Raising the rate

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Can embedded pharmacists increase influenza vaccination rates in residential aged care homes?

A pilot study in the ACT has looked at whether pharmacists embedded into established teams within residential aged care homes can help to improve vaccination rates among employees.

Vaccination-accredited residential care pharmacist Richard Thorpe was piloted for six months, from 20 April 2017 to 13 October 2017, at a home where he worked part time, two consecutive days per week.

During the pilot, residential care pharmacist Mr Thorpe performed influenza vaccination as well as further activities including comprehensive medicines reviews, quality improvement activities, offering pharmaceutical opinions, educating staff, handovers and handling new admissions. 

Of the 78 employees at the residential aged care home in 2017, 54 (69.2%) received an influenza vaccine.

This was higher than the 46.5% influenza vaccination rate of employees in 2016, when there was no pharmacist available to administer vaccinations (p < 0.01).

It was also higher than the average self-reported rate of 54.2% across ACT residential aged care homes (p < 0.01).

The pharmacist spent a total of 3.4 hours administering influenza vaccines to 20 (37%) of employees in 2017.

He also recorded administering vaccines to two residents at the study site who were unable to obtain the vaccine from their GP, and four employees from a separate residential aged care home nearby.

Study investigators said residential aged care homes with an employee vaccination rate above 75% report lower frequencies if influenza outbreak compared with homes with lower rates.

However the recommended vaccination rate across all residents and employees is 95%.

Based on the results it is feasible to include pharmacists as part of in-house influenza vaccination programs in such residential aged care homes, they say, despite the final employee vaccination rate not reaching the recommended rate.

The authors pointed out that there was limited accessibility of vaccination by the pharmacist for employees working exclusively on weekends, evening shifts, or part time on days where the pharmacist was not present.

Additionally while timing of influenza vaccination is recommended to commence in March and April, the residential care pharmacist did not commence employment until late April, limiting opportunities to provide employee education and promotion of the service.

Study author Dr Mark Naunton, Head of Pharmacy at the University of Canberra, said he is “very excited” about the promising role of residential care pharmacists.

“Very few other residential aged care homes have an on-site pharmacist, I’m aware of 1-3 other cases. There may be more,” Dr Naunton told AJP.

“In addition to vaccinations, other work that such pharmacists can do includes staff education, clinical audits, and better collaboration with community pharmacy, hospitals and GPs.

“Pharmacists can play a greater role in managing deprescribing, and a major role in improving medication safety.”

However he points out that while ACT pharmacists can administer vaccinations in aged care homes, “very few other states allow it as legislation restricts pharmacists to vaccinate only in pharmacies”.

Legislation changes would be required nationally for the model to be successful in other states and territories, say the authors.

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