Pharmacists giving vaccines

J Longford

Seems pharmacists are now going to be giving vaccines after going to a course for a couple of days. Starting with the swine flu jab

Must be easy to give them to people if that's the case !!!

Next the HSE will be shortening Nurse training to a couple of months !!!

bleg

Nurses learn more than how to give injections.

I presume the Swine flu vaccine will be IM or SC which are much easier to give than IV.

Ivona Tinkle

Its not rocket science when I was in France my mother broke her leg and she was given a blood thinner injections to prevent clots

I asked the doctor in the hospital who was to give the injection and he was surprised and said i was to do it gave me instructions and of how to inject into the stomach

At first it was terrifying but nearing the end I thought nothing of it

It should have been done years ago in this country

drkpower

A monkey could give a vaccine. But it is the (very low) possibility of an anaphylactic reaction where the need to have a trained professional on hand is needed. A pharmacist would not be sufficiently trained in this regard so I presume if they are giving vacinations it is in the prescence of a doctor (or at least a doc is on hand if the sh!t hits the fan).

tallaght01

My concern, as someone who gives vaccines regularly, is about anaphylaxis and vasovagal attacks.

You can have the best pharmacist in the world. But they're just not trained clinicians. Sometimes even the early stages of nasty anaphylaxis and a simple vasovagal can be quite similar.

Having said that, we very rarely have problems with vaccines. I give them a lot, and I've not had a case of anaphylaxis secondary to a vaccine so far. We've seen a few faints.

The reality is this will depend on cost. In healthcare, people take over other people's jobs all the time, because they're cheaper. Whether it's a good service or not seems to be the secondary concern. If pharmacists were sitting around scratching their assess all day, I'd say fair enough. But they're busy doing their own work.

i think the big chains would love this. they embraced the concept of GP-style consultations with pharmacists in the UK, and I suspect they'll welcome this, for the right price.

bleg

There were plans for pharmacists to give travel vaccines before swine flu emerged. The IPU has been running courses for pharmacists in giving them. It was recommended in the Pharmacy 2020 report I think.

tallaght01

I guess the question is who recommended it? And what did they propose in terms of dealing with reactions?

bleg

The Pharmacy 2020 group is composed of PSI members and was drawn up by the PSI. The interim report is here: http://www.pharmaceuticalsociety.ie/Publications/upload/File/Publications/PSI%20Interim%20Report%20April%2008.pdf


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tallaght01

I think the point is, bleg, the idea of pharmacists recommending pharmacists should do something doesn't often wash with people.

There is a degree of conflict of interest in the proposal.

I don't think the universe will collapse of it happens. But, when you work in health for a while, you get used to everyone telling you they can and should do your job.

The reason I'm uneasy about all this is because I'm not convinced this is all being done with the patients' best interests at heart.

bleg

Ah yea, completely understandable. However the fact remains that pharmacists giving vaccines has worked extremely well in other juristictions. The report may have been put together by pharmacists however it first had to be approved by the PSI council, which has a majority of non-pharmacists IIRC.

tallaght01

bleg wrote: »

Ah yea, completely understandable. However the fact remains that pharmacists giving vaccines has worked extremely well in other juristictions. The report may have been put together by pharmacists however it first had to be approved by the PSI council, which has a majority of non-pharmacists IIRC.

It's worked in some places in the UK, in terms of influenza vaccination uptake, which is great. But the question remains, are you confident you can recognise and manage anaphylaxis.

Pharmacists are not trained at all in acute management of illness. Having said that, I'm very much in favour of widening the vaccine net. I think it could be done in better ways, such as mobile vaccine clinics set up in community centres.

But I'm not sure how relevant it is to Ireland. It works well in the UK, where it can take a week to get an appointment with a practice nurse (it once took me 2.5 weeks). That's because it's free.

In Ireland you can see your GP or nurse much quicker, by and large.

The pharmacists in the UK also (from what I can remember) only did a one day course before being qualified.

Maye I just trust the competency of the PSI now. But reading their proposal to allow pharmacists prescribe any drug for any condition doesn't reassure me much.

Nonoperational

Pharmacists are desperately trying to find ways of increasing their value and banishing the over paid "lick pick and stick" image they have with the public. To me the giving vaccines initiative doesnt appeal at all. I'd question if there would be any value to the healthcare service in having pharmacists doing it over nurses and if their was it would surely only be sustainable for a short period of time. I cant see how they'd do it for a price that would have long term sustainability and benefits. In my experience pharmacists are under considerable pressure now and in many shops there is only one working at any one time. If they have to leave and go administer vaccines then the core business of dispensing prescriptions will suffer.

rgnmb

Ivona Tinkle wrote: »

Its not rocket science when I was in France my mother broke her leg and she was given a blood thinner injections to prevent clots

I asked the doctor in the hospital who was to give the injection and he was surprised and said i was to do it gave me instructions and of how to inject into the stomach

At first it was terrifying but nearing the end I thought nothing of it

It should have been done years ago in this country

This injection is a LMWH, given subcutaneously, and yes is a relatively easy injection to give,

A greater risk is associated with intramuscular injections, the route of most vaccines and other injected drugs; knowledge of the anatomy of surrounding structures is required for this. IM is normally reserved for healthcare professionals.

Patients in Ireland do self adminiter s/c injections and have done for many years.

bleg

tallaght01 wrote: »

It's worked in some places in the UK, in terms of influenza vaccination uptake, which is great. But the question remains, are you confident you can recognise and manage anaphylaxis.

Pretty sure I could recognise it at the moment. Could definitely do with additional training to ensure I could manage adequately. I wouldn't be willing to administer a vaccine otherwise.

tallaght01 wrote: »

But I'm not sure how relevant it is to Ireland. It works well in the UK, where it can take a week to get an appointment with a practice nurse (it once took me 2.5 weeks). That's because it's free.

In Ireland you can see your GP or nurse much quicker, by and large.

I think adequately trained pharmacists could provide a more cost effective approach to administration of vaccines in Ireland. I'm not saying it won't take time for things to change but I think it is inevitable that services like this will be provided in pharmacies. The way we're going we will have fewer pharmacies but increased numbers of pharmacists working in the fewer premises. This will allow for the dispensing to continue as normal and to have one or 2 pharmacists dedicated to vaccine admin and therapeutic monitoring.

tallaght01 wrote: »

The pharmacists in the UK also (from what I can remember) only did a one day course before being qualified.

Maye I just trust the competency of the PSI now. But reading their proposal to allow pharmacists prescribe any drug for any condition doesn't reassure me much.

There would obviously have to be adequate training. I don't think I'd be happy to administer vaccines after just 1 day of training.

The pharmacy 2020 was just a list of proposals, they didn't rule anything in or out to be subject to their assessment. No pharmacist is going to allow for anything more than supplemental prescribing.

tallaght01

I think it's all very well to say you think you could probably recognise anaphylaxis. But what if someone keels over and blacks out? That's how it can present in kids. Is a pharmacy equipped for an unconscious patient until an ambulance gets there? Will you be comfortable using a sats monitor and oxygen, as well as the adrenaline?

Will pharmacies be happy that there are screaming kids all over the place post vaccination?

My thoughts on this are that it will probably go ahead. There are so many other professions doing jobs that other people are better suited to doing, and it is unlikely that pharmacists will be excluded from this. But it can work.

The model I could see working best is where it's not a pharmacist led service, but rather a PHARMACY led service.

Why couldn't a big pharmacy hire a nurse to do things like vaccines and blood pressure checks, health screening etc? I think you're underestimating the time it takes to do a vaccine. There's a decent bit of paperwork involved, and it can be hard to settle a kid beforehand, and that's before you get to work on the parent.

I just wonder if it's cost effective for a pharmacist to spend 25 mins on one patient for whatever the fee will be. I would imagine the pharmacist will be better of financially doing other things with their time.

I don't know how much the HSE pays for a vaccine. But would it be worth the pharmacists while (this is why you don't see an expensive GP vaccinating kids). It would probably end up as a cherrypicking exercise, whereby pharmacists take the easier vaccines (eg people in their 20s having travel shots). But they'd want to be providing a good value service, as you can get a full travel medicine service from many of the clinics in Dublin, and you get to see a doctor too.

And...at the end of the day....do you trust Harney to agree to a per-vaccine fee, and stick to the agreement?

bleg

Tallaght01 I agree with you on most of those points. It will definitely have to ironed out. The pharmacy will have to be properly equipped and there will have to be a separate area for the administration of vaccines and/or health screening. I don't necessarily agree that a nurse would be required but that would depend on the services provided.

I also agree that the marked is definitely in the 18-50 age group.

AmcD

If I was a pharmacist I don't know if I would rush into doing vaccines. I work as a GP and have the backup of the patient's medical history on the computer, the "shock box" in case of anaphylactic reaction and other doctors/a nurse around in case help is needed. Having said that, giving the vaccine isn't that difficult and the vast majority are perfectly ok. I think I would be uncomfortable though, vaccinating strangers without my usual safety net.
I know that there is a school vaccination program where children are mass vaccinated without problems. But the swine flu jab is different. This will involve the whole population eventually from paediatrics to geriatrics and each group has its own features/problems.
Followup is another issue. It is quite common for people to ring up after having vaccinations or after a child is vaccinated, asking about vaccination reactions. Will the pharmacist give the advice or pass it onto the GP?
Maybe if pharmacists start with vaccinations they will move on to other injections: erythopoetin, depo provera, LHRH analogues?

drkpower

bleg wrote: »

Tallaght01 I agree with you on most of those points. It will definitely have to ironed out. The pharmacy will have to be properly equipped and there will have to be a separate area for the administration of vaccines and/or health screening. I don't necessarily agree that a nurse would be required but that would depend on the services provided.

I also agree that the marked is definitely in the 18-50 age group.

But if the pharmacy is goig to end up being kitted up just like a GP surgery, what is the advantage of passing this task to pharmacists? Is there a cost saving?

Why not just keep it as it is; docs prescribe, nurses give it in the doc's surgery?

agray669

Actually I am a practitioner and my girl friend is a pharmicist. She was just trained is giving these shots. She gives about 30 a day now for this swine flu. I can tell you that I would rather get it from her, who has 7 years of higher education and understands A&P then a LPN with less then 2 years.

agray669

drkpower wrote: »

But if the pharmacy is goig to end up being kitted up just like a GP surgery, what is the advantage of passing this task to pharmacists? Is there a cost saving?

Why not just keep it as it is; docs prescribe, nurses give it in the doc's surgery?

I think that is a old school approach to practice medicine... Doc's are supposed to diagnose, treat and prescribe as well as administer. Nurses are their to support, administer care, administer drugs and monitor. Pharmisicists are always finding faults in Dr's prescriptions and understand the effects of these drugs a lot more then most who write a simple fix on a pad of paper. I see nothing wrong with advancing this practice to a Pharmicist who is trained correctly and it will in the long run save money as not all have insurance and a Flu shot from Von's is about $35.00.

Thoie

AmcD wrote: »

I work as a GP and have the backup of the patient's medical history on the computer, the "shock box" in case of anaphylactic reaction and other doctors/a nurse around in case help is needed.

A few people have asked what a pharmacist would do in case of anaphylaxis, but what does a GP do? I'm assuming a shock box is one of those portable paddle sets? Non-medical people get training in those all the time, and are trained when and how to use them - I'm specifically thinking of a few that are hanging around my office.

People who are at risk of anaphylaxis (allergy suffers) and their parents/family (in the case of children) are often taught to administer adrenalin through epipens/inhalers which are conveniently available in a pharmacy. Do GPs usually have a stock of adrenalin to hand?

People learn CPR in 2 day first aid classes (whether effectively or not I couldn't say). A portion of those classes are usually spent learning how to roll bandages and other things not particularly relevant. I'd imagine a pharamcist, being a bright person, could learn CPR, the use of a shock box, and how to adminster the vaccine and adrenalin in a few days. I'm assuming most of them already know how to phone 112.

I'm certainly not trivialising a GPs skills, but I'd imagine that if I went anaphylactic after a vaccine in my GP's office that I'd end up in an ambulance at some stage anyway.

Would a GP be able to treat an anaphylactic patient in their office in such a way that the patient could just walk out and drive themselves home afterwards?

AmcD

Thoie wrote: »

A few people have asked what a pharmacist would do in case of anaphylaxis, but what does a GP do? I'm assuming a shock box is one of those portable paddle sets? Non-medical people get training in those all the time, and are trained when and how to use them - I'm specifically thinking of a few that are hanging around my office.

People who are at risk of anaphylaxis (allergy suffers) and their parents/family (in the case of children) are often taught to administer adrenalin through epipens/inhalers which are conveniently available in a pharmacy. Do GPs usually have a stock of adrenalin to hand?

People learn CPR in 2 day first aid classes (whether effectively or not I couldn't say). A portion of those classes are usually spent learning how to roll bandages and other things not particularly relevant. I'd imagine a pharamcist, being a bright person, could learn CPR, the use of a shock box, and how to adminster the vaccine and adrenalin in a few days. I'm assuming most of them already know how to phone 112.

I'm certainly not trivialising a GPs skills, but I'd imagine that if I went anaphylactic after a vaccine in my GP's office that I'd end up in an ambulance at some stage anyway.

Would a GP be able to treat an anaphylactic patient in their office in such a way that the patient could just walk out and drive themselves home afterwards?

I presume you are joking when you ask could a GP treat somebody for anaphylaxis and then let them drive themselves home? The shock box I was talking about contains adrenaline, hydrocortisone, an antihistamine, endotracheal tube etc. We also have an AED. Whether I was a GP or a pharmacist I would certainly be calling an ambulance regardless.
Anaphylaxis is rare, but vasovagal episodes/fainting are not. First of all you would have to have the confidence to distinguish between these and secondly if somebody was having a vasovagal episode it might be preferable to have them lying in a couch in a surgery under close supervision until they come round.

rgnmb

Thoie wrote: »

but what does a GP do?

A medical practitioner can administer a number of drugs to treat anaphylaxis, (im adrenaline, oxygen, iv chlorpheniramine, iv hydrocortisone, iv fluids and colloids) and also provide advanced life support, airway management including intubation, PPV, IV access etc etc. The presence of a nurse would augment this process.

Thoie

AmcD wrote: »

I presume you are joking when you ask could a GP treat somebody for anaphylaxis and then let them drive themselves home?

Sorry, yes I was, I should have put a smilie there. Here's one I should have used earlier :

Past experience of fainting is that people (including some doctors) end up calling an ambulance anyway, to the extent that I've more or less trained myself to mumble "No ambulance, I'm fine" as I come to.

I have no medical training - does anaphylaxis resemble fainting that closely? As a layman I'd expect a fainter to come to pretty quickly once they hit the ground, but I'd have expected anaphylactic shock victims to have problems/stop breathing, and to not come around once they'd gone down.

AmcD

Anaphylaxis and fainting can sometimes look quite similar. When somebody turns white and hits the deck it can be quite disconcerting. Tallaght01 described anaphylaxis in children in some earlier post, which seems to be even more of a difficult diagnosis.

rgnmb

agray669 wrote: »

Actually I am a practitioner and my girl friend is a pharmicist. She was just trained is giving these shots. She gives about 30 a day now for this swine flu. I can tell you that I would rather get it from her, who has 7 years of higher education and understands A&P then a LPN with less then 2 years.

There are no LPNs in Ireland, only Registered Nurses in different divisions. Nurses act within their scope of practice while administrating medications.

I suspect your girlfriend's seven years of 'higher education' impacts little on her ability to administer an IM injection, and while there are no LPNs or similar grade in Ireland, what you rather, does not define a healthcare professionals competence to perform a specific clinical procedure.

Everyone here accepts that a pharmacist can be educated in the administration of an IM injection. Our concern is their aptitude to assess, diagnose, plan and implement interventions for an adverse reaction or other complications associated with IM injections/vaccinations.

glaston

How frequently does anaphylactic shock occur after vaccination?
How many per million vaccinations?