Virginia Society of Health-System Pharmacists

2025

No grants in 2025

2024

The Health Wagon

St. Mary's Faith Pharmacy, Chronic Care Management

The Health Wagon also known as St. Mary's Health Wagon, is a nonprofit organization that has been providing free healthcare services to residents of the Appalachian Mountains of southwest Virginia since 1980. The organization was founded by Sister Bernadette “Bernie” Kenny of the Medical Missionaries of Mary, who initially delivered healthcare services to residents from her Volkswagen Beetle.

The Health Wagon began as a small operation and had since grown to provide primary, specialty, dental, vision, and now pharmacy care to the medically underserved in poverty-stricken areas of rural Appalachia. St. Mary's Faith Pharmacy recently opened its doors to the uninsured. Medication is available at no cost. Clinical Pharmacist are providing Chronic Care Management, and diabetes education to those who are often forgotten. This grant would help fund Pharmacist driven Chronic Care management.

Like VSHP's mission to inspire, educate, provide advocacy, and to collaborate to help people achieve optimal health outcomes. We believe that our pharmacist can use their knowledge and experience to bring the best care to our patients.

2024

Virginia Commonwealth University School of Pharmacy

Long-acting injectable antipsychotic active-learning laboratory for pharmacy students

Virginia is one of many states where pharmacists can administer long-acting injectable antipsychotic medications (LAI-APs). This administration predominantly occurs in ambulatory care environments in health-systems and outpatient pharmacy settings; however, pharmacists encounter patients using LAI-APs in all aspects of healthcare and can be a part of ordering, dispensing, administering, monitoring, and educating about these medications. When compared to vaccine administration which students are routinely taught in most pharmacy curricula, administration of many LAI-APs may require additional training to ensure students are familiar with different products and formulations, know the appropriate preparation and administrations which uniquely includes z-track and gluteal injection techniques, and prevention/monitoring of adverse reactions which can include post-injection delirium sedation syndrome and antipsychotic movement disorders.

The lab will be structured into stations to focus on the administration and monitoring of LAI-APs. Station 1 will focus on adverse effect monitoring, including recognition of extrapyramidal symptoms and metabolic monitoring. Station 2 will focus on the administration of the Abnormal Involuntary Movement Scale, which should be utilized in all patients prescribed an antipsychotic. Station 3 will focus on the first-generation agents (haloperidol and fluphenazine) as well as olanzapine pamoate. The goal of this station will be to recognize the differences between the long-acting and short-acting products of haloperidol and fluphenazine to prevent potential errors. It will also focus on z-track administration. Lastly it will discuss the risk of black box warning for post-injection delirium sedation syndrome with olanzapine pamoate and the importance of proper administration to PREVENT this from happening. Station 4 will focus on the risperidone and paliperidone products. It will compare and contrast the dosing and frequency of administration of these agents. It will also focus on the preparation of these suspensions and the importance of “adequately” shaking the suspension using devices provided by the manufacturer. Station 5 will focus on the aripiprazole products and comparing the differences between the monohydrate and lauroxil products. Focus will be on adequate preparation, the difference between one needing slow and the other rapid administration.

To evaluate this implementation, we will complete a research project that assesses student knowledge,confidence, skills competency, and perceptions of the laboratory.
Evidence of learning will be assessed with a “clinical pearls” bingo sheet to ensure they get the important pearls for each unique product. They will also be checked off on their administration technique for gluteal administration.

This educational lab for future pharmacists will promote education of proper reconstitution, administration of long-acting injectable antipsychotic medications as a growing number of ambulatory and community pharmacists are able to administer LAIs, and pharmacists in all areas of healthcare can engage with patients using LAI-APs and can be a part of ordering, dispensing, monitoring, and educating about these medications. It is innovative in that it is a new lab that focuses on reducing medication errors in all aspects of healthcare. Through education, pharmacists can ensure proper administration which will help reduce potential medication errors and help improve outcomes with LAI-APs. This lab may also inspire future pharmacists to develop protocols or administer these medications at their practice sites and will help highlight the importances of documenting administration to enable smooth transitions of care.

2024

Riverside Health

Implementation of Harm Reduction in a Rural Emergency Department

In partnership with the Community Service Board of the Eastern Shore of Virginia, implement vending machine in Riverside Shore Memorial Hospital to make available various harm reduction tools for vulnerable community members. Planned products to put in the vending machine are OTC naloxone, Fentanyl test strips, Xylazine test strips. Grant will provide support for purchase of product, oversight of program by pharmacy staff and development of harm reduction educational tools that will be provided with products in vending machine. Plan is to implement program fall 2024

VSHP mission statement includes innovative practice and collaboration to help people achieve optimal health outcomes. Through focus on harm reduction in a rural community with limited healthcare resources, and in collaboration with other community partners, the program aligns with the VSHP mission statement.

2023

Riverside Behavioral Health Center

Save Travels: Meds to Beds

In 2022, Riverside Behavioral Health Center launched a Meds to Beds Program in collaboration with our sister outpatient pharmacy service, Pavilion Pharmacy, to improve medication compliance, reduce readmission, and ultimately to aid in decreasing healthcare disparities that plague mental and behavioral health patents.

Our facility identified that many of the patients supported by the behavioral and mental health treatment provided at RBHC are often transported to our facility without personal belongings, except the clothing on their backs. Most come without IDs, money, or any means to support their transition back into society.
Because of this, our facility has allowed our healthcare team to support ensuring all patients receive medications upon discharge to aid in a successful discharge and support medication compliance while they await pending follow up care.
We also recognize that the paper bags supplied to patients does not provide much security to patient belongings and medications leaving these expensive and lifesaving medications unsecured

The Proposal:
Provide a travel bag/small suitcase for the Meds to Beds medications and belongings to ensure security and safe storage while patient’s transition back home or to their new residence. Includes toiletries, and weekly pill planner. All to continue to support service excellence and patient satisfaction.

Behavioral and Mental Health disparity is a top priority not only for our health system, but as identified by the various local, state, and federal partnerships supporting the actions of Riverside Health System’s opening of Virginia 1st Psychiatric specialty Emergency Room/Department. This service and our support to continuity of care, centers on changing the face of behavioral and mental health care in our community and speaks directly to VSHP’s mission of inspiring innovation, education, advocacy and collaboration to help achieve optimal health outcomes. This is innovative models is the 1st Psych ED in VA support; We all will be educated by experiences learned and share by the patients and team members supporting the project; This covers filling a need and providing advocacy that impacts a specific population: BH; the collaboration will be had by not only the pharmacists at our facility, but the whole medical community that aid in the efforts to care for this patient population and their families.
Our pharmacy team’s goal mirrors VSHP’s mission as we in turn care for others as we would care for those we love to enhance their well-being and improve their health.

2023

Sentara Norfolk General Hospital

Creation of Pharmacy-Specific Pulmonary Hypertension Certificate Program

Pulmonary hypertension patients are rarely seen in all hospital settings and can be vulnerable to detrimental medication errors. Hospital administration and staff need to be aware of the special needs of these patients; especially patients receiving continuous infusion prostacyclins. Continuous infusion prostacyclins are considered life-sustaining medications and cannot be discontinued or interrupted. Despite having clinics and hospitals with designations from Pulmonary Hypertension Association, patients may end up at any health institution at any time. Frequently, hospital staff may contact local pulmonary hypertension centers for guidance or hold patients until transfer to designated pulmonary hypertension hospital.
There is no pharmacy-specific training program currently available to cover essentials in the care of these patients. The medications used in pulmonary hypertension are dispensed from specialty pharmacies and have special devices for administration. These devices can be missed at medication reconciliation during hospital admission.
The intent of the certificate program is to provide pharmacy specific education regarding operational and clinical intricacies involved in managing pulmonary hypertension medications and patients. Several of the medications have REMS requirements and limited distribution. This education can increase awareness of pulmonary hypertension and promote patient safety regarding medication administration.
To create the curriculum, the faculty would be sent to Pulmonary Hypertension Professional Network (PHPN) Symposium in September 2023 to network and attend pharmacy specific lectures. This year is especially unique because other pulmonary hypertension centers are highlighting pharmacy services. Based on the knowledge gained at the symposium, the pharmacy specific education topics, material, surveys, and assessments will be formulated in October/November 2023 with plans for the education sessions in January/February 2024. The audience of the initial pilot education sessions would be recruited from local hospitals in the Hampton Roads area and Sentara Norfolk General Hospital. After the initial pilot of education sessions, the faculty will reformulate/revision education material based on survey feedback and assessment performance and plan for workshop in either Spring Seminar or Fall Seminar. These education sessions will be hands on and interactive to engage the audience.

This new program aligns well with VSHP mission statement. Currently, Virginia has 5 pulmonary hypertension centers designated by Pulmonary Hypertension Association. Other states with similar numbers are Texas and New York. Virginia pharmacists will likely see pulmonary hypertension patients and need education and guidance in handling their medications. Unfortunately, pulmonary hypertension is a rare and niche disease state which uses unique medication delivery systems to administer medication. (i.e., subcutaneous, or intravenous continuous infusions given via ambulatory pump, inhalation devices – jet nebulization and dry powder inhaler) The need to spread medication awareness of these patients is vital to avoid potential medication errors.

2022

Moments of Hope

Moments of Hope Outreach is a ministry that serves Hanover and Henrico counties, and Richmond north of the James River. We began as a one-man outreach in late 2014 and became a 501(c)(3) nonprofit organization in March 2016. Moments of Hope operates a homeless outreach and food pantry, hosts weekly community outreach luncheons with a mobile pantry and health screenings, and provides non-congregate emergency shelter to our homeless neighbors.

Through this project, we hope to provide more information and guidance to healthcare providers on assessing an HIV patient's osteoporosis risk and selecting the proper PrEP therapy. This project would help optimize care for patients undergoing PrEP therapy at an increased risk for osteoporosis. Hence, pharmacists can involve and directly monitor patients to inform physicians and patients about the risk and collaborate on appropriate and optimized treatment plans.

2022

Inova Health System

Project: Pre-exposure Prophylaxis (PrEP) for HIV has well-established efficacy but limited long-term safety data since the first FDA approval for a PrEP medication was only 10 years ago. Medications for PrEP include FTC/TAF, FTC/TDF, and LAI-CAB. LAI-CAB is not expected to have any major impact on bone health but the two oral options, FTC/TAF and FTC/TDF, both contain a form of tenofovir which has a known negative impact on bone mineral density. The full extent of this potential damage is still relatively unknown.
Despite these potential risks, DEXA scans are not routinely recommended in the 2021 CDC PrEP Guidelines due to the lack of benefit in clinical trials. DEXA scans are an optional test though, as DEXA scans are also cost-prohibitive and require an additional appointment which may deter some patients from choosing to get one.
I am a VSHP member and a Clinical Pharmacist at the Inova Juniper Program where I manage a variety of patients, including those on PrEP thanks to the recent Virginia statewide protocol that expanded pharmacists' scope of practice in this area. One question that is commonly asked by patients is how I monitor them for safety outcomes of PrEP. While it’s relatively easy to monitor estimated kidney function, I have unfortunately not been able to give patients a helpful answer regarding the status of their bone health. Recommendations and/or guidelines for osteoporosis screening patients with PrEP therapy are lacking but knowing a patient's osteoporosis risk could guide us in choosing and optimizing PrEP therapy for the patient. It could also help with insurance approvals, as insurance plans often deny FTC/TAF and/or LAI-CAB without a valid reason to switch from the cheaper and generic FTC/TDF (such as proof of bone health).
I, along with two students who are also VSHP members, would like to propose this project of purchasing and using a peripheral densitometer (essentially a DEXA of the ankle) to evaluate t/z scores in PrEP patients and look for any correlations to evaluate the utility of this potential process. The machine we are hoping to buy is the GE Lunar Achilles machine, which I have experience using already from my PGY1 residency. It is fast and simple to use and requires minimal training.

Through this project, we hope to provide more information and guidance to healthcare providers on assessing an HIV patient's osteoporosis risk and selecting the proper PrEP therapy. This project would help optimize care for patients undergoing PrEP therapy at an increased risk for osteoporosis. Hence, pharmacists can involve and directly monitor patients to inform physicians and patients about the risk and collaborate on appropriate and optimized treatment plans.

2022

Riverside Center for Excellence in Aging and Lifelong Health (CEALH)

The Riverside Center for Excellence in Aging and Lifelong Health (CEALH) offers a unique combination of clinical and health services research to pilot innovative programming to improve the quality of life for older adults. CEALH is committed to identifying community needs and to working with partners to enhance home, community-based, and long-term care services to better serve individuals living with dementia and their family and professional caregivers.
To this end, our team of clinicians and gerontologists developed and piloted a comprehensive medication management (CMM) program at CEALH starting in 2019. Since then, the CMM program has served more than 400 persons living with dementia and their family caregivers. Our program was oriented similar to a geriatric clinic with an emphasis on dementia care. Due to the highly positive feedback and significant outcomes from this program to date, we propose to expand the CMM to primary care practices in the Riverside Health System as a considerable amount of medical care for patients with memory loss occurs in primary care settings. With a steadily growing geriatric population, it is imperative to develop programs that provide resources and support for patients and their family caregivers.
The main purpose of a CMM program is to increase safety and reduce polypharmacy. Polypharmacy, where multiple drugs may have been prescribed to treat the same or similar conditions, is commonly experienced by individuals living with dementia (https://www.nia.nih.gov/news/dangers-polypharmacy-and-case-deprescribing-older-adults). Pharmacists play an integral role in reducing polypharmacy as they most often recommend changes to patients with a documented adverse drug event, patients taking a suboptimal drug, or those who show patterns of poor adherence.
Patients are eligible to receive the CMM based on certain factors, including probable or definitive dementia, taking five or more medicines, including prescription and over-the-counter (OTC), and having two or more chronic conditions. Patients who have dementia and who live alone have also been targeted to receive the medication review due to their additional vulnerabilities in managing their medications.
During the medication review and management session, the pharmacist, with additional credentials in geriatrics, discusses the patient's medications, determines the patient's medication literacy, and provides ways to safely reduce the number of medications taken, thereby reducing adverse reactions. This review includes input from and education for the family caregiver. The pharmacist's recommendations are communicated to the patient's primary care provider. Also, a summary sheet is provided to the patient and caregiver highlighting the key recommendations that were made and the importance of a timely follow-up with the provider to discuss potential changes based on the recommendations. The patient is re-assessed during a six-month follow up. Here, the pharmacist can determine if recommendations were accepted and if changes to the medication regimen had a positive impact in reducing the number of medications and the presence of polypharmacy.
Funding from VSHP will allow for this pilot to commence in October 2022 with the engagement of at least one primary care physician (PCP) who has already indicated her commitment to participate. This PCP carries a panel of 1,215 patients age 60 years or older with 72% (874) eligible for a CMM. During the first quarter (October - December 2022), we will finalize a practice agreement and establish a workflow including identification of high-risk criteria that would flag a patient for a CMM. This workflow will incorporate a process that is most efficient for the PCP and the geriatric pharmacist. For example, patients with chronic conditions are generally seen in the primary care practice every three to six months. This frequency allows for the PCP to identify which patients meet the criteria for a CMM or who are challenged with managing their medications. These patients will be referred for a follow-up appointment, in the same practice setting, with the pharmacist. The family caregiver will be encouraged to attend in cases where the patient has identified memory loss. Also, during the first quarter, a brief (20-minute) educational lesson will be prepared by the pharmacist to help build awareness among PCPs about the CMM and the value it affords their patients. During the second quarter (January - March 2023), the workflow will be refined as at least 10 older patients will complete the CMM. The educational sessions will be offered at least three times, both in person and virtually, to at least 10 PCPs. For the third and fourth quarters, we will coordinate initial (15 additional) and follow-up CMM appointments with patients referred by their PCP, allowing this pilot to support at least 25 eligible patients.

A CMM enables individuals to receive one-on-one education and tailored advice from a pharmacist. Following the review, the pharmacist communicates with the patient's medical provider, sharing recommendations and encouraging a partnership in the best interest of the patient. As this is completed alongside other clinical assessments by the PCP, patients receive holistic, high-quality care that directly benefits persons with dementia and their family caregivers in our community.
We have prepared a community integration manual that is available by request. Utilizing this manual and then refining our process to work specifically within primary care settings, allows us to effectively share our model and our experiences with other health system pharmacists around the Commonwealth. Our team is also interested to learn from other health system pharmacists completing medication reviews about their experiences in supporting persons with memory loss in the community. In addition to forming partnerships, Riverside's CMM places emphasis on the identification of and reduction in polypharmacy in improving dementia care. Deprescribing often improves quality of life by preventing adverse drug events and simplifying medication management. Further, our CMM extends beyond a prescription medication lens and carefully considers the impact of OTC products, including herbal remedies, and their interaction with the overall regimen. This process allows us to offer a more holistic approach to care with the pharmacist an integral part.

2021

Virginia Commonwealth University (VCU) Health System

To provide optimal care and support to patients who are aiming to make lifestyle changes or manage complex disease states, an understanding of motivational interviewing (MI) is vital to both outpatient and inpatient practitioners. The University of Massachusetts Medical School offers a semester-long, Certificate of Intensive Training in Motivational Interviewing that encompasses topics such as goal setting, improving medication adherence, facilitating tobacco cessation, and cognitive behavioral therapy, among others. We envision that by allowing the VCU Health System (VCUHS) PGY2 Ambulatory Care Pharmacy Resident to attend this certificate program they would gain the necessary tools to not only enhance their own clinical practice, but to develop training sessions and/or continuing education for other pharmacy residents and pharmacists at VCUHS.
If approved, the ambulatory care resident would attend the course from January 2022 to the end of April 2022. During this time, the resident would be attending lectures as well as actively applying these concepts in online interactive group learning labs and receiving two individualized coaching sessions with a professional experienced MI coach. After the resident has completed the program, they will create an original training session that teaches concepts of motivational interviewing and allow the attendees to apply these skills through interactive activities.

The benefits of MI in the healthcare setting to improve patient outcomes have been documented in the medical literature. One meta-analysis in the Journal of Patient Education and Counseling identified that patients who received MI were 1.55 times likely to improve, most notably within improvements in HIV viral load, body weight, physical activity, alcohol and tobacco use, and self-monitoring. This project aims to develop an MI training session and interactive activities personalized for developing pharmacists in a variety of practice settings. The ultimate goal is to improve patient care and outcomes by facilitating more meaningful patient-pharmacist relationships, establishing comfort in addressing sensitive issues, and empowering patients to begin and maintain change behaviors.

2021

University of Virginia Health

Naloxone is a life-saving antidote to reverse opioid overdose. Despite efforts to increase naloxone prescribing and availability through the standing order in the state of Virginia, barriers to patient access, specifically high cost, still remain. Our goal is to develop a naloxone distribution program within our emergency department. This will involve distributing naloxone at no cost patients and providing pharmacist-led education on administration prior emergency department discharge. This program will target patients who are in the emergency department for opioid overdose or at considered to be high risk for opioid overdose.

This program will increase patients with history of opioid overdose or at high risk of opioid overdose access to the life-saving antidote naloxone. It will also ensure these patients are educated thoroughly on naloxone administration. Our ultimate goal will be to reduce opioid overdose related deaths in the community through this program. We hope that sharing our outcomes will encourage our institution as well as other intuitions to devote permanent funding for naloxone distribution in the emergency department.