharmacy team implemented a program at UNC Medical Center called "Improving the Safety and Management of Patients with Suspected or Confirmed Heparin-Induced Thrombocytopenia." (Photo by Jamie Williams/UNC Health Care)

December 7, 2017

The Department of Pharmacy at the UNC Medical Center was honored this week with the 2017 Award for Excellence in Medication Safety by the American Society of Hospital Pharmacists (ASHP) Foundation and the Cardinal Health Foundation.

The award is the only national honor that recognizes a pharmacist-led interprofessional team for implementing significant system-wide improvements related to medication safety in a hospital or health system. At a ceremony held during the 2017 ASHP Midyear Clinical Meeting in Orlando this week, the pharmacy project team led by Kalynn Rohde, PharmD, received $50,000 to further their innovations in medication safety.

“Our team is very excited about this award and the opportunities it will provide for us to expand our medication safety initiative,” Rohde said. “This grant will allow us to impact patient safety both locally and hopefully nationally.”

Stephen J. Allen, ASHP Foundation chief executive officer, said, “The UNC Medical Center team and the two finalist tackled tough challenges that confront every hospital and health system in the United States. This program is an opportunity to recognize those who make improvements that not only benefit their institutions, but the entire profession.”

Rohde’s team implemented a program at UNC Medical Center called “Improving the Safety and Management of Patients with Suspected or Confirmed Heparin-Induced Thrombocytopenia.”

Heparin, unfractionated heparin, and other heparin derivatives are among the most frequently prescribed medications worldwide. Heparin-induced thrombocytopenia (HIT) is a rare and serious complication of heparin administration.

Continued heparin administration in this population leads to a hypercoagulable state with a greatly increased risk for thrombosis and significant implications for morbidity and mortality, potentially manifesting as a deep vein thrombosis, pulmonary embolism, or stroke. An unsupported but documented heparin allergy can result in a patient receiving high-risk and costly alternative anticoagulants during subsequent admissions.

Rohde’s pharmacist-led multidisciplinary team at UNC Medical Center set out to improve the care of patients with suspected or confirmed HIT. Medication error reports and retrospective review revealed a significant opportunity for improvement in this process. UNC Medical Center’s initiative involved five key areas: creating evidence-based guidelines, developing a standardized multidisciplinary workflow, utilizing the electronic health record (EHR) to improve patient safety, implementing a patient education program, and initiating a HIT stewardship program.

Post-implementation results showed a reduction in the incidence of heparin product administration in patients undergoing HIT testing and an increase in the rate of appropriate heparin allergy documentation at discharge.

The UNC team includes:

• Kalynn Rohde, PharmD, BCCCP – Medical ICU Clinical Pharmacist

• Sheh-Li Chen, PharmD, BCOP – Benign Hematology Clinical Pharmacist

• Jonathan Cicci, PharmD, BCPS – Cardiology Clinical Pharmacist

• Andrew Stivers, PharmD – Previous Medication Safety Officer

• Laura Mincemoyer, PharmD, BCPS – Previous Cardiology Clinical Pharmacist

• Raj Kasthuri, MD – Benign Hematology Physician

• Marian Rollins-Raval, MD, MPH – Special Coagulation Laboratory Director

• Jennifer Stegall, PharmD – Pharmacy Informatics Pharmacist

• Jennifer Emory, MSN, BA, RN-BC, CNL – Chair, Nursing Practice Council

• Kayla Waldron, PharmD, MS, BCPS – Assistant Director of Pharmacy, Acute and Ambulatory Clinical Services

• Lindsey Amerine, PharmD, MS, BCPS – Associate Director of Infusion, Medication Assistance Program, and Investigational Drug Services

• Scott Savage, PharmD, MS – Regional Director of Pharmacy, UNC Medical Center and Chatham Hospital

“Overall, this project built on established patient care processes, made vital improvements that were modest in resources, and resulted in improved safety for patients with suspected or confirmed HIT.,” Rohde said. “We are now in the process of implementing the initiative throughout the UNC Health Care system.”

Bill Owad, senior vice president of Operational Excellence at Cardinal Health, said, “As the health care industry continues to face enormous changes, the role that pharmacists play in improving the safety and quality of care is more critical than ever. This year’s Excellence in Medication Safety honorees address the key issues of better patient outcomes, cost containment, and efficiency. The Cardinal Health Foundation applauds their work.”

The award recipient and finalists were chosen by an inter-professional review panel of accomplished safety experts who evaluated all applicants. Finalists were selected based on the initiative’s scope, pharmacist leadership, demonstrated impact, innovation, sustainability, and generalizability. Reviewers visited each finalist’s site before selecting the award recipient.

Read more about the other finalists for the award here, and consider watching this video from ASHP about UNC’s winning program.

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