Who can administer FluMist®?

As a regulated health professional, it is your responsibility to ensure any drug or vaccine that you dispense or administer is appropriate for the patient and it is your responsibility to be informed.

Here are some of the questions you need to be able to answer before administering FluMist.

What does “competent” mean in this case?
Standard 1.7 of the Standards of Practice for Pharmacists and Pharmacy Technicians requires that you only engage in restricted activities that you are authorized and competent to perform.

Being “competent” to administer FluMist means you not only understand and have mastered the administration technique, but also understand the vaccine being administered, the condition being treated and the patient-specific conditions that may affect or be affected by FluMist.

What’s “special” about FluMist?
FluMist is a live vaccine. Therefore, in addition to the usual considerations with traditional influenza vaccine, you must consider additional safety concerns such as:

• immunosuppression
  • e.g., is the patient taking drugs that suppress the immune system, such as oral corticosteroids, are they a cancer patient or an organ transplant recipient, or will they be in close contact with people with any of these conditions
• aspirin use in patients 2 to 17 years
  • also, children in this age group should not use products containing aspirin for 4 weeks after receiving this vaccine unless directed by a doctor
• wheezing or asthma
  • The vaccine is contraindicated in patients with asthma or children under 5 years of age with recurrent wheezing unless the benefits outweigh the risks
• allergy cross sensitivities (including eggs),
• a history of Guillain-Barré syndrome
• precautions when administering to young children
  • Children aged 2 to 8 years who have not been previously immunized against influenza may require two doses of the vaccine. If you choose to administer to these patients, you have a responsibility to ensure that the parent/guardian is aware of this and to follow up to ensure the second dose is administered at the appropriate time.
  • Pharmacists should not administer FluMist to children under 2 years old as the product is not approved for use in this group.

What are the required procedures and environment for administration?
If an emergency such as an anaphylactic reaction occurs, are you able and prepared to deal with it? Do you have the supplies available? Do you and other staff members know what to do?

As outlined in Standards 16 and 17, if you administer drugs or vaccines you must have current policies and procedures for handling emergencies and you must be prepared to implement those policies and procedures. We recommend that you run staff practice drills to identify gaps in process before an emergency occurs.

Standard 16 also requires that you administer a drug or vaccine in an environment that is clean, safe, appropriately private and comfortable for the patient.

In addition, Standard 17 requires that a pharmacist who administers a drug, blood product or vaccine must have proper regard for the interests of the patient and take all steps necessary to ensure that the drug, blood product or vaccine is administered safely, including monitoring after administration, documentation and communication with other health care professionals.

What else do you have to consider?
Many of the precautions and considerations required for administration of FluMist are similar to those that must be taken when administering a drug or vaccine by injection. Therefore, pharmacists who have received authorization to administer injections have received training and have likely implemented appropriate policies and procedures. If you have not completed a training program to administer drugs by injection and you plan to administer FluMist, you will require additional planning and preparation.

Because FluMist is a vaccine, if your patient experiences an adverse reaction you must complete an “Adverse Event Following Immunization” report (http://www.phac-aspc.gc.ca/im/aefi-form-eng.php).

For more guidelines on administering FluMist, see:

• the Oct. 4 issue of The Link,
• the product monograph,
• the Public Health Agency of Canada’s Recommendations on the use of live, attenuated influenza vaccine (FluMist®): Supplemental Statement on Seasonal Influenza Vaccine for 2011-2012,  and
• the Standards of Practice for Pharmacists and Pharmacy Technicians.

Dispensing/prescribing note: Although FluMist is a Schedule 2 product, it is to be administered by a healthcare professional and is not to be self-administered by the patient or the patient’s parent/guardian. It is NOT appropriate to dispense FluMist if you don’t know that it is going to be administered properly and that the cold chain will be maintained.

Similarly, since prescribing of Schedule 2 products is not a restricted activity, pharmacists may prescribe FluMist. However, it is NOT appropriate to prescribe FluMist if you don’t know that it is going to be administered properly and that the cold chain will be maintained. Refer to Standard 8 of the Standards of Practice for Pharmacists and Pharmacy Technicians for your responsibilities when selling a Schedule 2 product.

Finally, as described above, the notification of other health professionals is an important part of vaccine administration. Although there is currently no formal process for pharmacists to notify public health regarding the administration of vaccines that are not part of the publicly funded system, it is expected that you will enter FluMist and other vaccines administered in your pharmacy on the patient’s record in such as way that it is uploaded to the provincial electronic health record (Netcare).*

*Reminder – ACP has previously communicated an expectation to upload information on the sale/dispensing of all Schedule 2 products to Netcare.