Annie Biesboer

Position PGY2 Critical Care Pharmacy Resident Hometown Oconomowoc, WI Pharmacy School/Graduation Date University of Wisconsin - Madison, 2010 PGY1 Residency Location Froedtert Hospital

PGY1 Rotations
Surgical Intensive Care, Drug Policy, Academia, Residency Recruitment, Hematology/Oncology, Neuro Intensive Care, Medical Intensive Care, Transplant, Cardiovascular Intensive Care

PGY1 Residency Project
Retrospective Analysis of Unfractionated Heparin Infusions in Obese Patients.
Purpose: This study was designed to evaluate an institution’s current unfractionated heparin (UFH) infusion protocol in obese (BMI 30-39.9 kg/m²) and morbidly obese (BMI ≥40 kg/m²) patients compared to non-obese patients (BMI <30 kg/m²) and to define an appropriate dosing strategy for all patient populations with respect to BMI and presence of thrombosis.

Methods: Electronic medical records were retrospectively reviewed to identify 373 inpatients who received a protocolized infusion of UFH for greater than 24 hours from July 1, 2009 to December 31, 2010 at a large academic medical center. Baseline demographics, heparin dosing, indication, hematologic laboratory values, and hemorrhagic complications during heparin infusion were collected.

Results: An association between BMI and UFH dose required to achieve two consecutive therapeutic partial thromboplastin times (PTTs), analyzed separately via linear regression for the no-bolus and bolus groups, was identified (p-value= 0.005 and <0.001, respectively). The mean infusion rate (units/kg/hr) to achieve two consecutive therapeutic PTTs for morbidly obese, obese, and non-obese patients was 13.6, 14.5, and 17.7, respectively (p<0.001).  There was no statistical difference in UFH doses required to achieve two consecutive therapeutic PTTs between patients with active thrombosis compared to those without. Following 24 hours of UFH infusion, 48 (38.4%) patients with BMI ≥40 kg/m2 and 46 (38%) patients with BMI 30-39.9 kg/m2 were considered subtherapeutic, in comparison to 67 (52.8%) non-obese patients (p=0.027). There was no statistical difference between groups in regards to the number of patients considered therapeutic or supratherapeutic at 24 hours following UFH infusion initiation.

Conclusions: A strong association between BMI and UFH dose to achieve two consecutive therapeutic PTTs exists. Obese and morbidly obese patients require smaller UFH infusion rates (units/kg/hr) to achieve stable therapeutic anticoagulation and were less likely to be subtherapeutic at 24 hours compared to non-obese patients.

PGY2 Rotations
Surgical Intensive Care, Drug Policy, Academia, Residency Recruitment, Hematology/Oncology, Neuro Intensive Care, Medical Intensive Care, Transplant, Cardiovascular Intensive Care

PGY2 Residency Project
Delirium in the Intensive Care Unit
The purpose of this project is to evaluate our institution’s current practice at preventing a treating delirium, then incorporating that information into a multidisciplinary team to create a standardized approach for preventing, screening and treating delirium. Time permitting, this project will then evaluate how well the new protocols have been implemented and functioning.

Why did you choose to pursue a residency?
I chose to pursue a residency for the fact that I knew that there was so much more about the profession that I wanted to learn, and I truly desire to become an expert in my field of interest.

What attracted you to Froedtert’s pharmacy residency program?
Froedtert’s residency program offered the potential to move on from the PGY1 position to a PGY2 in critical care. I wanted a program that could provide a variety of rotations lead by great preceptors. The flexibility within the program itself is also a huge advantage.

Professional interests
Critical Care

Hobbies
I love watersports!

What's your favorite thing to do in Milwaukee?
Summerfest and the Wisconsin State Fair are by far my favorite things to do every year.