Clinical Pharmacist

KATHRYN STARR, PHARMD, RPH

*** *** *** ******, ** 52340

319-***-**** *************@*****.***

PHARMACY WORK EXPERIENCE

Inpatient Clinical Pharmacist, Antimicrobial Stewardship Program Chair and Pharmacist, and Diabetic Educator

Washington County Hospital and Clinics, Washington, IA October 2016 – Current

Inpatient Clinical Pharmacist

Active member of the interdisciplinary rounding team (daily census 15-25 inpatients)

oChampioned alongside Dana Fowler, DNP and hospitalist team lead in creating the interdisciplinary rounding team at WCHC (Spring 2017) and increasing pharmacy presence on the inpatient floor

Provide therapeutic drug monitoring and pharmacotherapeutic recommendations based on patient specific factors, lab/imaging results, and cost and availability

Verify inpatient orders for accuracy, appropriateness, and safety

Communicate changes and recommendations to providers

Enter orders in the CPOE under WCHC’s collaborative practice agreement

Conduct medication reconciliation to all inpatients upon admission and provide discharge counseling on all medications upon discharge

oI independently and autonomously identified care gaps and developed, implemented, and streamlined the current workflow for medication reconciliation and discharge counseling involving nursing staff, pharmacy staff, and inpatient providers

Compound intravenous medications for inpatient and ambulatory care use and verify compounded medications prepared by technicians for accuracy

Maintain appropriately stocked ambulance bags and Omnicell cabinets

Respond to drug information questions from clinic and inpatient providers regarding patients of all ages and disease states

Develop policy, procedures, and protocols for inpatient medical staff use

oCompleted:

Antimicrobial Stewardship Policy for Washington County Hospital and Clinics

Antimicrobial Stewardship Policy and Procedures for McCreedy Long Term Care Home

Medication Reconciliation Process

Patient Own Home Medication Use

Insulin Infusion Protocol

Lasix Infusion Protocol

Extended Infusion Zosyn Protocol

oCurrently working on:

High Risk IV Medication Protocols

Heparin Infusion Protocol

Extended Infusion Cefepime Protocol

Diabetic Ketoacidosis Protocol

Antimicrobial Stewardship Program Chair and Pharmacist

Authored the policy and procedure for antimicrobial stewardship at WCHC (April 2017)

Implemented the multidisciplinary antimicrobial stewardship program at WCHC and recruited the members of the antimicrobial stewardship team at WCHC

Conduct daily prospective reviews of all inpatients on antimicrobial therapy for appropriate drug, dose, route of administration, etc. based on indication, patient specific factors and labs / culture and sensitivity results

Make recommendations on antimicrobial therapy such as IV to PO conversion, de-escalating therapy, renal dosing, etc.

Enter antimicrobial related drug and lab orders in the CPOE under WCHC’s collaborative practice agreement

Provide therapeutic drug monitoring on all antimicrobials including aminoglycosides and vancomycin

Collect data regarding antimicrobial usage, cost trends, and local resistance patterns to report to the Pharmacy and Therapeutics Committee and provide insight into the stewardship practices at WCHC

Provide educational in-services to providers regarding antimicrobial stewardship practices

Created and maintain an antibiogram using local sensitivity data that is utilized by both inpatient and outpatient providers

Created and maintain an Antibiotic Quick Guide that includes up to date diagnostic and prescribing recommendations for urinary tract infections, community acquired pneumonia, and skin/soft tissue infections for inpatient and outpatient use

Proactively update inpatient order sets for infectious disease states to reflect evidence-based practice and stewardship recommendations

Mentored two Doctor of Nursing Practice Projects involving streamlining Community Acquired Pneumonia and UTI outpatient prescribing practices based on evidence-based stewardship recommendations (January 2017 – May 2018)

oDeveloped hard copy and electronic prescribing aids for outpatient providers

oProvided education sessions on Community Acquired Pneumonia, Asymptomatic Bacteriuria, and Acute Uncomplicated Pyelonephritis to accompany the prescribing tools

oProvide regular follow up and accept feedback on tools’ success

Diabetic Educator

Facilitate diabetic management classes in collaboration with WCHC’s Certified Diabetic Educator, Dietician, and Social Worker

Created and maintain educational materials including a patient friendly diabetic medication brochure, a PowerPoint overviewing all diabetic medication therapies, over the counter medication recommendation for diabetic patients, and travel tips for patients with diabetes, and an interactive PowerPoint overviewing anti-diabetic medications released within the last 10 years including information on cost

Take calls from diabetic patients requiring assistance with their pump or other insulin related therapies when the CDE is not available

Consult on diabetic patients in the clinic and on the inpatient floor

McCreedy Nursing Home, Washington, IA January 2017 – December 2018

Pharmacy Consultant

Conducted monthly Medication Management Reviews (MMR) according to CMS guidelines and regulations as well provide therapy consults as needed

Made pharmacotherapy recommendations including psychotherapeutic medication tapers, renal and hepatic dose adjustments, appropriate bowel regimens, pain management regimens, etc.

Created, implemented, and still participate in yearly flu vaccine clinic to update all residents on their immunizations

Developed the infrastructure for their Antimicrobial Stewardship Program

oAuthored the policy and currently assisting in streamlining the work flow

Mentored Doctor of Nursing Practice Project involving Acute Complicated and Acute Uncomplicated UTI diagnosing and management in the long term care setting based on evidence-based stewardship recommendations (January 2018 – May 2019)

oDeveloped an SBAR tool to aid nursing staff at the McCreedy home in assessing patients with potential UTI and streamlining communication to providers regarding results and prescribing recommendations

oDeveloped and implemented work flow at the McCreedy home for SBAR utilization

oDeveloped hard copy and electronic prescribing aids on management of acute complicated and acute uncomplicated UTIs in the long-term care setting for outpatient providers

oProvided education sessions to providers and nursing staff on utilizing the SBAR tool and management of acute complicated and acute uncomplicated UTIs in the long term care setting

University of Iowa College of Pharmacy February 2017 - Current

Adjunct Faculty / Primary Site Preceptor to IPPE and APPE students

University of Iowa College of Nursing May 2017 - Current

Adjunct Faculty / Preceptor /Project Mentor to Doctor of Nursing Practice Students

Des Moines University College of Osteopathic Medicine September 2017 - Current

Preceptor to Doctor of Osteopathic Medicine Students

Hy-Vee Prairie Trail Pharmacy, Ankeny, IA November 2015 – October 2016

Pharmacy Intern then Graduate Pharmacist

Verified prescription accuracy and input into workflow system

Filled controlled, non-controlled, and compounded prescriptions

Counsel patients on new prescriptions

Assisted patients in proper over the counter drug selection

Administered immunizations (intramuscular, intradermal, intranasal, and needleless injection)

Conducted Outcomes and Mirixa Medication Therapy Management services and developed the work flow for completing cases

Mentored IPPE students from Drake University College of Pharmacy and Health Sciences and University of Iowa College of Pharmacy

Trained new staff (technicians, interns, and pharmacists)

Experienced pharmacy operations in a high volume community drug store setting (average 350 prescriptions/day)

Hy-Vee Drug Store, Marion, IA May 2013 – October 2016

Pharmacy Intern then Graduate Pharmacist

CarePro Liberty Pharmacy, North Liberty, IA January 2013 – July 2013

Pharmacy Intern

Target (Blairsferry) Pharmacy, Cedar Rapids, IA February 2010 – August 2010

Non-certified Pharmacy Technician

Advanced Pharmacy Practice Experience

Elective Family Medicine Rotation (200 hours) April 2016 Honors Designation

University of Iowa Hospitals and Clinics Family Medicine Clinic

Preceptor: Michael Ernst PharmD, Michelle Fravel PharmD, BCPS, Jeffery Reist PharmD

Prospectively reviewed 15-20 inpatients daily and provided evidence based recommendations on anticoagulation, antimicrobial therapy, psychiatric medicine, and other various disease state treatments

Actively participated in anticoagulation clinic and adjusted anticoagulation regimen based on lab values and patient specific factors

Interviewed patients and conducted medication reconciliation on admission and counseled patients on hospital medications upon discharge

Journal Clubs:

oCholesterol Lowering in Intermediate-Risk Persons without Cardiovascular Disease

Elective Infectious Disease Rotation (200 hours) March 2016 Honors Designation Veterans Affairs Medical Center Iowa City, IA

Preceptor: Brett Heintz, PharmD, BCPS (AQ-ID), AAHIVE

Prospectively reviewed 15-30 inpatients daily receiving antimicrobial therapy and provided evidence based antimicrobial therapy recommendations and feedback to providers dependent upon patient specific factors and lab/culture/imaging results, including therapeutic drug monitoring

Documented therapeutic interventions and recommendations in the EMR

Retrospectively reviewed outpatients receiving antimicrobial therapy and assessed appropriateness in therapy as part of a research initiative

Active participant and member of the antimicrobial stewardship program and attended and participated in multidisciplinary infectious disease and microbiology rounds weekly

Researched and responded to antimicrobial and infectious disease related drug information questions

Presentations:

oPatient Case: Surgical Site Infections

oOverview of the Practice Guidelines for the Management of Skin and Soft Tissue Infections

Journal Clubs:

oVancomycin Combined With Clindamycin for the Treatment of Acute Bacterial Skin and Skin-Structure Infections

Hematology / Oncology Acute Care Rotation (200 hours) January 2016

University of Iowa Hospitals and Clinics

Preceptor: Gwen Kirsch PharmD, Lindsay Ludwig PharmD

Prospectively reviewed 15-20 inpatients daily with recent or active malignancy and monitored patients on chemotherapy for signs of toxicity and suggested therapeutic interventions to manage current and subsequent toxicity

Developed appropriate strategies for treatment of oncologic emergencies including febrile neutropenia, hypercalcemia of malignancy, tumor lysis syndrome, etc.

Developed appropriate strategies for prevention of chemotherapy-induced nausea and vomiting as well as monitored patients for pain control and suggested changes in pain management regimen

Presentations:

oDisseminated Histoplasmosis in the Setting of Malignancy

oOverview of R-CHOP Therapy

Community Pharmaceutical Care Rotation (200 hours) November 2015

Medical Pharmacy Cedar Rapids, IA

Preceptor: Jill Okken, PharmD

Entered and filled prescriptions including preparing weekly and monthly medpaks and counseled patients on new medications

Conducted Outcomes and Mirixa complete medication reconciliations (CMRs), reviewed charts through Health Solutions Inc., and provided medication and lifestyle recommendations to primary care providers based on diabetes, hypertension, hyperlipidemia, asthma, and COPD guidelines

Presentations:

oPatient Case: Drug Therapy Problem Identification in the Community Pharmacy Setting

Journal Clubs:

oEarly Administration of Azithromycin and Prevention of Severe Lower Respiratory Tract Illness in Preschool Children with a History of Such Illnesses: A Randomized Clinical Trial

Cardiology / Pulmonary Acute Care Rotation (200 hours) October 2015

University of Iowa Hospitals and Clinics

Preceptor: Heather Bream-Rouwenhorst PharmD BCPS

Actively participated in cardiomyopathy interdisciplinary rounds

Reviewed 10-15 patients on the cardio/pulmonary team daily focusing on drug therapy problems and provided evidence based pharmacotherapy recommendations dependent upon patient specific factors and lab/culture/imaging results

Developed informational handouts and in-services to medical residents

Educated patients including patients discharged on home anticoagulation therapy (warfarin and enoxaparin)

Provided therapeutic drug monitoring and provided dosing recommendations for vancomycin, tobramycin, digoxin, warfarin, tacrolimus and iron

Presentations:

oDiuretic Resistance in the Setting of Acute Decompensated Heart Failure

oOverview of Acute Decompensated Heart Failure and Its Management

General Hospital Rotation (200 hours) September 2015

Washington County Hospital and Clinics

Preceptor: Katie Mitchell PharmD

Facilitated group therapy programs centered on newly diagnosed heart failure, COPD, and diabetes

Compounded intravenous medications in laminar flow hood

Provided therapeutic drug monitoring and provided dosing recommendations for vancomycin, gentamicin, tobramycin, and warfarin

Administered seasonal flu vaccines during a hospital wide flu clinic (administered approximately 250 vaccines in a cumulative 8 hours)

Developed a new VTE prophylaxis protocol for nursing and medical staff involving implementing the PADUA score into initial patient interviews for appropriate VTE risk stratification and prophylactic recommendations, preparing a lecture on VTE prophylaxis and presenting to nursing staff and administration for CEU credits

Presentations:

oPatient Case: Hospital Acquired Pneumonia

oVenous Thromboembolism: Pathophysiology, Risk Stratification, Appropriate prophylaxis, and Implementing a New protocol

oPraluent versus Repatha for addition to formulary

oDefinity for addition to formulary

Elective Inpatient Psychiatry Rotation (200 hours) July 2015

University of Iowa Hospitals and Clinics

Preceptor: Joseph Mac PharmD, Sarah Overturf PharmD

Actively participated in interdisciplinary psychiatric rounds including daily patient interviews

Reviewed 15-20 patients on inpatient psychiatric team daily focusing on drug therapy problems and made medication therapy recommendations based on patient specific characteristics, laboratory values, and previous therapy trials

Monitored for side effects on psychiatric medications using laboratory values and serum drug levels and adjusted accordingly

Managed comorbidities that are often over looked in psychiatric patients including diabetes, hypertension, hyperlipidemia, asthma, COPD, and anticoagulation therapy and made recommendations as necessary

Presentations:

oPharmacists’ Role in Electroconvulsive Therapy for the Management of Bipolar Disorder Type 1: Acute Mania

Ambulatory Care Rotation (200 hours) June 2015

Broadlawns Family Health Center, Des Moines, IA

Preceptor: Emily Beckett PharmD, BCPS

Provided evidence based pharmacotherapy recommendations for both inpatient and clinic patients

Educated patients on discharge medications, anticoagulation therapy including indication for anticoagulation, medication and administration (warfarin and enoxaparin), and INR monitoring, and on diabetes management including medication therapy management, diet, and lifestyle changes

Recommend dose adjustments and clinic follow-up dates based on INR values

Updated the Medicaid Preferred Drug List for office and provider use

Developed diabetic meal plans based on patient preference, lifestyle, and habits

Created a patient friendly educational poster and pamphlet on warfarin therapy and INR currently being utilized in the clinic

Presentations:

oPatient Case: Multifactorial Hypokalemia

oOverview of Chronic Heart Failure and Its Management

oOverview of Atrial Fibrillation and Its management

oOverview of Diabetes Mellitus Type 2 and its management

o“Why Did My INR Change?” Patient Educational Poster

EDUCATION

University of Iowa College of Pharmacy

August 2012 to May 2016 Doctorate of Pharmacy

Graduated with honors

University of Iowa College of Pharmacy

2010 to 2012 Pre-pharmacy

Dean’s list

LICENSES AND CERTIFCATIONS

Licensed Iowa Pharmacist

oNumber: 22900

oActive

SIDP Certified Antimicrobial Stewardship Pharmacist

oApril 2019

Basic Life Support and Advanced Cardiac Life Support

oAugust 2018 to present

Outcomes MTM Certification

oApril 2014 to present

American Pharmacist Association Immunization Certification

oNovember 2013 to present

References

Current Employer: Washington County Hospital and Clinics

Pharmacy Manager: James VanWinkle, PharmD

References and contact information available upon request

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