September/October 2018 Newsletter
In this issue:

  • Tony's Tenets: A Message from the President
  • Board Update
  • Financial Report
  • Public Policy Update
  • Research and Education Foundation Update
  • Affiliate Chapter News and Events
  • Best Practice Spotlight: Antimicrobial Stewardship
  • Featured Clinical Topic – Cardiology/Anticoagulation
  • Pharmacist Continuing Education Opportunities
  • Logo Contest (last chance)
  • Upcoming Newsletter Info
Tony’s Tenets: A Message from the MSHP President
Failing to plan is planning to fail.
- Alan Lakein
You can do irrefutably impossible things with the right amount of planning and support from intelligent and hardworking people and pizza.
- Scott M. Gimple
Board Update
Elaine Ogden, PharmD, BCPS, BC-ADM
MSHP Secretary/Kansas City VA Medical Center

July Updates
  • R&E is working to update the process for submitting posters for the Spring meeting as well as updating the judges form
  • The board approved funding requests by 3 of our 4 affiliates for upcoming member appreciation events
  • Lots of exciting public policy information was reviewed with the board as well as how the board can assist members with getting involved by contacting state representatives… more to come on this!!
  • MSHP will be collaborating with MPA for our Fall meeting this year, assisting with 3 different sessions:
  • Collaborative practice
  • Transitions of care billing
  • Clinical pearls for Innovative Practice Ideas - a roundtable discussion

August Updates
  • The board has been reviewing budget and discussing ways to enhance budget for next year
  • New discount for residents and new graduates was approved for 9/25-10/16 – great opportunity to join MSHP… tell your residents and new grads!!
  • The membership committee is investigating how to engage membership – more to come on this!
  • Public policy continues to be a focus of the board meetings with several items high on the list, including tech check tech, remove supervision of technicians, cannabinoid legislations, and more...
  • And yes, we have started talking about the Midyear reception so stay tuned!
Financial Report
Author: Davina Dell-Steinbeck, PharmD, PharmD, BCPS
MSHP Treasurer/SSM Health St. Mary’s Hospital – St. Louis

Each year, the Treasurer has the responsibility to report to the membership on MSHP’s financial condition. MSHP’s financial year is from July 1 through June 30, coinciding with our policy development process and timetable. This report describes MSHP’s past and projected financial performance.
Fiscal Year Ending June 30, 2018 - Actual
In May 2018, members of the internal audit team performed a review of MSHP’s finances covering July 2017 through December 2017. It was decided that in March 2019, we will do an internal audit based on the 2018 calendar year. The audit found no significant deviations. It was also decided that an external audit would be completed during the next fiscal year.

As of June 30, 2018, the MSHP’s balance sheet reported our total assets at $150,392.08 with a net income of $3561.21 for the fiscal year. For the fiscal year the organization brought in just over $25,000 in dues. Spring Meeting had a net income of just over $14,000.
Fiscal Year Ending June 30, 2019 - Projected
In June 2018, the MSHP Executive Board approved the fiscal year 2018-2019 budget which is balanced with a surplus of $1821.00. Notable changes in the proposed budget included budgeting money to cover the external audit fees. MSHP also retains a CD with US Bank which is projected to mature in November 2018 at which time the Executive Board will review future investment strategies.

I am honored to serve as your Treasurer and proud to serve on an Executive Board that is committed to progressing the practice of pharmacy in Missouri.
Public Policy Update
Marijuana in Missouri-What Missouri Pharmacists Should Know

On June 25, 2018, the Food and Drug Administration (FDA) approved the first drug containing a “purified drug substance derived from marijuana”, Epidiolex. This new medication differs from medications such as dronabinol and nabilone that are synthetic derivatives of marijuana based on how the medication is manufactured. 1

Research & Education Foundation Update
Author: Jackie Harris, PharmD, BCPS
R&E Foundation Chair/St. Louis College of Pharmacy/Christian Hospital Northeast

The R&E Foundation is gearing up for a Donation Pledge campaign. Please consider making a monthly, yearly, or one time donation to the R&E Foundation to help support our pharmacists in Missouri advance the practice of pharmacy through education and research.  

How do we do that you may ask? Donations contributed go directly towards supporting the many awards provided at the MSHP Spring Meeting including the Thomas J. Garrison award, Best Practice award, Best Residency Project award, Preceptor of the Year award, and Poster awards. In addition, R&E provides financial support to the students who win the Clinical Skills Competition at STLCOP and UMKC to attend the ASHP Midyear Clinical Meeting.  

As you start making plans for attending the ASHP Midyear Clinical Meeting, don’t forget to add the MSHP reception to your itinerary. This year we will be providing free drink tickets for donations to the R&E Foundation. You will receive 1 free drink ticket with a donation of $25, 3 drink tickets for a donation of $50, and 6 tickets for a donation of $100. Please consider donating!
Affiliate Chapter News & Events
Greater Kansas City Society of Health-System Pharmacists (GKCSHP)

Upcoming Events:
October 18 th : Distinct Blood Management for Distinct Disease
Time TBD
Location: Capital Grille, 4740 Jefferson St, Kansas City, MO 64112

Congrats to the 2017-2018 GKCSHP Member Award Winners which were presented at the Membership Event on August 25 th .
  • Pharmacist of the Year: Claire Elson
  • Pharmacy Technician of the Year: Rachel Drey
  • Pharmacy Student of the Year: Anna Parker       

GKCSHP is on Instagram! Follow us @gkcshp!

President: Katie Korte , PharmD, BCPS, BCCCP
Mid-Missouri Society of Health-System Pharmacists (MMSHP)

Upcoming Events:
October 9 th : Uncover CIDP
Time: 6:00 PM
Location: CC’s City Broiler, 1401 Forum Blvd, Columbia, MO 65203

Thank you to everyone who participated in our membership drive trivia night!

Call for student pharmacist continuing education presenters – for more information please contact Colleen Patton.

Like us on Facebook!

President: Colleen Patton , PharmD
Saint Louis Society of Health-System Pharmacists (STLSHP)

Upcoming Events:
October: Dalvance (Dalbavancin) – Allergan Sponsored Event
Time and Location: TBD

President: Carmen Smith , PharmD, BCPS
Southeast Missouri Society of Health-System Pharmacists (SEMSHP)

Upcoming Events:
October 11 th : Briviact (Brivaracetam) – UCB Sponsored Event
Time: TBD
Location: 36 Restaurant & Bar – 36 Main St, Cape Girardeau, MO 63701

To join SEMSHP:

President:   Ashley McCormick , PharmD, BCPS
Best Practice Spotlight
Best Practice Spotlight: 
Antimicrobial Stewardship
At the MSHP/KCHP Spring Meeting, the pharmacy staff at St. Luke’s Hospital in Kansas City, MO were recognized with the Best Practice Award for their innovative antimicrobial stewardship activities surrounding utilization of rapid diagnostic tests. Shelby Shemanski, PharmD, BCCCP (Critical Care Pharmacist) and Nick Bennett, PharmD, BCPS (Antimicrobial Stewardship Pharmacist) have graciously shared details of their program with the MSHP membership for those who may be interested in instituting similar practices.

Featured Clinical Topic: Cardiology/Anticoagulation
The Role of Extended Thromboprophylaxis in Acutely Ill Medical Patients
Venous thromboembolism (VTE) encompasses two interrelated conditions that are part of the same spectrum: deep vein thrombosis (DVT) and pulmonary embolism (PE). 1  A DVT is a venous blood clot that typically forms in the veins of the lower extremities. A PE occurs when part of a DVT breaks off and travels to the lungs, where partial or complete occlusion of blood flow can be fatal. 2  VTE affects about 900,000 patients in the United States every year. 3  The risk of VTE remains even after diagnosis and treatment, with one-third of patients diagnosed with a VTE having a recurrence within 10 years. It is estimated that over 50% of hospitalized medical patients are at risk for VTE, with VTE being the second most common medical complication that can occur during a patient’s hospital stay. The total annual cost per patient for secondary diagnosis of DVT is $7,594, and the total annual cost per patient for secondary diagnosis of PE is $13,018. 3-6  Early recognition of patients who are at an increased risk of developing VTE is imperative to reduce the medical and economic burden of this complication.

Direct-Acting Oral Anticoagulants (DOACs) use in Patients with Chronic Kidney Disease
Since the approval of the first direct-acting oral anticoagulant (DOAC), dabigatran in 2010, the management of oral anticoagulation in patients has significantly changed. In the years following its approval, four more agents were approved as well: rivaroxaban, apixaban, edoxaban, and betrixaban. 1-5  The introduction of these drugs into practice provides an alternative to warfarin, which has historically been the only option for oral anticoagulation in patients. Where warfarin requires monitoring every 2-4 weeks and frequent regimen modifications, the DOACs do not have any monitoring requirements and rarely require dose adjustments. 1-5  The DOACs also have notably less interactions with diet and other medications or supplements. These qualities make the DOACs a more patient and provider-friendly option to those requiring anticoagulation.

Andexanet Alfa: A Novel Reversal Agent for Factor Xa Inhibitors 
In recent years, direct acting oral anticoagulants (DOACs) have been gaining increased utilization due to fewer drug and food interactions and less frequent blood monitoring required than the traditional anticoagulant of choice, warfarin. However, like warfarin, DOACs still possess a risk for acute major bleeds.
Portola Pharmaceuticals’ andexanet alfa (Andexxa®) has recently garnered significant attention for being the first FDA-approved reversal agent for the factor Xa (fXa) inhibitor class of DOACs. 1 Given the limited real-world experience in the use of this drug, this overview may serve as useful source for providers to feel more comfortable with its use in practice.
Overview of Management of Local Anesthetic Systemic Toxicity (LAST) Based on Updated 2017/18 ASRA Practice Guidelines
Local anesthetic therapy has become an increasingly utilized component of multimodal analgesia. 1 Potential benefits include decreasing opioid exposure, decreasing postoperative nausea and vomiting, improving patient satisfaction, decreasing hospital length of stay, improving the quality of recovery from surgery, and reducing the risk of chronic postoperative pain. 2  Despite the potential benefits, administration of local anesthetics can lead to a rare and potentially fatal event known as local anesthetic systemic toxicity (LAST). Organ systems affected by LAST include the cardiovascular system and/or central nervous system (CNS). The treatment, management, and prevention of LAST is multifactorial and involves multiple pharmacological interventions with lipid emulsion administration as the cornerstone of therapy.
Pharmacist Continuing Education
2017 IDSA/SHEA Clostridium difficile Infection Guideline Updates: The Role of Fecal Microbiota Transplant
Authors: Nicholas Kovarik, PharmD and Samuel Mikovich, PharmD, PGY-1 Pharmacy Residents, SSM Health St. Mary’s Hospital – St. Louis
Preceptor: Davina Dell-Steinbeck, PharmD, BCPS, PGY-1 Pharmacy Practice Residency Director, SSM Health St. Mary’s Hospital – St. Louis

Program Number: 2018-07-18
Approval Dates: October 1, 2018 to December 31, 2018
Approved Contact Hours: One (1) CE(s) per LIVE session. 

Stress ulcer prophylaxis: Is it still necessary?
Author: Michael Serlin, PharmD; PGY1 Pharmacy Practice Resident, SSM Health St. Clare Hospital
Preceptor: Christopher Carter, PharmD, BCCCP; Clinical Pharmacy Specialist - Critical Care, SSM Health St. Clare Hospital

Program Number: 2018-09-04
Approval Dates: October 1, 2018 to December 31, 2018
Approved Contact Hours: One (1) CE(s) per LIVE session.

MSHP Logo Contest
Get your creative juices flowing, MSHP is looking for a new logo. If you are creative and/or can come up with a design concept for a new logo that would represent Pharmacy in Missouri, then you can be part of this fun too. This logo will become the new brand identity for MSHP.

Here is the process:

  • Submit your concepts/designs by Wednesday, October 3rd.
  • MSHP Executive Committee will review and select the top 3-4 submissions.
  • All MSHP members will be able to vote on the selected logos during 2018 Pharmacy Week.
  • The logo that gets the most votes will win some swag with the new logo on it.
  • The new logo will be unvailed at ASHP Midyear in Anaheim, CA
If you have a creative idea for a new logo, but just can't create it, tell us about it and Jim will try and design it to be part of the contest.

Please send questions, concepts and designs to Jim Andrews via email at MSHP@QABS.COM
Upcoming Newsletter Info
November/December 2018 Newsletter

Featured Clinical Topic:  Infectious Disease

Submit to: Sarah Cook
Upcoming Featured Clinical Topics

Nov/Dec: Infectious Disease
Jan/Feb: Endocrinology
Mar/Apr: Psych/Neuro/Pain
May/June: Critical Care/Pulm/Emergency Med
July/Aug: Cardiology/Anticoagulation
Sept/Oct: Oncology
Nov/Dec: ID/Vaccines 
Newsletter Submission Guidelines
  • Pharmacists, pharmacy technicians, and pharmacy students in Missouri are eligible to submit content for publication in the MSHP Newsletter. Student submissions need to include pharmacist oversight.
  • Submit content to the current Newsletter Committee Chair on or before the established deadlines.
  • CE and Featured Clinical Topics must be approved by the Newsletter Committee Chair in advance of article submission, to prevent duplicates. Duplicate articles submitted without advanced approval may not be published.
  • Recommended length of submissions for committee, affiliate, college/schools of pharmacy, and student chapter reports is half to one page in length.
  • Recommended length of submissions for featured clinical topics is 1 to 2 pages, without references.
  • Recommended length of CE articles is individualized, based on the amount of CE provided.
  • Recommended length of submission for other categories is 1 to 2 pages.
Newsletter Submission Deadlines
  • Nov./Dec. 2018: November 12th
  • Jan./Feb. 2019: January 14th
  • March/April 2019: March 11th
  • May/June 2019: May 13th
  • July/Aug. 2019: July 8th
  • Sept./Oct. 2019: September 9th
  • Nov./Dec. 2019: November 11th
Is there a Pharmacy Best Practice happening at your institution? Would you like to share your successes with MSHP Membership? We'd love to highlight your institution in a future MSHP Newsletter!

Please contact the MSHP Newsletter Chair, Sarah Cook
Interested in becoming a MSHP member or need to renew? It's easy! Click the above button or visit the MSHP website:

Membership Dues:
Pharmacist: $110
Joint Pharmacist: (Husband/Wife) $155
Technician: $35
Associate Member: $110
Recent Graduate (within 24 months): $45
Student: $25
Retired Pharmacist: $35
MSHP Board of Directors
2018 - 2019
President: Tony Huke
President-Elect: Alex Oschman
Immediate Past President: Jeremy Hampton
Secretary: Elaine Ogden
MSHP Committee Chairs
Vendor Relations Board Liaison -  Evanna Shopoff
Membership Committee -  Ashley Evans
Communications Committee -  Elaine Ogden
Public Policy Committee -  Sarah Cox
Newsletter Committee -  Sarah Cook
Education and Programming -  Elizabeth Englin
Website Committee -  Kathryn Burnett
If you have any questions, comments, or wish to submit an article to for MSHP Newsletter, please contact the Newsletter Committee Chair: Sarah Cook or another Newsletter Committee member.

2018-2019 MSHP Newsletter Committee Members
Sarah Cook, PharmD, BCPS (Chair)
Laura Challen, PharmD, MBA, BCPS, BCACP (Vice-Chair)
Barb Kasper, PharmD, BCACP
Hannah Pope, PharmD, BCPS