860. HIV Post-exposure Prophylaxis Availability at Small and Critical Access Hospitals in the Western Region

Background Post-exposure prophylaxis (PEP) is essential to minimize the risk of human immunodeficiency virus (HIV) acquisition following an occupational or nonoccupational exposure to potentially infectious body fluids. PEP is most effective when initiated as soon as possible after HIV exposure. Patients in rural areas may rely on small (< 50 beds) and critical access (< 25 beds) hospitals for access to PEP – especially after-hours and on holidays, when outpatient pharmacies are typically closed. However, PEP medications are costly to maintain on a hospital formulary due to unpredictable use and expiration. We hypothesized that PEP availability may be variable and limited at such hospitals. Methods The University of Washington Tele-Antimicrobial Stewardship Program (UW-TASP) is comprised of 68 hospitals in Washington, Oregon, Arizona, Idaho, and Utah, most of which are rural and critical access. In August 2020, we surveyed UW-TASP participating hospitals and a convenience sample of other networked rural hospitals in Western states using REDCap, a HIPAA-compliant, electronic data management program. Respondents reported all antimicrobials on their hospital formulary and their hospital size. Data were reviewed by physicians and pharmacists trained in infectious diseases. Preferred PEP regimens, defined by the CDC, for adults and adolescents ≥ 13 years, included combination tenofovir disoproxil fumarate-emtricitabine (TDF/FTC) and either raltegravir (RAL) or dolutegravir (DTG). Results Responses from 49 hospitals were received. Six were excluded – one was incomplete and five were excluded due to hospital size ( > 50 beds) (Table 1). The majority of hospitals (40/43, 93.0%) were critical access. Half of the hospitals’ formularies (22/43, 51.2%) contained a preferred PEP regimen. One hospital reported a non-preferred regimen. Most hospitals with a preferred PEP regimen on formulary (18/22, 86.3%) offered TDF/FTC + RAL, and the remainder (4/22, 18.2%) offered TDF/FTC + DTG. Conclusion Many small and critical access hospital formularies do not include antiretroviral agents needed for HIV PEP. Improving urgent access to these critical medications in rural communities is an opportunity for HIV prevention. Disclosures Jehan Budak, MD, Nothing to disclose Chloe Bryson-Cahn, MD, Alaska Airlines (Other Financial or Material Support, Co-Medical Director, position is through the University of Washington)

CURRENT SITUATION OF OUTPATIENT DRUG PRESCRIPTION FOR OBSTETRICS AND GYNECOLOGY

Objective: Describing the current situation of outpatient drug prescriptions at the Department of Obstetrics and Gynecology, Tan Chau Regional General Hospital, An Giang Province in 2019. Subjects and methods: Study of cross-sectional description over 400 oupatient treatment prescriptions stored at the Department of Obstetrics and Gynecology, Tan Chau Regional General Hospital, An Giang Province during from January 1st, 2019 to December 31st, 2019. Results: Comply with the provisions in the prescription; 100% of prescriptions were fully filled out the name, age, sex, diagnosis, cross out the blank, full name and signature of the doctor, the amount of medicine; 100% full patient address; 78.25% written their original names in accordance with regulations; 89.00% recorded sufficient content; 100% indication of the full dose and time of drug usage; 100% full used way. The average number of drugs in 1 prescription was 4.53; 80.75% of drugs were prescribed by the original name; 20.50% of prescriptions had antibiotics; 14.0% of prescriptions had vitamins; 100% of the drugs prescribed were on the essential drug formulary and the hospital formulary. Conclusion: A high proportion of compliance with regulations on prescription was observed. The average number of drugs in 1 prescription was 4.53. Mainly, drugs were prescribed by original name, drugs in the essential drug formulary, the proportion of prescriptions with antibiotics and vitamins was low.

Budget impact analysis of antiplatelet therapy with cangrelor in patients with acute coronary artery disease undergoing percutaneous coronary intervention in Portugal

Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): Ferrer, Barcelona, Spain Background Cangrelor is a novel, intravenous, potent, fast onset, direct-acting, P2Y12 receptor antagonist that blocks adenosine diphosphate-induced platelet activation and aggregation with a half-life of 3-6 min. Co-administered with acetylsalicylic acid, it is indicated for reducing thrombotic cardiovascular events in patients with coronary artery disease (CAD) (ST-elevation myocardial infarction (STEMI), non-STEMI, stable CAD) undergoing percutaneous coronary intervention (PCI) who have not received an oral P2Y12 inhibitor (clopidogrel, prasugrel or ticagrelor) prior to PCI procedure and in whom oral therapy with P2Y12 inhibitors is not feasible or desirable. Purpose To assess the economic implications of incorporating cangrelor into the hospital formulary for the acute care of CAD patients undergoing PCI in Portugal. Methods A budget impact model (BIM) was developed. The 3-year pharmacological and clinical event costs of two hypothetical scenarios, without and with cangrelor in the formulary for the total PCI population (base case) in Portugal were compared. Also, the primary PCI (STEMI) and a PCI population with special needs (ie. unable to swallow) were assessed as complementary setups. Epidemiological, efficacy (stent thrombosis, myocardial infarction (MI), ischaemia-driven revascularization, death), safety (Thrombolysis in Myocardial Infarction (TIMI) bleeding criteria) and costs (€, 2019) data were based on clinical trials, meta-analyses and on Portuguese registries. Only the costs of pre-treatment with oral P2Y12 inhibitors and glycoprotein IIb-IIIa inhibitors (GPI) for bail-out were considered. One-way sensitivity analysis established the effect of uncertainty on BIM results. Results The model assumes that the total PCI population grows from 13,422 to 14,370 adults (age 65 years, mean) over three years in Portugal. Pre-treatment with oral P2Y12 inhibitors increases from 9,932 to 10,634 patients, and uptake of cangrelor rises from 0.80% to 1.40% in the same period. The number of total PCI patients receiving cangrelor grows from 79 to 149. At current usage of antithrombotics and at existing pharmacological and management costs, adding cangrelor into the hospital formulary represents 115 thousand € over 3 years in Portugal. Results are most sensible to the percentage of patients on GPI bail-out. Conclusions Under BIM assumptions, introducing cangrelor for the acute care of CAD patients undergoing PCI represents a safe and affordable option in Portugal, particularly when the required control of thrombosis is not certain with oral pre-treatment.

Utilizing Hospital Formulary System in Nepal

Since the early 1950s, for medication management, the hospital formulary system subsisted as a list of drugs into the supply chain management process in hospitals. With the advent of pharmacy practice services, the system now is more oriented towards the rational use of drugs taking into account the safety of therapy, cost-effectiveness, and uninterrupted availability of drugs to improve and reflect upon the clinical judgment of healthcare professionals. Though very few hospitals in Nepal have adopted hospital formulary system, the perfect practice is still skimpy. The formation of drug and therapeutic committee along with the establishment of hospital pharmacy services is a growing trend with the arrival of hospital pharmacy guidelines 2072, thus, a positive spill-over of the hospital formulary system to each hospital in Nepal would be valuable in promoting rational drug therapy.Keywords: Cost-effectiveness; hospital formulary system, rational drug therapy.

Insights on developing a field hospital formulary and medication distribution process in preparation for a second surge of COVID-19 cases

Purpose The coronavirus disease 2019 (COVID-19) pandemic has caused health systems across the country to plan for field hospitals to care for patients outside of traditional healthcare settings in the event of a second surge. Here we describe key considerations for the implementation of pharmacy operations and a field hospital formulary at an offsite location within a 2-week time frame. Summary Development of an offsite field hospital formulary is first dependent on the location and patient population defined for the field hospital. Creation of a limited formulary for a planned field hospital in Michigan involved reviewing physical space limitations and drug distribution workflows, assessing current prescribing trends, creating drug categories, and creating formulary guidelines to limit formulary options in each therapeutic category. Ultimately, our institution developed a 140-medication field hospital formulary, a process to enable appropriate use of nonformulary drugs, and a mixed operations model including automated dispensing cabinets and a manual cart-fill process. Although the institution did not have to open the field hospital, the process used for developing the formulary and determining distribution models will allow for an immediate implementation if a second surge occurs. Conclusion A methodical approach to developing limited formularies and pharmacy operations in a field hospital setting will allow health systems to establish efficient and effective medication distribution services in the event of a second surge of COVID-19 cases.

PROFIL KESESUAIAN PENULISAN RESEP PADA PASIEN UMUM RAWAT INAP DENGAN FORMULARIUM DI RUMAH SAKIT BEDAH MITRA SEHAT LAMONGAN

The hospital minimum service standard becomes the minimum reference for assessing the services provided by the hospital. One important point is the suitability of prescribing to patients based on hospital formulary. In this study aims to determine the suitability profile of inpatient prescribing in Rumah Sakit Bedah Mitra Sehat Lamongan with hospital formulary. The research method used was cross-sectional with accidental sampling as many as 614 prescriptions from May until June 2019. The results showed that the percentage of compliance with the average prescribing in May-June did not reach the minimum service standards (100%). therefore, a periodic evaluation of the formulary and outreach is needed to all doctors who write prescriptions for inpatients Keyword : prescribing, hospital formulary, inpatient

A QUALITY IMPROVEMENT PROJECT TO REDUCE THE USE OF COMBINATION OPIOID/ACETAMINOPHEN MEDICATIONS WITHIN A LARGE HEALTH SYSTEM

Background: Combination analgesics are among the most commonly prescribed pain medications in pediatric orthopedic patients. However, combined analgesics do not allow for individual medication titration, which can increase the risk of opioid misuse and hepatoxicity from acetaminophen. Increasingly, the risks of combined analgesics associated with opioid misuse and hepatotoxicity are recognized by the FDA and other organizations. Given these risks, consideration should be made for independent administration of acetaminophen and opioids. Hypothesis/Purpose: The primary aim was to alter the prescribing habits of pediatric orthopedic providers at our institution from postoperative combined opioid/acetaminophen medicines to independent opioids and acetaminophen. Methods: The study took place at a children’s hospital level one trauma center. A multidisciplinary team of health professionals utilized lean methodology to develop a project plan. Guided by a key driver diagram, (1) combination oxycodone/acetaminophen products were removed from hospital formulary, (2) a revised inpatient and outpatient electronic order set was implemented, and (3) multiple education efforts (emails, in person meetings) were conducted. Outcomes included inpatient and outpatient percent combined opioid/acetaminophen orders by surgical providers over twenty-seven months. Statistical process control charts were used to measure combination opioid prescribing practices for orthopedic and other surgical specialties. Results: Prior to intervention, inpatient combination opioid/acetaminophen products were prescribed for an average of 46% of all opioid prescriptions for orthopedic patients. After intervention and multiple educational efforts, the percent of combined opioid/acetaminophen products dropped to 31% and then to 3% by end of the investigational period. For outpatient prescriptions, the combined products accounted for 88% prior to intervention and dropped to 15% at project completion. Conclusion: By removing combined oxycodone/acetaminophen products from hospital formulary, educating the medical staff, and employing electronic order sets, the inpatient/outpatient prescribing practice of pediatric orthopedic surgeons changed from the common use of combined opioid/acetaminophen products to independent medications. This project demonstrates that changing medication prescription practice can be accomplished with 3 steps within a hospital system. Reducing the use of combination opioid/acetaminophen products may have further positive impacts on opioid misuse and hepatoxicity.