Pharmacist involvement in influenza immunization—an update
August 25, 2009
While there are still many questions about pharmacists’ role in the recently announced seasonal influenza immunization program, answers are gradually emerging. We have summarized the details available to date.
NOTE: Please do not contact AHW or AHS now. Program details and contacts have not been finalized. ACP will notify you as soon as this information is available. Also note that this information applies only to seasonal influenza immunization.
A Pharmacists Immunization Working Group (PIWG) is coordinating pharmacists as immunizers with Alberta Health & Wellness (AHW). The PIWG is made up of members from AHW, Alberta Health Services, ACP, RxA, and corporate pharmacy. The group is facilitating pharmacist involvement in the immunization program such that it will:
- provide recommendations for pharmacists providing immunizations,
- ensure the high quality immunization program continues, and
- meet the standards of Alberta’s Immunization Program outlined in the National Guidelines for Immunization Practices.
Prioritization of tasks for this group resulted in development of standards, guidelines and processes for pharmacists’ engagement ONLY as they apply to seasonal influenza immunizations. At this point, there are no formal discussions as to pharmacists’ engagement in any potential public health programs as they relate to H1N1.
Processes and procedures for pharmacist participation in the AHS Public Health seasonal influenza immunization program
Step 1. Pharmacist with authorization to administer injections receives invitation to participate in provincial seasonal influenza program through ACP.
Rationale: Pharmacists will be responsible and accountable for administration of influenza vaccine supplied from public health. This product will not be supplied to pharmacists without the authorization to administer drugs by injection.
Pharmacists will not be allowed to delegate administration of provincially funded influenza vaccine to other healthcare workers, e.g. nurses. Authorization ensures that pharmacists understand all the components of an immunization program, including cold chain management, identifying and reporting adverse reactions, responding to patient questions and concerns, and when to refer the patient to another health care professional such as a Public Health nurse.
Step 2. If pharmacist is interested and able to participate, he/she considers requirements of participation:
- must complete one-day AHS Public Health seasonal influenza immunization program orientation;
- has excellent cold chain management (confirmed by reviewing temperature log sheets for the past two weeks and reviewing the checklist for Safe Vaccine Handling and Storage);
- must collect and submit all information required (client-specific and aggregate data); and
- must report all adverse events to AHS Public Health.
Rationale: Program orientation is the same educational session offered annually to public health nurses. It includes training specific to influenza vaccine and will include such topics as dealing with high risk patients and reporting requirements. Orientation will be offered in late September or early October. The training will be available to pharmacists with authorization to administer drugs by injection in a variety of formats (e.g., live training session, Telehealth, WebEx, DVD). There is no cost to pharmacists for program orientation education.
Step 3. Pharmacist contacts his/her local AHS Public Health (contacts will be available through ACP) to confirm participation in provincial program and establish partnership with AHS. Please do not contact AHW or AHS now.
Step 4. AHS Public Health sends pharmacist letter describing program processes and provides specific contact information.
Step 5. Pharmacist orders seasonal influenza vaccine from local AHS Public Health contact. Delivery or pick-up is arranged with local AHS Public Health.
Rationale: Distribution of public health influenza vaccine occurs at the zone level (formerly the regional level). This process meets the needs of the Medical Officers of Health for these areas and it aligns with their distribution process for physicians.
Step 6. Pharmacist receives seasonal influenza immunization program package, including Report of Adverse Reaction to Immunization Agents, from AHS Public Health contact.
Step 7. Pharmacist provides immunizations and documents the following:
a. client-specific information
- client’s immunization record
- pharmacy’s patient record
- copy to be retained and submitted to AHS public health at a future date
b. aggregate data (submitted to AHS Public Health)
c. all adverse reactions
Step 8. Pharmacist re-orders seasonal influenza vaccine as needed and submits data collection forms to account for doses administered.
Step 9. Unused unopened vaccine will be returned to AHS in April and unused opened product will be discarded at the pharmacy.
Immunization age restriction for pharmacists
Although all Albertans over six months of age are eligible for seasonal influenza vaccine, pharmacists will not be immunizing individuals less than nine years of age or pregnant women. Children from six months to nine years and all pregnant women will be immunized by Public Health.
Rationale: For children six months to nine years and pregnant women there are special immunization considerations.
a. Dosage considerations
The dosage may be different for children depending on age
The need for two doses versus one dose for some children
The need to look up immunization information on registry to determine if two doses are needed
b. Product considerations for children and pregnant women
Influenza vaccine with a lower thimerosal content is specifically indicated for children and pregnant women; it will not be distributed outside of Public Health.
c. Client care considerations
Anaphylaxis protocol is different for young children in terms of doses of epinephrine and diphenhydramine.
Discussions involving payment for administration of public seasonal influenza vaccine are ongoing with AHW Pharmaceutical Funding and Guidance department.
This communication is intended to give you an overview of where we are currently at with the public seasonal influenza vaccine program. We realize that it may not have addressed all your specific questions; however more information will be forthcoming.
Originally published in the August 25, 2009, issue of The Link