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Vizient Pharmacy Market Outlook Winter 2022

Carina Dolan, Editor in Chief of Vizient’s Pharmacy Market Outlook and Senior Director of Clinical Oncology and Pharmaceutical Outcomes at Vizient, shares insights on January’s Vizient Pharmacy Market Outlook with host Gretchen Brummel. Carina discusses the outlook’s accuracy, ways that frontline staff can use the report, and the values members can get out of the results.
 
Guest speakers:Carina Dolan, PharmD, MS, BCOPSenior Director of Clinical Oncology and Pharmaceutical Outcomes VizientModerator:Gretchen Brummel, PharmD, BCPSPharmacy Executive DirectorVizient Center for Pharmacy Practice Excellence
 
Show Notes:
[00:49-1:24] Outlook refresher
[01:25-2:14] What is different in this version
[02:15-3:51] Grading past projections
[03:52-4:33] How frontline staff can use outlook
[04:34-5:28] What surprises are in this version?
[05:29-7:00] New topics in this version  
[07:01-10:39] The future forecasts and other useful resources
 
Links | Resources:
Vizient Pharmacy Market Outlook Member link Click here
Vizient Pharmacy Market Outlook highlights public version Click here
 
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Information overload: tips and tricks for staying on top of the literature, part 2

Sara J. Hyland, Clinical Pharmacist at OhioHealth Grant Medical Center, returns in Part 2 to share tools, expertise and strategies on how to stay ahead of the overwhelming volume of contributions to in this information age. Sara discusses with host Gretchen Brummel how to develop a multi-pronged system for limiting the workload of keeping up, skimming and drilling strategies and maintaining your system so it stays current.
 
Guest speaker:Sara J. Hyland, PharmD, BCCCPClinical Pharmacist OhioHealth Grant Medical Center Moderator:Gretchen Brummel, PharmD, BCPSPharmacy Executive DirectorVizient Center for Pharmacy Practice Excellence
 
Show Notes:
[00:41-3:25] Ways to limit the workload associated with staying current
[03:26-11:26] Skimming and drilling strategies
[11:26-13:42] Maintaining your system
 
Links | Resources:
Haines Answer final - ACCP: Click here
How to keep up to date with medical information using web-based resources: a systematised review and narrative synthesis Click here
Keeping Up With the Medical Literature: Why, How, and When? | Stroke Click here
Staying Up to Date and Managing Information Overload Click here
Keeping Up with the Medical Literature: How to Set Up a System - American Family Physician - American Academy of Family Physicians Click here
Learn Like a Pro: Barbara Oakley, PhD: 9781250799371: Amazon.com: Books Click here
#50: How to read the medical literature like a journal editor - The Curbsiders Click here
Evidence-Based Strategies to Better Remember What You Learn - learntrepreneurs Click here
Seventy-five trials and eleven systematic reviews a day: how will we ever keep up? - PubMed Click here
Scientific literature: Information overload | Nature Click here
 
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Vizient Pharmacy Vision Awards - Excellence in Public Policy

Erin Fox, Senior Pharmacy Director at the University of Utah Hospitals and Clinics and winner of the Vizient Pharmacy Vision Award for Excellence in Public Policy, discusses her advocacy with host Gretchen Brummel.
 
Guest speakers:Erin Fox, PharmD, BCPS, FASHPSenior Pharmacy DirectorUniversity of Utah Hospitals and Clinics Moderator:Gretchen Brummel, PharmD, BCPSPharmacy Executive DirectorVizient Center for Pharmacy Practice Excellence
 
Show Notes:
[01:05-1:55] What got Erin interested in advocacy
[01:56-2:43 ] How advocacy became a goal
[02:44-3:20] How has Advocacy work progressed and expanded over the years
[03:21-4:18] What Erin is most proud of
[04:19-4:49] What has been most challenging    
[04:50-5:45] Advice Erin would give herself 20 years ago
[05:50-6:16] Collaborating with peers
[06:17-7:39] How front-line pharmacy professionals can get involved
[07:40-8:29] Biggest issues over next 5-10 years
 
Links | Resources:
Vizient Pharmacy Vision Awards: Excellence in Public Policy Click here
Vizient Pharmacy Vision Awards Click here
 
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Information overload: tips and tricks for staying on top of the literature, part 1

Sara J. Hyland, Clinical Pharmacist at OhioHealth Grant Medical Center, shares tools, expertise and strategies on how to stay ahead of the overwhelming volume of contributions to in this information age. Sara discusses with host Gretchen Brummel how to develop a multi-pronged system for identifying relevant literature to your practice, automating, and organizing that literature and balancing reading with work and personal time.
 
Guest speaker:Sara J. Hyland, PharmD, BCCCPClinical Pharmacist OhioHealth Grant Medical Center Moderator:Gretchen Brummel, PharmD, BCPSPharmacy Executive DirectorVizient Center for Pharmacy Practice Excellence
 
Show Notes:
[00:47-1:43] Sara’s background and current practice
[01:43-3:10] Problem in keeping up with medical literature
[03:10-4:05] Where do you start?
[04:06-7:40] Tools Sara uses for keeping up
[07:41-10:39] Leveraging other professionals
 
Links | Resources:
How to keep up to date with medical information using web-based resources: a systematised review and narrative synthesis Click here
Keeping Up With the Medical Literature: Why, How, and When? | Stroke Click here
Staying Up to Date and Managing Information Overload Click here
Keeping Up with the Medical Literature: How to Set Up a System - American Family Physician - American Academy of Family Physicians Click here
Learn Like a Pro: Barbara Oakley, PhD: 9781250799371: Amazon.com: Books Click here
#50: How to read the medical literature like a journal editor - The Curbsiders Click here
Evidence-Based Strategies to Better Remember What You Learn - learntrepreneurs Click here
Seventy-five trials and eleven systematic reviews a day: how will we ever keep up? - PubMed Click here
Scientific literature: Information overload | Nature Click here
 
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Getting to the heart of the matter: insights from a new infective endocarditis prevention statement

Dr. Jason Goodchild, Vice President of Clinical Affairs at Premier Dental Products Company, and Dr. Mark Donaldson, Associate Principal in Pharmacy Advisory Solutions at Vizient discuss the merits of a recent statement on antibiotic prophylaxis for infective endocarditis with host Gretchen Brummel.
 
Guest speakers:
Jason Goodchild, DMD
Vice President of Clinical Affairs
Premier Dental Products Company
 
Mark Donaldson, BSP, ACPR, PHARMD, FASHP, FACHE
Associate Principal, Pharmacy Advisory Solutions
Vizient
 
Moderator:
Gretchen Brummel, PharmD, BCPS
Pharmacy Executive Director
Vizient Center for Pharmacy Practice Excellence
 
Show Notes:
[00:53-1:55] Antibiotic prophylaxis against infective endocarditis as an important tool
[01:56-2:48] Risks of over- or underutilization of this treatment modality
[02:49-4:52] History of the guidelines
[04:53-5:48] New statement impacts moving forward
[05:49-8:49] Doxycycline as alternative to clindamycin in penicillin-allergic patients
[08:50-9:47] The rationale to abandon clindamycin
[09:48-11:49] How clindamycin compares to other agents
[11:50-12:59] The bottom line
 
Links | Resources:
Prevention of Viridans group Streptococcal infective endocarditis: a scientific statement from the American Heart Association: Click here
Prevention of infective endocarditis: guidelines from the American Heart Association: Click here
Antibiotic prophylaxis guidelines: is there new information for 2021? Click here
 
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Vizient Pharmacy Vision Awards: success story in innovation

Megan LaBreck, Antiarrhythmic Clinic Pharmacist at OhioHealth and winner of the Vizient Pharmacy Vision Award for Excellence in Innovation, discusses her program that transfers the management of nearly 1,400 patients on an antiarrhythmic drug and their monitoring from the exclusive management of a physician to a pharmacist-led service with host Gretchen Brummel.
 
Guest speakers:
Megan LaBreck, PharmD, BCPS, CACP
Antiarrhythmic Pharmacist
OhioHealth
 
Moderator:
Gretchen Brummel, PharmD, BCPS
Pharmacy Executive Director
Vizient Center for Pharmacy Practice Excellence
 
Show Notes:
[01:00-2:30] Transferring the management of nearly 1,400 patients on antiarrhythmic drugs and monitoring from a physician to a pharmacist-led service
[02:32-4:05] Solving the problem from the pharmacy point of view
[04:06-5:00] Identifying complexities and fixing issues
[05:01-6:06] Where did the idea come from for this program
[06:07-6:49] Designing the collaborative practice agreement    
[06:50-7:41] Training necessary to offer these services
[07:42-10:09] Discovering other opportunities
[10:10-11:53] Impact of shifting this activity to an outpatient setting
[11:55-13:01] How the program influenced patient satisfaction
[13:02-14:03] Future plans
[14:04-15:38] Advice for new practitioners or frontline staff
 
Links | Resources:
2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: Click here
Comparison of QT Interval Readings in Normal Sinus Rhythm Between a Smartphone Heart Monitor and a 12-Lead ECG for Healthy Volunteers and Inpatients Receiving Sotalol or Dofetilide: Click here
2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: Click here
Vizient Pharmacy Vision Awards: Excellence in Innovation: Click here
Vizient Pharmacy Vision Awards: Click here
 
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When your cup is empty: secondary traumatic stress in pharmacy practice

The pressures and stress of traumatic clinical events affects everyone in the room including pharmacists. Two pharmacists, Jennifer Mando-Vandrick, Clinical Pharmacist in Emergency Medicine at Duke University Hospital and Philippe Mentler, Consulting Director of Pharmacy at Vizient, discuss the emotional impact pharmacist may have when witnessing the distress of others when traumatic events happen in the clinical workplace.
 
 Guest speakers:
Jennifer Mando-Vandrick, PharmD, BCPS
Clinical Pharmacist, Emergency Medicine
Director, PGY2 Emergency Medicine Residency
Department of Pharmacy
Duke University Hospital
 
Philippe Mentler, PharmD, BCPS
Consulting Director, Pharmacy
Vizient
 
Moderator:
Gretchen Brummel, PharmD, BCPS
Pharmacy Executive Director
Vizient Center for Pharmacy Practice Excellence
 
Show Notes:
[3:31] Secondary traumatic stress or compassion fatigue is a state of emotional distress that results from indirect exposure to traumatic events
[4:00] How secondary traumatic stress differs from burnout
[6:15] How to manage your stress level
[9:23] Acknowledge  and accept that you are feeling stress and be open to listening to other people’s feelings
[9:50] How leadership can help their employees deal with stress
[12:00] Peer support
[13:07] Talking to your learners and applicants about how your organization’s culture manages employee stress
 
Links | Resources:
CDC: Mental Health articles
Psychology Today
 
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A periop love story: sugamma-next? Or stay with your (neo) ex?

The debate on whether to use sugammadex or neostigmine has heated up dramatically in recent years. Two industry experts, Eric Johnson, perioperative critical care pharmacist at UK HealthCare, and Stacy Lauderdale, senior director for drug information at Vizient, discuss the many considerations involved in choosing between the two agents.
 
Guest speakers:
Eric Johnson, PharmD, BCCCP
Perioperative Critical Care Pharmacist
UK HealthCare
 
Stacy Lauderdale, PharmD, BCPS
Senior Director, Drug Information
Vizient
 
Moderator:
Gretchen Brummel, PharmD, BCPS
Pharmacy Executive Director
Vizient Center for Pharmacy Practice Excellence
 
Show Notes:
[01:11] Neuromuscular blockers play two main roles in the perioperative setting. 
[01:52] The ability to reverse neuromuscular blockade is important for prevention or decreased incidence of adverse effects.   
[03:07] In 2013, neostigmine received FDA approval, eliminating all other non-FDA-approved versions from the market.
[03:32] The sole supplier of neostigmine raised the cost ~450%.
[03:52] In 2015, sugammadex received FDA approval and hit the market at a cost similar to neostigmine.
[04:13] Neostigmine’s cost has dropped since 2015, causing member hospitals to question the added value of sugammadex.
[04:37] One institutional use was 90% sugammadex vs. 10% neostigmine.    
[05:07] Via Pharmacy Market Outlook, Vizient has found that sugammadex is the number-three top-spend drug in the acute care setting.
[06:01] One benefit of sugammadex is its ability to reverse at a deeper level.
[06:24] Another benefit of sugammadex is its lack of cardiovascular effects.
[06:55] Sugammadex displays more optimal pharmacokinetics.
[07:58] Important safety and quality factors to consider.
[08:53] Studies cannot conclusively determine if sugammadex reduces postoperative respiratory complications.
[09:10] The cost difference between sugammadex and neostigmine continues to grow.
[09:50] Vizient assembled an expert panel of 12 multidisciplinary specialists to review the comparative effectiveness of sugammadex vs. neostigmine.
[10:32] The focus of the panel was to look at outcomes that have a measurable impact on patient quality, safety and cost.
[11:45] The panel used the Institute for Clinical and Economic Review Matrix to rate the comparative effectiveness of sugammadex and neostigmine.
[12:21] The ICER Matrix assisted the panel in determining the magnitude of difference between the two therapies. 
[14:46] Anesthesiologists’ concern about the lack of resident training with neostigmine
[15:39] Final report, that will include many more findings, to be published in the fourth quarter of 2021.
[16:08] Importance of train-of-four monitoring
 
Links | Resources:
National Library of Medicine, “Sugammadex versus Neostigmine for Reversal of Neuromuscular Blockade and Postoperative Pulmonary Complications (STRONGER): A Multicenter Matched Cohort Analysis,” Anesthesiology, 2020 June 1 Click here
National Library of Medicine, “Postoperative Pulmonary Complications' Association with Sugammadex versus Neostigmine: A Retrospective Registry Analysis,” Anesthesiology, 2021 June 1 Click here
 
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Enhanced Recovery After Colorectal Surgery

Historically there have been countless paths to recovery following colorectal surgery. However, having a well-rounded, evidence-based enhanced recovery program is critical to patient success. Two Vizient experts, Mark Ninno and Karen Smethers discuss the details and the power of these programs.
 
 Guest speakers:
Mark Ninno, PharmD
Senior Consulting Solutions Director
Vizient
 
Karen Smethers, PharmD, BCOP
MSS Pharmacy Network
Senior Director
Vizient Pharmacy Member Services
 
Moderator:
Gretchen Brummel, PharmD, BCPS
Pharmacy Executive Director
Vizient Center for Pharmacy Practice Excellence
 
Show Notes:
[01:21] Enhanced recovery programs are specific programs designed to help patients after surgery
[01:59] Strong recovery programs involve four pillars to achieve its goal of patient discharge: patient-centered, multi-modal, multidisciplinary and evidence-based approaches
[03:29] Vizient observes that health systems have a wide variety of practices following colorectal surgery
[03:56] Vizient gathered a panel of experts to assess and evaluate recovery programs
[04:16] The expert panel focused on two specific domains: literature review and expert opinion    
[05:33] Vizient evidence review includes pharmacological and non-pharmacological interventions
[06:09] Early introduction of oral feeding proved to have the strongest support in recovery
[06:24] Studies involving alvimopan contain many factors that hinders its application in an enhanced recovery program
[07:10] Vizient found many systems are supporting alvimopan use in minimally invasive surgery even though the evidence may not fully support this practice
[07:46] Non-drug regiments such as chewing gum and caffeine have been handed down for many years, yet these therapies have minimal benefits
[08:33] It’s critical for front line pharmacists to collaborate with all health care professionals
[08:59] Education of prescribers, patients and family members provide many benefits
 
Links | Resources:
American Association of Nurse Anesthesiology (AANA): Enhanced Recovery after Surgery Click here
Scott MJ, Baldini G, Fearon KCH, et al. Enhanced Recovery After Surgery (ERAS®) for gastrointestinal surgery, part 1: pathophysiological considerations. Act Anaesthesiol Scand. 201559(10):1212-1231 Click here
Gustafsson UO, Scott MJ, Hubner M, Et al, Guidelines for perioperative care in elective colorectal surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations: 2018. World J Surg. 2019 ;43(3):659-695 Click here
 
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The Unknowns of Anti-factor Xa Reversal: The Experts Weigh In

The ability to chronically anticoagulate a patient has prevented significant morbidity and mortality from thromboembolic events. Over time, our anticoagulation choices for oral use have evolved, but the need for reversal agents still persist. Two Vizient pharmaceutical experts weigh in on the clinical implications and latest standings of reversal agents. 
 
Guest speaker:
Stacy Lauderdale, PharmD, BCPS
Senior Director, Drug Information
Vizient
 
David Reardon, PharmD, BCPS
Senior Director, Pharmacy Networks
Northeast Purchasing Coalition (NPC)
Pharmacy Member Services
Vizient
 
Moderator:
Gretchen Brummel, PharmD, BCPS
Pharmacy Executive Director
Vizient Center for Pharmacy Practice Excellence
 
Show Notes:
[01:15] Warfarin has been the cornerstone of oral anticoagulant therapy since the 1950s but has many limitations including causing bleeding and thrombosis if not managed properly.
[01:45] In 2011, a new class of oral factor 10a inhibitors was approved which drastically changed the oral anticoagulant landscape.  
[01:45] Most common:  apixaban and rivaroxaban.  They have fewer drug-drug interactions and fewer drug-food interactions than Warfarin.  
[02:26] In May 2018, FDA approved andexanet alfa. It has an accelerated biologic license conditional approval based on some surrogate markers in the trials. Clinical trials are underway.
[03:41] In January 2021, Vizient published a consensus-based document regarding the expert task force’s findings on how to manage the pharmacological reversal agents for factor 10a inhibitor-related bleeding. 
[05:27] What the literature says regarding the factor 10a inhibitors
[06:53] Task force compared the clinical effectiveness of andexanet versus pro-hemostatic agents using the ICER Evidence rating Matrix tool.  
[08:37] Task force recommends that institutions have an anticoagulation reversal policy.  The Joint Commission National Patient Safety Goal for anticoagulation therapy provides guidance for that organizations should have on hand.
[09:06] Policy should address standard of care, radiographical and laboratory studies, as well as appropriate pharmacological interventions. Anticoagulation reversal agents will not correct hemodynamic instability, so you’ll need to start other therapies.
[09:35] Pharmacists can drive the protocols and adoption of prothrombin complex concentrates
[10:43] Expert panel is in consensus that use of pro-hemostatic agents for reversal of a factor 10a inhibitor-related bleed is ethically and legally justified, despite the fact that andexanet is FDA approved for it.
[12:42] Budgetary considerations with the two agents, the prothrombin complex concentrates or PCCs and andexanet alfa
 
Links | Resources:
Consensus statement on use of reversal agents for factor Xa inhibitor – related bleeding, December 2020, Vizient Click here
 
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