Background: There is currently little evidence regarding the use of medical cannabis for the treatment of intractable pain. Literature published on the subject to date has yielded mixed results concerning the efficacy of medical cannabis and has been limited by study design and regulatory issues. Objective: The objective of this study was to determine if the use of medical cannabis affects the amount of opioids and benzodiazepines used by patients on a daily basis. Methods: This single-center, retrospective cohort study evaluated opioid and benzodiazepine doses over a 6-month time period for patients certified to use medical cannabis for intractable pain. All available daily milligram morphine equivalents (MMEs) and daily diazepam equivalents (DEs) were calculated at baseline and at 3 and 6 months. Results: A total of 77 patients were included in the final analysis. There was a statistically significant decrease in median MME from baseline to 3 months (−32.5 mg; P = 0.013) and 6 months (−39.1 mg; P = 0.001). Additionally, there was a non–statistically significant decrease in median DE at 3 months (−3.75 mg; P = 0.285) and no change in median DE from baseline to 6 months (−0 mg; P = 0.833). Conclusion and Relevance: Over the course of this 6-month retrospective study, patients using medical cannabis for intractable pain experienced a significant reduction in the number of MMEs available to use for pain control. No significant difference was noted in DE from baseline. Further prospective studies are warranted to confirm or deny the opioid-sparing effects of medical cannabis when used to treat intractable pain.

BACKGROUND AND LEAN JOURNEY In 2007, a 4-hospital community health care system located in the East Metro area of St. Paul, Minnesota, started a system-based residency program that began with a single resident and later expanded to 2. In 2013, the program was modified and expanded to 3 site-based postgraduate year 1 (PGY1) residencies. This was done to help grow the residency programs and secure pass-through funding to financially support the resident positions within the organization. One of the sites is a 230-bed acute care facility with an average daily census of 190 patients. Twenty full-time equivalent clinical staff pharmacists are employed to manage over 11,000 admissions annually. In late 2012, the health system began its process improvement journey to implement the Toyota Production System (ie, lean) across the enterprise. This initiative is called value-based improvement (VBI) and involves everyone in the organization, from frontline contributors to senior leadership. A key to the Toyota Production System is the implementation of the frontline management system (FMS), which engages the employees who do the work in the problem-solving and improvement process. Leaders coach and are "barrier busters" for improvement work done by frontline staff as part of FMS. This model puts the ownership of the change in the hands of those who are closest to the work. Worth et al define lean as a set of concepts, principles, and tools used to create and deliver the most value from the customer's perspective while consuming the fewest resources by fully utilizing the skills and knowledge of those who do the work. 1 In a lean system, frontline staff drive the majority of process improvement. A successful lean program improves

Background: Clinical pharmacy services are known to improve patient outcomes. Pharmacists contribute to patient care in the acute care setting in multiple ways, including providing advice and information to patients and the health care team, performing medication histories to prevent waste and support medication adherence, analyzing the cost-effectiveness of medications, and ensuring patient safety through patient monitoring and medication review. Specific clinical pharmacist services include managing intravenous to oral medication adjustments, renal dose adjustments, and performing pharmacokinetic dosing of medications, among others. Many of these clinical services are performed daily but are not evaluated for clinical quality or compliance with policies. Evaluating these clinical services may provide a multitude of benefits to pharmacy departments, health systems, and patients. Methods: The purpose of this study was to evaluate pharmacist use and percent compliance of a renal dose adjustment policy upon initial order verification and discharge. This was completed through retrospective chart review to determine if dose adjustments were made appropriately and descriptive statistics were used to establish pharmacist compliance. Those orders that were inappropriately adjusted were analyzed for trends that could lead to possible policy improvements or pharmacist education opportunities. The completed evaluation also led to the development of an evaluation system that can be utilized to routinely assess clinical pharmacist services. Conclusions: The results of this study are being used to develop and support future clinical service evaluations, inspire process improvements, and improve patient outcomes and pharmacist accountability.