<p><strong>ABSTRACT</strong></p><p><strong>Background: </strong>Despite the recent increase in opioid overdoses across Canada, few pharmacy-led initiatives have been implemented to address issues related to opioid prescribing in the hospital setting.</p><p><strong>Objectives: </strong>The primary objective of this study was to develop a clinical tool, intended for use by hospital pharmacists and informed by best practices from the literature, that would provide a structured approach to enhancing</p><p>the safety of opioid prescribing. The secondary objective was to collect pharmacists’ opinions about the feasibility and utility of this tool.</p><p><strong>Methods: </strong>A comprehensive literature search and pharmacist focus group analysis provided content for development of a candidate clinical tool. This tool was then piloted by clinical pharmacists working on general</p><p>medical and surgical units in a single hospital. Pharmacists participating in the pilot were invited to complete an online survey concerning their perceptions of the tool. Descriptive statistics were used to analyze the survey results.</p><p><strong>Results:</strong>The literature search and focus group analysis led to development of a candidate clinical tool that focused on Medication review, Optimization, Reassessment, and Education (MORE). It included key risk factors relating to opioid safety, along with suggested mitigating strategies. The MORE tool was piloted for 3 weeks by 14 clinical pharmacists, 9 of whom responded to the subsequent survey. Five respondents indicated that the clinical tool increased their ability to identify risk factors. Five respondents also noted an increase in their ability to identify possible interventions. Most respondents felt that the tool was useful and that it would be feasible to integrate it into their practice; however, they noted that a more streamlined version could improve ease of use.</p><p><strong>Conclusions: </strong>The MORE tool was well received by clinical pharmacists. Implementation of the tool into routine practice requires additional changes to improve ease of use. Suggestions for modifying and streamlining the tool will be incorporated into future versions.</p><p><strong>RÉSUMÉ</strong></p><p><strong>Contexte : </strong>Malgré l’augmentation récente des surdoses d’opioïdes au Canada, peu d’initiatives menées sous la houlette de pharmacies ont été mises en place sur les enjeux potentiels liés à la prescription d’opiacés en milieu hospitalier.</p><p><strong>Objectifs : </strong>L’objectif principal de cette étude visait à élaborer un outil destiné aux pharmaciens d’hôpitaux, s’inspirant des meilleures pratiques rapportées dans la documentation, qui fournirait une approche structurée</p><p>pour améliorer la sécurité de la prescription d’opioïdes. L’objectif secondaire consistait à recueillir les opinions des pharmaciens sur la faisabilité et l’utilité d’un tel outil.</p><p><strong>Méthode : </strong>Des recherches bibliographiques étendues ainsi qu’une analyse de groupes de discussion de pharmaciens ont fourni le contenu necessaire à l’élaboration d’un outil clinique expérimental. Ensuite, cet outil a été testé par des pharmaciens cliniciens travaillant dans des unités médicales générales et chirurgicales au sein d’un seul hôpital. Les pharmaciens participant au projet pilote ont été invités à répondre à une enquête en ligne sur leur perception de l’outil. Des statistiques descriptives ont permis d’analyser les résultats de l’enquête.</p><p><strong>Résultats : </strong>Les recherches bibliographiques et l’analyse des groupes de discussion ont débouché sur le développement d’un outil clinique nommé MORE [pour <em>Medication review, Optimization, Reassessment, and</em> <em>Education</em>, ou Examen, optimisation, réévaluation et éducation aux médicaments]. Il comprenait des facteurs de risque liés à la sécurité des opioïdes ainsi que des suggestions de stratégies d’atténuation. Quatorze</p><p>pharmaciens cliniciens, dont neuf ont répondu à l’enquête qui a suivi, ont testé le MORE pendant trois semaines. Cinq répondants ont indiqué que l’outil clinique augmentait leur capacité à déterminer les facteurs de risque. Cinq ont également noté une meilleure capacité à déterminer les interventions possibles. La plupart des répondants ont estimé que l’outil était utile et qu’il serait possible de l’intégrer dans leur pratique; cependant, ils ont aussi noté qu’une version simplifiée pourrait faciliter son utilisation.</p><p><strong>Conclusions : </strong>Les pharmaciens cliniciens ont bien accueilli l’outil MORE. Sa mise en oeuvre dans la pratique courante exige cependant des changements supplémentaires pour faciliter son utilisation. Les versions à venir tiendront compte des propositions visant à le modifier et à le simplifier.</p>

1136 Poster Board I-158 Introduction Invasive fungal infections (IFI) are associated with significant morbidity and mortality in hematopoietic stem cell transplant (HSCT) patients. Prophylaxis of high risk patient groups has become a key strategy in managing these infections, which are characteristically difficult to pre-emptively diagnose. The benefit of newer prophylactic agents depends in part on the local incidence of IFI in a population. This study was carried out to define the incidence of IFI in a cohort of HSCT patients treated by the Leukemia/Bone Marrow Transplant Program of British Columbia, to elucidate risk factors for IFI and to assess the efficacy of our current prophylaxis strategy. Methods Two hundred and forty-nine adult HSCT patients who underwent autologous or allogeneic transplantation between October 2006 and March 2008 were retrospectively evaluated. One hundred and eighty patients underwent high dose chemotherapy and autologous HSCT during this period. The indication for HSCT in this group was predominantly multiple myeloma (n=95; 53%) or non-Hodgkins lymphoma (n=59; 32.8%). Sixty-nine patients underwent allogeneic HSCT using a related sibling (n=46) or matched unrelated (n=23) donor. The predominant indication for allogeneic HSCT was acute leukemia/ myelodysplasia (48%), followed by non-Hodgkins lymphoma (25%) and chronic lymphocytic leukemia (12%). Patients enrolled in prophylaxis clinical trials or with previously documented IFI were excluded from analysis. Routine antifungal prophylaxis with low dose amphotericin B (10mg/m2/day) for inpatients and oral fluconazole (400mg/day) for outpatients was given during the neutropenic phase throughout the period of the study. Results The overall incidence of proven, probable or possible IFI was 2.2% (4/180) and 19% (13/69) in autologous and allogeneic HSCT groups, respectively. The median time to IFI in autologous HSCT recipients was 12.5 days (7-19) post transplantation. In allogeneic HSCT patients, a bimodal incidence of IFI was observed with the first peak occurring within the first 30 days of transplantation and a later peak after 100 days. Invasive aspergillosis (IA) was the predominant IFI encountered (82%); the remaining IFI were due to invasive candidiasis (IC). The incidence of IA was 1.7% (3/180) and 16% (11/69) in autologous and allogeneic HSCT patients. Mortality attributable to fungal infection was 18% (3/17) and all deaths were cases of IA occurring in the allogeneic HSCT group. Modification of antifungal prophylaxis occurred in 23% of patients. Indications for changes in prophylaxis included: initiation of empiric therapy for suspected infection (18%), change to an orally active agent to facilitate discharge from hospital (12%), nephrotoxicity (14%) or infusion reactions (2%). Patients who developed IFI were more likely to have received prolonged high-dose corticosteroid therapy (i.e. prednisone >7.5mg daily for 3 weeks or more) for graft-versus-host disease (82% in IFI vs. 24% in non-IFI, p<0.001). Patients who received alemtuzumab or fludarabine as part of the conditioning regimen were also more likely to develop IFI (23% in IFI vs. 1.3% in non-IFI, p<0.001) and (23% in IFI vs. 6% in non-IFI, p=0.005), respectively. IFI patients were more likely to have received total parenteral nutrition during the peritransplant course (47% in IFI vs. 18% non-IFI, p<0.001). Conclusion Invasive fungal infections occurred in 19% of allogeneic HSCT recipients with an attributable mortality of 18%. IFI is less concerning in autologous HSCT recipients, occurring in 2% of cases. The predominant infection of concern is invasive aspergillosis in our population. Patients should receive prophylaxis during the neutropenic phase following allogeneic HSCT; those who develop graft-versus-host disease requiring prolonged steroid therapy should be particularly targeted for antifungal prophylaxis with mould-active antifungal agents. The role of T cell suppression in conditioning therapy and the influence of TPN exposure on the incidence of IFI is an area which warrants further study in defining specific risk groups for costly and potentially toxic prophylactic therapy. Disclosures No relevant conflicts of interest to declare.

BackgroundPrevention of Clostridium difficile infection (CDI) remains a significant healthcare challenge. Risk prediction tools can potentially identify high-risk patients and allow for early prophylactic interventions. Various tools have been studied but none have been widely adopted. Our objective was to develop a simple risk prediction tool to identify medicine inpatients at high risk for developing primary CDI.MethodsWe conducted a retrospective, single-centre case–control study including patients admitted to the internal medicine service at our institution with a positive C. difficile polymerase chain reaction assay in loose stool. Controls were randomly selected from the same population. Risk factors for CDI were identified using univariate and multivariate logistic regression analyses. A model was created using variables that minimized Akaike Information Criterion and yielded higher area under the curve values.ResultsA total of 314 patients were included (157 with CDI and 157 controls). Variables included in the final 5-point, 3-variable risk prediction tool were age, modified Horn’s index and antibiotic use within 3 months. The tool demonstrated good discrimination with a C statistic of 0.79 and model optimism of 0.04 based on a bootstrap sample of 2,000 replicates.ConclusionOur simple 3-variable risk prediction tool based on age, disease severity and recent antibiotic use facilitates rapid bedside assessment by clinicians to identify medicine patients at high risk of CDI on admission. Further research is needed to determine whether this tool can reduce primary CDI incidence and healthcare costs.Table 1.Five-Point CDI Clinical Risk Tool and Predicted Risk.Figure 1.Receiver operating characteristic (ROC) curve for CDI risk prediction modelFigure 2.CDI risk prediction model calibration plot. Clostridium difficile infection risk prediction model calibration plot showing agreement between observed and predicted risks. Dashed line shows perfect agreement; lines above the dashed line indicate the predicted risks are lower than the actual risk.Disclosures All authors: No reported disclosures.