June 2019 Volume 7, Issue 1 Sanford Residency Newsletter

Guess the

resident!

Fun Fact Was a lifeguard in

high school First job was at

McDonalds Auditioned for

American Idol Has a twin brother From a town with

no stop lights

Favorite Food Super Nachos Steak Chicken flautas Pizza Spaghetti

L to R: Maja Stoneberg, Whitney Richman, Ryan Gumbleton, Nicole Stenzel, Kaylee Davidson

Meet the Current Residents!

Kaylee Davidson

Kaylee’s research project was to evaluate the

financial feasibility of changing the formulary from

the use of the originator infliximab to an

infliximab biosimilar product on an Enterprise-

wide basis and to evaluate outcomes in patients

within the Sanford Health system who had been

switched from the infliximab parent product to

the biosimilar. Her MUE evaluated appropriate

inpatient use of rituximab, pegaspargase, and

antithymocyte globulin. She is excited to be

staying on at Sanford Fargo as a 7 on/7 off

pediatric pharmacist and returning to her hobbies

of reading, playing piano, weightlifting, and

enjoying park dates with her little monkey,

Mowgli!

Fun Fact #2 I don’t think

pineapple belongs on pizza

I enjoy fishing and hunting

I love public transportation

I like to cook/bake I love weightlifting

Fun Fact #3 I played college

lacrosse I have worked

road construction, flagging & driving off-road truck

I was in the NICU for 30 days when I was born

I was a foreign exchange student

I hate baked beans but love refried beans

Answers: (1) Nicole, Ryan, Kaylee, Maja, Whitney (Favorite Food) Whitney, Maja, Nicole, Kaylee (2) Maja, Ryan, Nicole, Whitney, Kaylee (3) Ryan, Kaylee, Whitney, Maja, Nicole

Maja Stoneberg Maja’s research project was in the field of pharmacogenomics. For her project, she was working to create a standardized process for discovery, research, dose adjustment recommendations, and implementation of guidance beyond Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines. For one of her MUEs, she implemented C.diff PCR lab stewardship into pharmacy workflow, and also evaluated the use of procalcitonin lab in the hospital. Maja’s medication safety projects included pharmacy department education on different non-intuitive pharmacist workflows, linking naloxone to opioid orders in EHR and ensuring all aliquots have prep instructions in EHR. Maja is excited to stay on at Sanford Medical Center Fargo as a Med-Surg pharmacist. In her free time, she likes playing sports, traveling with her husband, and reading.

Whitney Richman Whitney’s research project looked at the safety and efficacy of abciximab and eptifibatide in neurointerventional procedures. Her MUE was looking at appropriateness of piperacillin/tazobactam and cefepime due to an increase in usage of these antibiotics. The results of this MUE led to changes to the pneumonia orderset to have respiratory cultures as a default as well as sputum induction orders to allow for more respiratory cultures collected. Whitney is amazed at how quickly the last 2 years went and is glad she made the decision to do the non-traditional residency. She is excited to be going back to her staffing role on the cardiology unit. In her free time, she likes to go to the lake, hang out with family and friends, and golf.

Nicole Stenzel Nicole’s research project was to embed herself into the workflow of the new specialty pharmacy as this service line was being initiated, and to narrate the experience. Her MUE was looking at vaccine alignment in enterprise-owned clinics to contract manufacturers. Nicole is excited to be able to continue working on her override medication safety project during her PGY2 year. During her PGY1 year, Nicole enjoyed exploring the restaurants and breweries in the Fargo/Moorhead area with her friends. She is excited for a busy summer of weddings and lake weekends!

Ryan Gumbleton Ryan is from Troy, MI. He attended Ferris State University for Pharmacy School. His residency research project looked at the effect of American Indian ethnicity and its effect on 30-day mortality in traumatically injured patients. His MUE was an evaluation and reconciliation of current sedation practices in the ICU. After residency, Ryan is excited to stay on at Sanford in a 7 on 7 off evening ICU role. Outside of work, Ryan enjoys hunting, fishing, playing sports and hiking.

Meet the Incoming Residents!

Sammie Nguyen (PGY1 Non-

Traditional) In 1993, my family and I immigrated to the U.S. and have since remained in the Fargo-Moorhead area. I received my Doctorate of Pharmacy from North Dakota State University in 2012. Prior to joining Sanford as an inpatient pharmacist in 2014, I was a pharmacist with Target and Sanford outpatient pharmacies. Residency training has always been my long-term career goal, and I am beyond thrilled to finally begin the journey this summer! I look forward to expanding my clinical knowledge base and enhancing my critical thinking skills, especially in cardiology, infectious disease, critical care, and specialty as well as ambulatory care clinics. Following residency, I hope to become a well-rounded clinical pharmacist who is able to provide great patient care and effectively precept students. Outside of work, I like to relax with my husband and two little monsters (Jazlyn-3 years, Jayson-7 months). Most people find it surprising that I also own and operate a nails salon, a small business in Grand Forks, ND. Most days, I love my life for it brings me joy and keeps my heart (and hands) full. Other days, I just [attempt to] sleep. As time allows, it is my goal within the next 5 years to pick up ballroom dancing and painting again, two of my favorite things to do before the invasion of the kiddos!

Anna Fox (PGY1 Ambulatory Care) Anna is from Winchester. VA. She is a Virginia Commonwealth University graduate with interests in ambulatory care, geriatrics, and psychiatry. She completed her undergraduate degree at Virginia Tech in nutrition and exercise science. She is looking forward to working with a variety of clinical preceptors and continuing to develop clinical skills. She is excited to begin her career as a pharmacist with Sanford Health. One of her professional goals is to become a board certified clinical pharmacist in ambulatory care in addition to teaching and precepting students. When she isn’t working, Anna enjoys spending time outside, traveling, and spending time with her husband Matthew. Anna will be moving to the Midwest with her dog Daisy. They are excited to discover new restaurants, sporting events, and the parks in North Dakota. She will miss living in Richmond, Virginia but is ready for a new adventure.

Siri Burck (PGY1) Siri is from Fargo, ND. She completed her undergraduate degree in Biochemistry at the University of North Dakota in Grand Forks, ND, where she also played Women’s Basketball. She earned her Pharm.D. from the North Dakota State University School of Pharmacy. She is excited to begin her residency at Sanford Medical Center in Fargo, with clinical interests in internal medicine, psychiatry, and infectious diseases. After residency, she would like to practice as an inpatient clinical pharmacist in a large teaching hospital. Outside of work, Siri enjoys spending time at the lake with family, reading, and staying active in recreational sports leagues.

Michael Erickson (PGY1) Mike is originally from Langford, SD. He graduated from South Dakota State University and is looking forward to starting his pharmacy career in Fargo! Mike is excited to expand his pharmacy knowledge base and gain experience in a variety of clinical settings. His clinical areas of interest include infectious disease, critical care, and internal medicine. Mike would like to work as a clinical pharmacist in an area of interest or complete a PGY-2 residency upon completion of his first residency year. Outside of work he enjoys sports, hiking, fishing, and snowboarding.

Maxx Enzmann (PGY1)

Maxx is from Carmel, Indiana and received his Pharm.D. from Drake University. Maxx is excited to begin his clinical pharmacy career at Sanford and is looking forward to living in Fargo. His current clinical areas of interest are infectious disease, neurology, and emergency medicine. After PGY-1, Maxx would like to pursue a PGY-2 residency or a position as a clinical pharmacist in an area of his interest. In his spare time, Maxx enjoys spending time at his family cabin on Rainy Lake in Ontario as well as playing soccer, reading Stephen King novels, and exploring different restaurants and breweries.

Nicole Stenzel (PGY2)

Nicole is happy to be staying at Sanford Health in Fargo to continue to provide a little Jackrabbit flavor to the land of the Bison. As a PGY2, she is hoping to continue to develop her critical thinking skills, primary literature knowledge, and teaching style. Nicole has enjoyed being active in NDSHP and will continue to serve as the Resident Liaison as a PGY2. In her free time, Nicole enjoys spending time with her friends in and out of Fargo, reading, and hanging out with her better half – Millie.

Preceptor of the Year

Each year the current residents vote for the preceptor of the year: a preceptor that has inspired and encouraged residents to work hard, develop their clinical skills, and provide safe and effective patient care. We would like to thank all of our preceptors for their dedication, advice, and hard work! We would also like to acknowledge the 2017-2018 recipient of Preceptor of the Year:

JESSICA DICKS, PHARM.D.

What is your favorite part of precepting?

I love the energy and eagerness of our residents. They come ready to learn and that excitement is contagious. I really

enjoy watching the residents grow in their knowledge and confidence throughout the year. They ask great questions

that are not only beneficial to their learning, but also help keep me up to date and push me to be a better pharmacist

and preceptor.

Why is precepting important to you?

Precepting gives me an opportunity to give back. I’ve had preceptors/mentors throughout my residency and my career

that have helped to shape me to be the pharmacist that I am today. Now it’s my chance to help shape and influence the

incoming pharmacists.

Residency Highlights

The residents had a Christmas Dinner Party and a White Elephant gift exchange

that was hosted at our RPD’s house

Residents graded Midas safety events

throughout the course of the year

Medication use evaluations were completed

on:

Piperacilllin/tazobactam and cefepime usage

Vaccine alignment

Inpatient chemotherapy utilization

C.diff PCR and procalcitonin ordering

Restraints in the ICU

Poster presentations of residents’

research projects were presented at the

2018 ASHP Midyear Conference in

Anaheim, California, and PowerPoint

presentations at Midwest Pharmacy

Resident Conference in Omaha, Nebraska.

Pharmacy Grand Rounds provided the residents an opportunity to research areas of interest and present to pharmacists and students. Each resident also completed a Pediatric Grand Rounds for Pediatric providers.

Whitney, Carlina, Nicole, Maja, Kaylee, and Ryan won their challenge in the

Fargo Escape Room!

Falls Clinic has been an opportunity

for the residents to provide

medication therapy management

services for patients at risk for a fall.

This year also served as the first year

residents responded to Falls pages in

the inpatient setting to see if

medications could have contributed

to the fall.

Medication Safety Projects Whitney worked on several ISMP Best

Practices related to sterile compounding processes, removing 1-liter bags of sterile water from areas outside of the pharmacy, standardizing our neuromuscular blocker storage/labeling throughout the pharmacy and in automated dispensing, and antidote availability.

Nicole worked to validate an Enterprise-wide malignant hyperthermia orderset designed to aid in decision support in the post-acute phase, as well as a medication panel for the Fargo hospital in the acute phase.

Kaylee created an electrolyte order panel integrated into Epic to facilitate the replacement of calcium, magnesium, potassium, and phosphorous on medical-surgical floors.

Whitney also worked on stability and sterility of pediatric aliquots/dilutions. With this project, we dissolved the batching of lorazepam aliquots due to limited stability data and low usage of the compounded aliquots. She also came up with a standardized dispensing process for oral suspensions that require glass dispensing.

Maja worked on optimizing Medication Reconciliation and MAR Holds workflows, and put together an education activity for pharmacists on different non-intuitive pharmacist workflows.

Ryan worked on a best practice advisory to help remind nursing staff when trough levels are due. With this project, we hope to eliminate missed trough levels on medications.

Nicole facilitated workflow change in multiple capacities to decrease the number of medications taken out of automated dispensing cabinets on the “override” function, as well as decrease the number of those overrides never linked to an order.

Maja worked on creating naloxone best practice alert (BPA) which would fire every time an opioid is ordered, as well as adding naloxone to current ordersets with opioids. She also worked on writing prep instructions for existing pediatric aliquots without current prep instructions in Epic.

Ryan is facilitating the build of a new ER order panel for DKA. This project will hopefully help with the appropriate management of pediatric patients affected by DKA in the ER.

Kaylee also worked on an Enterprise-wide USP 800 initiative and created a risk assessment tool for identifying NIOSH list medications as negligible, low, or high risk in terms of handling & exposure in order to be compliant with USP 800 standards.