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Pharmacists

Community pharmacist vaccination

To make vaccines more easily and conveniently available to the general public, a number of countries have introduced pharmacist vaccinators. In 2012, when the influenza vaccine was reclassified, pharmacists in New Zealand who had completed an approved vaccinator training course established vaccine delivery services. In 2013, zoster (shingels), Tdap and meningococcal vaccines were reclassified increasing the range of vaccines community pharmacists could deliver. In 2017 PHARMAC approved funded influenza vaccine being delivered in community pharmacies to pregnant women and people aged 65 years and over. Eligible members of our communities 64 years and below who have a chronic condition will still have to be referred to General Practice for their influenza vaccine.

This page provides community pharmacists with a one-stop-shop for the information they require to set up and maintain an immunisation delivery service.

Legislation

The Medicines Regulations 1984, states that the Director General of Health or a medical officer of health may authorise any person to administer a vaccine (which is a prescription medicine) for the purposes of an approved immunisation programme. Clause 44A(2) requires that the vaccinator must meet certain criteria around knowledge, skills, safe handling of vaccines and equipment and resuscitation.

The Health Practitioners Competence Assurance Act 2003 defines the scope of practice for pharmacists.

In the early stages of pharmacists vaccinating in New Zealand all vaccines were prescription medicines and pharmacists had to seek authorisation from their local medical officer of health. However, with the 2012 and later reclassifications by the Medicines Classification Committee of certain  vaccines, pharmacists were no longer required to seek authorisation under The Medicines Regulations 1984.

The practice of all vaccinators must meet the current Immunisation Standards for Vaccinators which can be found in Appendix 3 in the Immunisation Handbook 2014 (3rd edition)

How to qualify as a pharmacist vaccinator

Pharmacist vaccinators are required to undertake vaccinator training and assessment that meets the same standards as authorised vaccinators. The requirements to maintain competency are also the same.

Initial training

All vaccinators are required to complete an approved vaccinator training course (VTC) and pass the written assessment, complete an independent clinical assessment, hold a current annual practicing certificate (APC) and have a current CPR certificate. Approval lasts two years from the date of the VTC.

Pharmacists who have completed the theoretical and clinical assessments, or vaccinator update courses should notify the Pharmaceutical Society (PSNZ) and the Pharmacy Defence Association (PDA). The PSNZ collects the information to track the numbers of pharmacists currently vaccinating in NZ, whereas the PDA collects the information for indemnity purposes.

An email with the information below is sufficient. No copies of the vaccination certificate or resuscitation certificates are required. Emails should be sent to both p.society@psnz.org.nz and pda@psnz.org.nz.

  • Full name Membership number (PSNZ and PDA membership numbers are the same)
  • Name of the pharmacy or pharmacies which vaccinations will be provided from, or if the pharmacist is a locum
  • Date of the course

See A4.1.2 Process for all vaccinators in the Immunisation Handbook 2017 for further details.

Ongoing qualification

Approval to vaccinate, as stated, lasts for two years from the completion of the VTC. Before this period is up pharmacist vaccinators must renew their vaccinator status. To do this all vaccinators must; complete a vaccinator update that meets the current Vaccinator Update Course standards, maintain a summary of immunisation practice over the previous 12 months and have current APC and CPR certificates. See A4.1.4 Process for two-yearly renewal of vaccinator status for all vaccinators in the Immunisation Handbook 2017 for further details.

Keeping up-to-date

  • Sign up here to receive the bi-monthly newsletter ImmNuZ from IMAC
  • Ministry of Health (MoH) monthly Immunisation Update

Pharmacist vaccine programmes

Influenza

Initially influenza vaccines were delivered by community pharmacists only to members of the public who purchased the vaccine. From 1 April 2017, pharmacists have delivered vaccine on the funded influenza programme to people 65 years and over and pregnant women. People under 65 years with chronic conditions like asthma, heart disease or diabetes, still need to go to their general practitioner to get their funded influenza vaccine, although some of this group may choose the convenience of purchasing the vaccine at a pharmacy. Pharmacists may administer influenza vaccine to people aged 13 years and above. To provide a funded influenza vaccine programme from a community pharmacy the pharmacy must have a signed contract with their respective District Health Board (DHB).

The Immunisation Advisory Centre provides an annual ‘Influenza Kit’ to community pharmacies with all the information required for the year’s influenza vaccine campaign. In addition two websites provide influenza information to:

At the start of each influenza vaccine season community pharmacists should:

  • review their brochures, handouts and other resources to ensure they are appropriate for that year, and dispose of/recycle expired resources and order current information
  • update any Standard Operating Procedures (SOP) relevant to best practice and ensure they align with any new guidelines released
  • read the new Influenza Kit and make accessible to all staff
  • pre-order vaccines in accordance with instructions provided in the Influenza Kit and www.influenza.org.nz
  • communicate the key messages and any programme changes to all staff
  • ensure they have an updated pharmacist vaccinators consent form that includes a notification to the patient's general practitioner or lead maternity carer (with patient consent)
  • encourage all staff to receive the flu vaccine

Zoster (Shingles)

Herpes zoster (shingles) vaccine is indicated in individuals 50 years and over for:

  • prevention of herpes zoster (shingles)
  • prevention of postherpetic neuralgia
  • the reduction of acute and chronic zoster-associated pain

The approved zoster vaccine is Zostavax. More information can be found on the IMAC factsheet Quick answers to frequent Zostavax questions and Chapter 22 Zoster (herpes zoster/shingles) in the Immunisation Handbook 2017.

Tetanus, diphtheria, and acellular pertussis vaccine (Tdap)

The first year of life is the most vulnerable age group for pertussis (whooping cough). The primary aim of the reclassification of Tdap was to increase the access to the Tdap booster vaccine (not primary course doses) to improve uptake by adults in close contact with infants. This includes parents, grandparents, health workers, and caregivers. Pregnant women are eligible for funded Tdap vaccine between 28 and 38 weeks of every pregnancy administered in general practice or by a midwife. Funded Tdap vaccine is currently delivered to pregnant women by pharmacist vaccinators within the Waikato DHB region only.

Pharmacist vaccinators may administer Tdap vaccine to people 18 years and older. The approved Tdap vaccines are Adacel and Boostrix. For more information see Chapter 14 Pertussis (whooping cough) in the Immunisation Handbook 2017.

Meningococcal disease

The primary aim of the reclassification of meningococcal vaccine was to reduce the incidence, morbidity, and mortality from meningococcal invasive disease, primarily in at-risk adolescents, by increasing access to the vaccine.

Pharmacist vaccinators may administer meningococcal vaccines to people aged 16 years and over. There are two different types of meningococcal vaccine; conjugated and polysaccharide. Pharmacist vaccinators should be familiar with the range of vaccines and reasons for using different ones. For more information see the IMAC factsheet Purchase of non-funded meningococcal vaccines for detailed information on meningococcal vaccines and Chapter 12 Meningococcal disease in the Immunisation Handbook 2017.

Delivering a vaccination service in a community pharmacy

When planning a vaccine delivery service the community pharmacist needs to consider vaccine storage, staff training, the physical requirements in regard to consultation and waiting space, and emergency and vaccine equipment.

Cold chain management

All immunisation providers who store vaccines and/or offer immunisation services must achieve Cold Chain Accreditation (CCA). To achieve Accreditation providers must meet the required 10 standards as outlined in the  National Standards for Vaccine Storage and Transportation for Immunisation Providers 2017These standards supersede the National Guidelines for Vaccine Storage and Distribution 2012 and the Immunisation Handbook 2014 3rd Edition.

Visit the MoH website page National Immunisation Programme cold chain management for links to the current National Standards for Vaccine Storage and Transportation for Immunisation Providers 2017, documents and forms required for temperature monitoring and CCA (or CCC). Contact your Immunisation or Cold Chain Coordinator for advice on meeting the cold chain standards.You can also find more information on cold chain on our cold chain page.

Training pharmacy staff

Community pharmacists offering a vaccination service must ensure that all staff are familiar with the service being provided and their role in that service. In particular ALL frontline staff must be aware of the risk of anaphylaxis following immunisation and the pharmacy procedure for its management. It is important to note that while a pharmacist vaccinator requires a level 4 or equivalent CPR at least one other member of the team must have basic level 1 first aid skills. This is to be adhered to at all times when vaccination services are provided.

Ordering vaccines

Funded influenza vaccines are ordered through Healthcare Logistics (HCL). Minimum quantities apply and orders can be placed online or via fax. Details can be found in the Influenza Kit. To log in to the HCL website, go here.

Other vaccines can be ordered through the pharmacy’s pharmaceutical wholesaler.

Policies/procedure/SOPs

Pharmacy vaccination standard operating procedures (SOPs) can be found on the Pharmacy Guild of New Zealand and Green Cross Health websites.

Pharmacists and other staff should be familiar with their local procedures around sharps management and injury, resuscitation/anaphylaxis management and incident reporting.

Obtaining written resources

MoH patient immunisation resources are available from HealthEd. Pharmacists should have After your immunisation code HE2505 available.

For influenza vaccine your annual Flu Kit and www.influenza.org.nz are the key locations of written resources and how to order them. It is not necessary to photocopy patient leaflets. Please ensure that you always use resources specific to the current year. Essential items are the:

  • Consumer information brochures and
  • After immunisation pads

In addition to the HealthEd site, Meningococcal, Tdap and Zostavax vaccine patient resources may be available from the local pharmaceutical company representative.

Vaccination and waiting areas

Prior to establishing a vaccination service the pharmacist must ensure that they have a space that enables them to administer vaccines and a safe manner that provides for patient privacy and confidentiality. You also need to consider where your client will wait for the 20 minutes post-immunisation.  They should always be within line of sight. Will you have a specific waiting area or will they browse the pharmacy? Your local immunisation/coordinator can provide advice on this.

Physical setup considerations/privacy

You should consider the organisation of your ‘vaccinating space’. To facilitate a conversation that provides for ‘informed’ consent you should have two chairs available. Having this conversation while the client and/or you are standing is not good practice. It implies you are in a hurry and is not comfortable for many people.

Can you access the adrenaline and emergency equipment quickly? Are you left or right handed? Ideally the syringe and needle are popped in the sharps bin immediately after removing from the client's arm. Can you reach it? You may need to reposition chairs etc. to provide for your comfort and the client’s safety.

Do you require/have computer access in the room? Are patient leaflets and any forms required, hand sanitiser, swabs, plasters etc. accessible? This video discusses setting up your work area.

Infection control and sharps management

Normal clinical procedures related to vaccine handling and sharps management must be adhered to.

Administering vaccines

In a community pharmacy vaccines can only be administered by approved pharmacist vaccinators. To revise vaccine administration please refer to Chapter 2. Processes for safe immunisation in the current Immunisation Handbook and your VTC manual. All vaccinators must:

  • Maintain the appropriate emergency equipment and check prior to administering vaccines
  • Check that vaccines have been appropriately stored prior to administration
  • Undertake a pre-vaccination check to ensure the correct vaccine is delivered to the client and that there are no contraindications or precautions that preclude delivery as per the pharmacists pre-vaccination checklist and consent.
  • Obtain informed consent, including about the National Immunisation Register (NIR) and information sharing
  • Deliver vaccines safely and dispose of the syringe and needle appropriately
  • Provide verbal and written post-immunisation advice including details of who to contact in the event of an adverse event following immunisation
  • Remind the client they need to wait for 20 minutes before leaving the pharmacy
  • Appropriately document the immunisation event including advising the clients general practice and/or NIR (if the client consents)

These four videos give a basic overview of the preparation and administration of Meningococcal, Tdap and Zoster vaccines. Click on the fullscreen icon  to view larger.

 

Sharing information/confidentiality/NIR

Pharmacist vaccinators can now send vaccination information to the NIR. They must first complete an NIR Authorised User Agreement (AUA) for pharmacies form and submit this to onlinehelpdesk@moh.govt.nz. Once access confirmation is received they can go into the MoH web application ImmuniseNow and enter the vaccination event information. NB: ImmuniseNow is only available through the Connected Health network at the pharmacy. Click here for the ImmuniseNow user guide. Until ImmuniseNow is fully connected to general practice patient management systems pharmacists should, with the clients consent, continue to notify the GP or LMC of vaccines delivered

Incident reporting

Pharmacists must ensure that all untoward incidents are reported appropriately following local procedures.

Incidents that (may) affect vaccine delivery may also need to be reported to the Centre for Adverse Reactions Monitoring (CARM). For example a vaccine administration error that may affect vaccine effectiveness such as administering expired/compromised vaccine. Pharmacists should also notify their local immunisation co-ordinator/facilitator when making a CARM report.

Audit and research

Immunisation data is collected through the NIR however, community pharmacies may occasionally be asked to participate in audits, for example through PHO’s, DHB’s or pharmacy organisations or research projects, for example by IMAC. They may also choose to undertake their own audits within the pharmacy or pharmacy group.

Pharmacists delivering vaccines ‘off-site’

Some pharmacists may offer an off-site immunisation service e.g. vaccinating staff in a workplace or patients in a rest home. The requirements for authorised vaccinators delivering this service may provide a helpful check list for community pharmacists and can be found on pages 639-642 of Appendix 4 in the Immunisation Handbook 2017. Pharmacists must also meet the cold chain requirements for offsite vaccination described in the National Standards for Vaccine Storage and Transportation for Immunisation Providers 2017. Community pharmacist are not required to apply to the Medical Officer of Health for programme approval.

Useful links

Organisation

Role

Pharmaceutical Society of New Zealand (PSNZ)

Professional membership based association representing the pharmacy profession. The PSNZ maintains a register of all pharmacist vaccinators in NZ and pharmacist vaccinators are therefore required to advise them when they become approved

Pharmaceutical Defence Association (PDA)

A non-profit, pharmacist support organisation.

Membership of PDA is designed specifically to provide assistance to pharmacists in the event of professional indemnity, public liability and statutory liability claims.

Pharmacists must advice the PDA when they become vaccinators

Pharmacy Council

Protects the health, safety and wellbeing of the public by ensuring pharmacists are competent and fit to practise

Pharmacy Guild of NZ

Provides support and services to community pharmacy owners. The aim is to ensure members realise their professional and financial potential

Green Cross Health

Primary health care provider representing community pharmacies under the Unichem and Life Pharmacy brands and medical centres under The Doctors brand.

Other useful sites

Ministry of Health Immunisation

Ministry of Health Pharmacist Vaccinators

Medsafe Reclassification of vaccines January 2016

HealthEd health promotion/education resources

ESR annual influenza reports

SHIVERS (Southern Hemisphere Influenza and Vaccine Effectiveness Research and Surveillance) Key findings. Conference presentation

http://www.influenza.org.nz/ NISG influenza website for health professional

http://www.fightflu.co.nz/ NISG influenza website for the public

https://vimeo.com/album/3604422/video/142086684 This video demonstrates a strategy to manage a needle-phobic patient requiring a flu vaccine and provides an overview of immunising an adult with influenza vaccine

Waikato DHB vaccine administration videos

Last updated: Jun 2017