Clinical tips: Vaccination in pharmacy

While vaccination in pharmacy is maturing and now seen as an essential service, COVID-19 vaccination services won’t just be a simple add-on, warns Karalyn Huxhagen

2021 is the year that sees pharmacists really step up to the plate to vaccinate. We are now recognised as being a health provider vaccinator and our skills and ‘easy to access’ status are being utilised.

As I write pharmacist vaccinators are performing COV-19 vaccinations in many settings, including General Practice and hospital clinics. The rollout of the Australian Road Map for COVID-19 vaccination has been a tool that has finally brought pharmacy-led vaccination programs to where it should be in Australia.

Travel vaccines should easily follow once COVID-19 settles down!

Influenza vaccines arrived in pharmacies last week. While some pharmacists have started providing COVID-19 vaccination services in selected areas the community pharmacy sector probably will not come online until May 2021.

Pharmacists themselves are finally recognised as essential health workers and can access COVID-19 vaccination under group 1B. Sadly the ruling for pharmacy staff is still under review.

Every state has its differences in schedules of what a pharmacist can vaccinate against and for what age groups (very annoying but let us hope for a unification policy of age groups, type of vaccines and where we can vaccinate in the year 2021!) In some states, for example Victoria, pharmacists are part of the National Immunisation Program providing subsidised vaccines to certain groups in the community

What does a pharmacy have to do to provide a vaccination service?

For basic services such as Influenza, whooping cough, measles and mumps there are basic requirements but for COVID-19 vaccination services there is a dearth of regulation, training, compliance and reporting.

COVID-19 vaccination services should not be seen as an easy add on to your existing vaccination clinics. It has a lot of extra compliance and reporting and management structure as this is an initiative that is being scrutinised and researched. Data collection is paramount to ensure we capture every small detail that a patient may experience during and after COVID-19 vaccination.

So how do you set up a vaccination service?

  1. First up you really need a deep consideration about logistics:
  • Space for waiting patients before and vaccination.
  • Enough staff to provide vaccinations, monitor patients and perform administration tasks.
  • Are you overrun with tasks already in a very busy pharmacy?
  • Can you afford the extra costs for the paltry return on investment if you only rely on the fee for service model?
  1. Ensure your vaccinator pharmacists have a current first aid certificate with anaphylaxis and you ensure at least one member of the team that is rostered on vaccination days has this qualification. Then:
  2. Decide how big you want to expand the service. Do you just want to offer Influenza and Whooping cough? Are you wanting to expand to other vaccinations? What about COVID-19?

If you want to provide COVID-19 vaccinations, then you should have sent in the expression of interest (EOI) and you would be awaiting your fate. Even if you have not sent in the EOI you may become a COVID-19 vaccination service later in the year.

The Government training for COVID-19 vaccinators is MANDATORY – you cannot be a vaccinator without completing this training. Your administration staff and support staff should undertake the first three sections of the training. You should ensure all pharmacy staff have undertaken training and compliance testing in infection control.

The following have excellent resources and training programs are available to enable the pharmacy to become a vaccination pharmacy. How far you extend the service depends on the capacity of the pharmacy staff.

If you decide to become a COVID-19 vaccination service, make sure you subscribe to all updates as there are daily changes that you need to keep up with.

You will need to establish your own standard operating procedures (SOP) and incorporate protocols that may come from various jurisdictions. Some examples are:

  • Strive for 5 cold chain guidelines
  • Management of anaphylaxis guidelines
  • Adverse event from immunisation reporting guidelines (AEFI)
  • After vaccination care

You will need to consider the cultural diversity of your patients and ensure you have the ability to communicate to ALL patients on the following:

  • Why vaccination of all residents of Australia is important
  • When to vaccinate and whether a booster is required
  • The adverse effects that can be experienced and how to manage them
  • The problem of vaccine hesitancy – counsel on the concerns, mainstream and social media reports, antivaxxer campaigns.

The ATAGI website has access to information leaflets across many languages. There is support material available for Aboriginal and Torres Strait Islander patients.

The pharmacy should have a current subscription to one of the services that offer a booking and recording system to upload immunisations to the Australian Immunisation Register (AIR). It is now compulsory for pharmacy to upload all immunisations given in the pharmacy premises.

All vaccinating pharmacists require a PRODA account that will allow them access to the AIR to check the immunisation history of a patient before the immunisation is given. The current recommendation is for influenza and COVID-19 vaccinations to be given at a minimum of two weeks apart. It is recommended that pharmacy staff encourage the patient to make both bookings when booking their initial COV-19 vaccination.

The government funded National Booking System will link across to the pharmacy software programs to try and ensure the bookings and uploading of data is as seamless as possible. Consumers can utilise the National Booking System to verify their eligibility for vaccination in the pharmacy premises. See here for eligibility checker.

While we are well versed in providing immunisation services for Influenza and Whooping cough it is time to extend the scope of pharmacy practice to vaccinate for all of the preventable diseases as listed in each of the State and territory schedules. You need to revisit the immunisation schedule for your state or territory.

The Australian Government COVID-19 roll out and road map ALWAYS planned to utilise every possible health professional to deliver COVID-19 vaccinations. Pharmacy was always included in the health ministers list of vaccinators BUT we do have to adhere to the rules and undertake the compliance reporting that is an important part of the COVID-19 roll out campaign.

Immunisation services has been a hard program to gain traction for community pharmacy. If you do not have the training and support services in place to provide the service correctly than do not take it on. The logistics and regulations are onerous but necessary.

We must deliver this service according to the guidelines and regulations. Do not take shortcuts and do not bend the rules.

Karalyn Huxhagen is a community, consultant and locum  pharmacist and was 2010 Pharmaceutical Society of Australia Pharmacist of the Year. She has been named winner of the 2015 PSA Award for Quality Use of Medicines in Pain Management. Karalyn currently has many roles within the Health and Hospital Services and Primary Health Network sector in Queensland.

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