Purpose Results of the first ASHP National Survey of Health-System Specialty Pharmacy Practice are presented. Methods A sample of 230 leaders in health-system specialty pharmacies were contacted by email and invited to participate in a survey hosted using an online survey application. The survey sample was compiled from ASHP member lists, through review of data from other ASHP surveys indicating the presence of specialty pharmacies, and by outreach to ASHP member organizational leaders. Results The response rate was 53.0%. Most health-system specialty pharmacies dispense 30,000 or fewer specialty prescriptions per year, have an annual revenue of $100 million or less, are part of an entity eligible to participate in the 340B Drug Pricing Program, operate 1 specialty pharmacy location, have at least 1 specialty pharmacy accreditation, dispense nonspecialty medications in addition to specialty medications, and employ an average of 13 pharmacists and 15 technicians. More than two-thirds of health-system specialty pharmacies (68.8%) dispense no more than half of the prescriptions written by their providers due to payer network restrictions or limited distribution drugs. The health-system specialty pharmacy practice model includes access to the electronic health record (100% of respondents), pharmacists and technicians dedicated to specific clinics (64.9% and 57.7%, respectively), specialty pharmacist involvement in treatment decisions and drug therapy selection prior to the prescription being written (64.9%), and documenting recommendations and progress notes in patients’ electronic health record (93.4%). Most health-system specialty pharmacies (83.3%) offer experiential or formal education in specialty pharmacy. Top challenges that survey respondents expected to face in the next year included restricted access to payer networks and limited distribution drugs, 340B Drug Pricing Program changes, and shrinking reimbursement from payers. Conclusion The health-system specialty pharmacy represents an integrated advanced practice model that incorporates specialty medication-use management across the continuum of care.

BackgroundA negative nasal MRSA PCR test has a 98–99.6% sensitivity in confirming that MRSA is not the causative organism associated with pneumonia in hospitalized patients. Evidence supporting the clinical utility of nasal MRSA PCR testing in the Veteran patient population is limited, with no identified publications to date. The purpose of this project was to share outcomes associated with implementation of nasal MRSA PCR testing in the Veteran population to guide duration of vancomycin therapy.MethodsThis retrospective cohort quality initiative compared treatment of pneumonia that included vancomycin during a pre-Antimicrobial Stewardship Program (ASP) intervention phase (August 2013–February 2014) to an active ASP intervention phase (August 2017–March 2019). ASP intervention consisted of utilization of a negative nasal MRSA PCR as a rapid diagnostic test to support discontinuation of vancomycin prior to microbiologic culture results. Retrospective chart review evaluated vancomycin days of therapy (DOT), hospital length-of-stay (LOS), 30-day hospital readmission, and 30-day mortality. Patients admitted to the intensive care unit during the identified hospitalization were excluded.ResultsThe average vancomycin DOT significantly declined by 1.08 days when comparing the pre-ASP intervention phase (N = 25) to the ASP-intervention phase (N = 47) (3.6 vs. 2.52 days, respectively; P = 0.0088). Mean hospital LOS decreased by 1.5 days (6.04 vs. 4.54 days, respectively, P = 0.0885). There was no significant difference in 30-day hospital readmission rate (12% vs. 8.5%) or 30-day mortality rate (12% vs. 10%).ConclusionVancomycin DOT was reduced by 30% (1.08 days) and hospital LOS was reduced by 24.8% (1.5 days) in patients with pneumonia during a Vet. Affairs medical center’s utilization of negative nasal MRSA PCR testing to support vancomycin discontinuation. This project highlights the role of nasal MRSA PCR as a rapid diagnostic test to aid in diminishing empiric vancomycin usage and its associated toxicities. Disclosures All authors: No reported disclosures.