5 Helpful Tips on Immunization Management

By Jerry Mejia

The BC Pharmacy Association, in partnership with the College of Pharmacists of BC, has developed a new training program for community pharmacy managers to ensure regulatory compliance, encourage best practices and offer overall guidance and support. BCPhA pharmacy practice support specialist Jerry Mejia shares some useful tips on immunization management for community pharmacy managers. Read the full series at t.bcpha.ca/pmtraining.

As perhaps the most accessible member of B.C.’s health-care team, community pharmacists are well positioned to play an important role in vaccine provision in the province. Having administered more than 660,000 flu shots during the last flu season, pharmacists have become a go-to source for immunization. Let’s take a look at how community pharmacy managers can help manage immunization services at their pharmacies. 

1. Review staff roles and responsibilities 
With flu season in full swing, it’s important to review with your staff their responsibilities around vaccine administration. This can include giving an overview of the pharmacy’s immunization procedures from patient intake and assessment to the actual injection of the vaccine and how each staff member can support every step. Other topics could involve supplies ordering and preparation, public and private vaccine procurement process and hours of available immunizers. As a reminder, although pharmacy assistants and registered pharmacy technicians can aide in determining patient eligibility for certain immunization programs, pharmacists are ultimately responsible for assessing the appropriateness and safety of immunizations for each patient. Take this time to review pharmacy’s staffing levels to determine if they are sufficient to meet the increased demand of the busy flu season, further establishing pharmacy’s role as a key and safe community vaccine provider.

2. Cold chain management 
This is the time of the year when pharmacies receive hundreds of vaccine doses, in addition to existing fridge inventory, which can potentially go to waste if cold chain protocol is not properly followed. 

Your discussion with staff could include:

• the recommended temperature range (+2ºC to +8ºC)
• thermometer temperature monitoring
• implications of cold chain incidents that are irreversible and permanent (e.g. freezing can reduce vaccine potency and heat and light can affect the stability of live-virus vaccines)
• how to manage cold chain incidents (e.g. back-up plans for power outages)* 

The College of Pharmacists of BC’s Professional Practice Policy-68 (PPP-68) Cold Chain Management of Biologicals provides guidance and directs pharmacy managers to BC Centre for Disease Control’s (BCCDC) Communicable Disease Control Manual, Immunization, Appendix E – Management of Biologicals for specific requirements. Please take the time to review these documents and ensure your pharmacy manuals are up-to-date.

3. Resources and education materials 
Pharmacy Operations and Drug Scheduling Act (PODSA) bylaws require that materials regarding new information are readily available and up-to-date for all staff members. Specific to immunization, many government agencies and health authorities have developed resources designed to help vaccine providers in their respective practices. However, it is important to note that BCCDC’s immunization manual remains the ultimate guide for publicly funded vaccine programs in the province. The National Advisory Committee on Immunization (NACI), on the other hand, publishes recommendations on the intended use of both publicly funded and private-pay vaccines currently available in Canada. These two resources are updated periodically and users can subscribe to mailing lists for email notifications of any revisions. Encourage staff members to review these resources at least annually and use the information to increase patients’ awareness and uptake of available vaccines, both public and private.

The BCPhA has created and maintains a list of immunization-related resources and learning materials for members. Pharmacy managers in particular may find the Flu Resource page useful, which contains up-to-date and season-specific influenza information including health authorities’ implementation plans, vaccine products and relevant forms. 

4. Inventory management and billing 
Since 2009, pharmacists authorized to administer injections have had access to publicly funded vaccines. These can be either routinely ordered or requested on a case-by-case basis from public health units for eligible B.C. residents. Ordering procedures vary between health authorities so ensure that your pharmacy notes appropriate quantities and uses the correct order forms if applicable (usually found on their respective websites). To prevent wastage and ensure equity amongst other vaccine providers, BCCDC generally recommends that orders should be limited to quantities that can be reasonably used within one month. For vaccines with limited and allocated supply such as influenza vaccines, this guideline could be even less. 

As a reminder, pharmacists can only provide publicly funded vaccines and claim clinical service fees for their administration using PINs to eligible patients who meet the criteria described in Part 4 of the BCCDC immunization manual. All other individuals must be immunized using the private supply and billed accordingly. 

5. Documentation and reporting 
As pharmacists become increasingly established community vaccine providers, our role in helping maintain accurate and current immunization history for our patients also becomes more pronounced. It is crucial that we notify patients’ primary physicians as well as relevant health units, after obtaining consent, whenever we administer any vaccines apart from influenza. Doing so removes the guess work in establishing a patient’s immunization history and potential missed opportunities or duplicate vaccinations. Patients should also be provided with a record of their immunization either using the traditional fillable cards or on newer electronic platforms such as CANImmunize.  

Adverse reactions stemming from vaccines must also be reported using the Adverse Events following Immunization (AEFI) document. Developed by British Columbia Immunization Committee’s Vaccine Safety Working Group, this form is designed to track unwanted effects after a vaccine that cannot be attributed to other etiologies. Part 5 of the BCCDC immunization manual provides further details on the reporting criteria for these events and their management and implications for other vaccinations. The reporting process is summarized in a pharmacist-specific flowchart and is available for download on PharmaCare’s website. 

*For full details, consult BCCDC Communicable Disease Control Manual, Immunization, Appendix E – Management of Biologicals.