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Pharmacists

Community pharmacist vaccination

Since 2012, pharmacists in New Zealand who have completed an approved vaccinator training course and comply with the immunisation standards of the Ministry of Health are able to administer influenza and Tdap vaccines. In 2013, this was extended to include zoster (shingles) and meningococcal vaccines. In 2019 Influenza vaccine was also reclassified for intern pharmacists who met the educational and immunisation standards.

In 2019 measles, mumps and rubella containing vaccines were reclassified under s106 in the Medicines Act 1981 to enable a reclassification by Ministerial notification for pharmacist and intern pharmacist who met the requirements. Not all pharmacies will offer MMR vaccines and it will be based on DHB measles plans and contracts.

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

Quick links to information on this page

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 of certain vaccines by the Medicines Classification Committee, pharmacists were no longer required to seek authorisation under the Medicines Regulations 1984.

The practice of all vaccinators must meet the current Immunisation standards and guidelines for all vaccinators that can be found in Appendix 3 in the Immunisation Handbook 2017 2nd Edition.

How to qualify as a pharmacist vaccinator

Pharmacist vaccinators are required to undertake vaccinator training and clinical 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 (or date of the Flexi VTC Tutorial).

Pharmacists who have completed their vaccination training course need to contact their Immunisation Coordinator to arrange their clinical assessment. Visit our webpage Regional advisors and local coordinators to obtain the contact details for your local Immunisation Coordinator. Pharmacists should ensure they keep a copy of their clinical assessment outcome and their VTC certificate within their personnel file, as Medicines Control may request evidence of completion.

Pharmacists who have completed the theoretical and clinical assessments must notify the Pharmaceutical Society (PSNZ). No copies of the vaccination certificate or resuscitation certificates are required. Emails should be sent to [email protected] and should include Pharmacist Vaccinator in the subject line. It is sufficient to send an email with the information below:

  • Full name
  • Membership number
  • Name of the pharmacy or pharmacies which vaccinations will be provided from, or if the pharmacist is a locum
  • Date of the course
  • Date of their clinical assessment

See A4.1.2 Process for all vaccinators in the Immunisation Handbook 2017 2nd Edition 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 2nd Edition for further details.

On completion of their vaccinator update course, pharmacists should advise the PSNZ using the process for initial training (described above).

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. On 18 March 2020, pharmacist vaccinators began delivery of vaccine on the funded influenza programme to eligible people aged 13 years and over. Children under 13 years with chronic conditions like asthma, heart disease or diabetes, still need to go to their general practitioner to get their funded influenza vaccine. Pharmacists may administer purchased 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). If you would like more information on this, please email the Ministry of Health Support team [email protected].

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 Flu Kit booklet 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
  • ensure that they record flu vaccinations on the National Immunisation Register (NIR) through the ImmuniseNow portal

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 2nd Edition. Pharmacists are not able to claim for administration of this vaccine to individuals who meet the National Immunisation Schedule eligibility criteria.

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 from the second trimester of every pregnancy and recommended to be administered from 16 weeks, preferably within the second trimester, but at least two weeks prior to birth administered in general practice or by a midwife. Funded Tdap vaccine is currently delivered to pregnant women by pharmacist vaccinators only within the Waikato DHB region.

Pharmacist vaccinators may administer Tdap vaccine to pregnant women aged 13 years or older (not funded unless the pharmacist is within Waikato DHB) and men and non-pregnant women aged 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 2nd Edition.

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 2nd Edition.

Measles, mumps and rubella (MMR) vaccine

In 2019 New Zealand experienced a significant outbreak of measles and smaller outbreaks of mumps. As part of the response to the measles outbreak, preparations containing measles, mumps and rubella vaccines in a combination product consented by the Minister of Health were reclassified as PHARMACY ONLY. To be eligible to administer this vaccine Pharmacy vaccinators are required to have successfully completed a training course approved by the Ministry of Health and comply with the immunisation standards of the Ministry of Health. This means that trained pharmacist vaccinators with current vaccinator status may provide the MMR vaccines. The classification is temporary and currently concludes on 24 April 2020.

An amendment to the Pharmaceutical Schedule means that it is possible for the MMR vaccine to be funded via pharmacy contracts with DHBs. These vaccines are not available for private purchase.

A new service schedule describing the service specifications and eligible groups has been developed for the pharmacy agreement. Each DHB will implement this individually depending on the needs of their population. Please contact your DHB Pharmacy Portfolio Manager if you have any questions regarding the contract process.

Pharmacist vaccinators may administer MMR vaccine to persons aged 16 to 50 years. The approved MMR vaccines are MMRII and Priorix. For more information see Chapters 11, 13 & 18  in the Immunisation Handbook 2017 2nd Edition.

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 regarding consultation and waiting space, and emergency and vaccine equipment.

Cold chain management

From 1 February 2018, cold chain management in pharmacies is regulated as part of the pharmacy licensing framework administered by Medicines Control. Visit the Ministry of Health (MoH) website page National Immunisation Programme cold chain management to read the FAQs on vaccine Cold Chain Compliance for community pharmacies fact sheet. A fact sheet for Immunisation Coordinators FAQs for immunisation coordinators on vaccine Cold Chain Compliance for community pharmacies is also available on the MoH cold chain management webpage.

Community pharmacies who are offering or who plan to offer vaccination services are responsible for complying with all requirements within the Standards (including appropriate equipment, monitoring, recording, and policies and procedures) outlined in the National Standards for Vaccine Storage and Transportation for Immunisation Providers 2017. The MoH cold chain management webpage National Immunisation Programme cold chain management has links to the current National Standards for Vaccine Storage and Transportation for Immunisation Providers 2017 (2nd Edition) and other documents and forms required for temperature monitoring and cold chain compliance. You can also find more information on cold chain on our cold chain page.

Immunisation Coordinators will continue to provide community pharmacies with:

  • Cold chain advice (e.g. when purchasing new cold chain equipment)
  • Assistance with cold chain breaches or failures
  • Clinical assessments for pharmacists who have completed their vaccination training course
  • Three yearly spatial logging of pharmaceutical refrigerators (it is the pharmacist's responsibility to contact their Immunisation Coordinator to arrange this).

Visit on our webpage Regional advisors and local coordinators to obtain the contact details for your local Immunisation Coordinator. 

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 CORE immediate - Adult and Child certificate at least one other member of the team must be able to call for emergency support and have a basic first aid certificate. 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 Flu Kit booklet, and an electronic copy is available on the resources page on the Influenza info for health professionals website, www.influenza,org.nz.

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

Policies/procedures/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 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 at least 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? The syringe and needle are placed 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 Immunisation Handbook 2017 2nd Edition 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 pharmacist's 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 client's general practice and NIR (if the client consents)

These four videos give a basic overview of the preparation and administration of Meningococcal, Tdap and Zoster vaccines. Please note that the Zostavax diluent now comes in a prefilled syringe and the diluent no longer needs to be drawn up. However, the MMRII (MMR vaccine) is presented in this format. Click on the full screen icon  to view larger.

National Immunisation Register and ImmuniseNow

National Immunisation Register (NIR)

The NIR is a national database, held by the Ministry of Health (the Ministry). The NIR records National Immunisation Schedule vaccinations given to children and some Schedule vaccines given to adults, such as influenza vaccinations. Children are automatically enrolled onto the NIR unless actively ‘opted-off’ while adults will need to be actively and manually ‘opted on’. The Ministry and District Health Boards use the NIR to help monitor vaccination coverage, including vaccination of pregnant women, assess protection against diseases such as influenza, and plan future population health programmes. The NIR leaflet (HE2423) informs adults about the NIR and can be ordered from HealthEd. Where possible, all immunisations should be recorded on the NIR unless a patient has specifically requested to opt off or has not given consent to be opted on.

  • The NIR provides an accurate record of a person’s vaccination history, to help with their ongoing heath care even if they change doctors, and to help the Ministry measure vaccination coverage across the whole population.
  • The NIR records a person’s NHI number, name, gender, address, date of birth and vaccination information.
  • Only authorised professionals will see, use or change the information.
  • Information that does not identify individuals may be used for research or planning.

ImmuniseNow

Pharmacist vaccinators are required to use the NIR web application called ImmuniseNow to to check vaccinees’ immunisation history and record all funded vaccinations on the NIR, and should be encouraged to also record non-funded vaccinations. If the person is already registered on the NIR, a notification will be sent to their general practice advising that a vaccination has been given by a pharmacist. 

ImmuniseNow is only available via the Connected Health network on the PC, which must be on the PC you are using to access the application. Click on this link to download a copy of ImmuniseNow User Guide as it outlines the process of creating an account. The ImmuniseNow User Guide is also available within the application.

How do I access ImmuniseNow?

  1. You must be a pharmacist vaccinator who has met the Ministry’s requirements.
  2. Pharmacist vaccinators must complete and sign an NIR Authorised User Agreement (AUA) for pharmacies form.
    • An NIR authorised user agreement (AUA) protects and safeguards individuals.
    • Request the AUA form from the Ministry of Health Support team.
      • Email: [email protected].
      • Phone: 0800 855 066, select option 5 and then select option 3.
    • The AUA needs to be completed by your pharmacy’s nominated lead pharmacist for all pharmacist vaccinators employed at your pharmacy.
    • Each pharmacist vaccinator will also need to sign the AUA form. You will need to read, understand and agree to comply with this agreement.
    • When the AUA form has been completed and signed, scan the form and email it to the Ministry of Health Support team at [email protected]
  3. Each pharmacist vaccinator will need an ImmuniseNow user name and login (refer to the ImmuniseNow User Guide above).
  4. Once access confirmation is received, pharmacists can go into the MoH web application ImmuniseNow and enter vaccination event information.
  5. Please notify the Ministry of Health Support team when a pharmacist vaccinator either joins or is no longer employed at your pharmacy.

I already have a user name and password to access the Medicines Control Online System (MCOLs). Can I use this one for ImmuniseNow?

Yes. Please use the same credentials to login into ImmuniseNow. Enter this username on the AUA form for each pharmacy that you work for. Once you have been authorised by the Ministry of Health Support team you can access ImmuniseNow and record the vaccinations you have given at https://immunisenow.moh.health.nz/nir/.

How do I get an ImmuniseNow username and login if I don’t have a MCOLs login?

Please follow these steps:

  1. Open the browser on your pharmacy PC.
  2. Navigate to https://immunisenow.moh.health.nz/nir/ then go to the ‘Login’ option and click ‘Create an account’.
  3. Complete each field and click ‘Register’. You will receive a message that the submission has been successful.
  4. Close the message and exit the web browser.
  5. Remember your username and password

I work at more than one pharmacy. Do I need to be listed in the NIR for each pharmacy I work at?

Yes. The AUA only applies to one pharmacy so you will need to be included on the AUA form for each pharmacy that you work at.  Please ensure you use the same MCOL or ImmuniseNow username.

Who do I contact for more information about ImmuniseNow or a username?

Please contact the Ministry of Health Support team about ImmuniseNow or a username and login:

Do I need to inform a patient’s GP that I have administered the influenza vaccine?

No. There is a section called GP Practice in the ImmuniseNow web application. After the vaccinating pharmacist has added the vaccination information to the GP Practice section on ImmuniseNow, the NIR will send a notification to the patient's general practice/clinic/medical centre to advise them that their patient has received a vaccination.

What about informing the midwife/LMC I have administered the influenza vaccine?

It is desirable that, with a pregnant woman’s consent, you inform her midwife that you have administered an influenza vaccine to their patient or give a copy of the vaccine notification form to the woman to keep with her maternity notes and to show her midwife.

Entering influenza vaccinations on ImmuniseNow

ImmuniseNow provides three options for pharmacist vaccinators to select when entering an influenza vaccination:

  • Influenza - Unfunded
  • Influenza - Pregnant woman
  • Influenza - Over 65

Instructions for entering funded influenza vaccination into ImmuniseNow

    Individuals aged 13–15 years inclusively

    • Complete an NIR3 Notification form (see link below) and send to your local DHB NIR administrator.

    www.health.govt.nz/system/files/documents/pages/nir3-immunisation-event-form.pdf

    Individuals aged 16–64 years inclusively

    • Select the Unfunded option in ImmuniseNow. This will ensure the vaccine is entered onto the NIR.

    Pregnant women

    • Select the Pregnant woman option in ImmuniseNow.

    Individuals aged 65 years or older

    • Select the Over 65 option in ImmuniseNow.

    Claiming for the cost of the vaccine and the administration fee

    The pharmacy vendors, RxOne and Toniq, have made the necessary system changes to support you in claiming for the cost of the vaccine and the administration fee when given to an eligible patient. Please contact your software vendor if you have any questions about the changes.

    Pharmacists should claim for administration of all funded influenza vaccinations to individuals aged 13–64 years through their pharmacy system as they currently do for other funded influenza vaccinations. The Ministry is currently investigating the feasibility of amending ImmuniseNow to support the new funded criteria, and will communicate the findings to the sector once the investigation is complete.  

    For claim enquiries, please contact Pharmacy Claim enquiries on 0800 353 2425 and select option 1.

    Incident reporting

    Pharmacists must ensure that all untoward incidents are reported appropriately following local procedures, including their Immunisation Coordinator. Attached is the IMAC Vaccine incident reporting form for online completion, which should be used if a local/provider incident is not available.

    Adverse events following immunisation (AEFIs) should be reported to the Centre for Adverse Reactions Monitoring (CARM). Pharmacists should also notify their local Immunisation Coordinator/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 off-site programmes are outlined in Appendix 4 in the Immunisation Handbook 2017 2nd Edition. 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 (2nd Edition). 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.

    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 National Immunisation Programme cold chain management

    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: Mar 2020