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Purpose The development and implementation of a residency project advisory board (RPAB) to manage multiple pharmacy residents’ yearlong projects across several residency programs are described. Summary Preceptor and resident feedback during our annual residency program review and strategic planning sessions suggested the implementation of a more-coordinated approach to the identification, selection, and oversight of all components of the residency project process. A panel of 7 department leaders actively engaged in residency training and performance improvement was formed to evaluate the residency project process and provide recommendations for change. These 7 individuals would eventually constitute the RPAB. The primary objective of the RPAB at Aurora Health Care is to provide oversight and a structured framework for the selection and execution of multiple residents’ yearlong projects across all residency programs within our organization. Key roles of the RPAB include developing expectations, coordinating residency project ideas, and providing oversight and feedback. The development and implementation of the RPAB resulted in a significant overhaul of our entire yearlong resident project process. Trends toward success were realized after the first year of implementation, including consistent expectations, increased clarity and engagement in resident project ideas, and more projects meeting anticipated endpoints. Conclusion The development and implementation of an RPAB have provided a framework to optimize the organization, progression, and outcomes of multiple pharmacy resident yearlong projects in all residency programs across our pharmacy enterprise.

Purpose Patient safety and cost-control benefits achieved through a medical center’s conversion to commercial fluids for continuous renal-replacement therapy (CRRT) are described. Summary In keeping with national patient safety recommendations, a medical center undertook a quality-improvement initiative to increase the standardization of CRRT fluids and associated patient care practices. After a feasibility study to ascertain CRRT fluid usage patterns and baseline costs, an appropriate commercial product was selected. The transition was implemented over several months in a three-phase process entailing (1) conversion to a commercial product for regional citrate anticoagulation, (2) changing the standard formula on preprinted orders to one that modeled a commercial product, and (3) conversion to the actual commercial product as the standard. Thorough education of all parties involved, as well as modifications to preprinted orders, occurred during each phase of the project. The use of the commercial product reduced the need for pharmacy compounding of CRRT fluids by more than 80%. A postconversion cost analysis indicated sharp reductions of product and labor (i.e., compounding) expenses relative to estimated baseline costs, with estimated total savings of at least $399,290 during the first six months after the conversion initiative. Implementation challenges included the need to manually adjust the potassium content of the commercial CRRT fluid and the need to provide i.v. supplementation of phosphorus and magnesium to some patients receiving the fluid. The initiative emphasized the need for institution-specific research and planning before conversion initiatives targeting CRRT fluids and other critical therapies, as well as proper education and training of all parties involved. Conclusion The standardization of CRRT fluids using commercially available products improved a medical center’s compliance with patient safety standards and yielded substantial cost savings.

1020 Transitioning Patients with Pulmonary Arterial Hypertension from Inhaled Prostacyclin to Oral Prostacyclin: Single-Center Experience S. Paulus, A. Kallio, E. Roberts, T. Freichels, D. Zwicke St. Luke’s Medical Center Purpose: 1) Demonstrate safety of Saint Luke’s Pulmonary Hypertension Clinic’s protocol to transition patients from inhaled to oral prostacyclin; 2) Identify common patient characteristics of patients who would benefit from transition; and 3) Patient outcomes after transition. Background: Pulmonary arterial hypertension (PAH) is a devastating disease with various treatment options dependent on many factors. An oral prostacyclin has been approved for treatment of PAH, but no guidelines exist for transitioning patients to this therapy. This is a report of Saint Luke’s Pulmonary Hypertension Clinic’s single-center experience transitioning patients with PAH from inhaled treprostinil to oral treprostinil. Methods: Retrospective chart review of patients transitioned from inhaled treprostinil to oral treprostinil from June 2014 through May 2015. Results: A total of 22 patients (mean age 61.1 years [range 21-86], 16 females) with PAH (7 idiopathic, 7 congenital heart disease, 8 collagen vascular disease) were transitioned from inhaled treprostinil therapy to oral treprostinil therapy. Common characteristics of patients transitioned included: cough – 13, higher dose – 4, and convenience was cited by 5. All patients were transitioned using Saint Luke’s Pulmonary Hypertension Clinic’s specific protocol. Twenty patients were dosed 3 times daily, 1 patient twice daily, and 1 patient went from 3 times daily to twice daily. Of the 22 patients transitioned, 6 discontinued (27.2%) oral treprostinil. Reasons for discontinuation included: inability to comply with dosing – 2, higher dosing required than tolerated orally – 1, side effects – 2, therapy no longer required – 1. There was one death unrelated to disease state/transition. Based on this small case series, patients can safely transition from inhaled to oral prostacyclin therapy. Twice daily dosing improved patient compliance with the calorie requirements. Patients unable to comply with calorie requirements failed oral treprostinil treatment. Conclusion: Larger studies and longer durations of clinical follow up are required to validate oral treprostinil transition protocols. Further study is required to evaluate the impact of caloric intake on the durability of oral treprostinil therapy.