At the 1996 APhA Annual Meeting held in Nashville, Tennessee, the House of Delegates adopted policy encouraging pharmacists to take an active role to increase the rate of immunizations among vulnerable patient populations. This role could be fulfilled by pharmacists’ becoming educators, facilitators, or immunizers of the public.
APhA has invested many resources in the development of education, advocacy, practice support, and scientific programs related to the role of pharmacists in immunizations. These activities have assisted the profession to develop collaborative relationships with other health professionals and to highlight the pharmacist’s position within the health care system.
In response to a call by pharmacists and other entities for assistance in developing these expanded roles, a set of draft guidelines were developed and adopted in 1997. The guidelines are a dynamic document and are periodically reviewed as the health care arena changes. The guidelines were reviewed in 2012. The APhA-APPM Immunizing Pharmacists SIG was asked to review and revise the guidelines in 2018. The draft Guidelines have been released for public comment. The deadline for submitting comments is January 7, 2019.
Guideline 1 – Prevention – Pharmacists should protect their patients’ health by being vaccine advocates.
(a) Pharmacists should adopt at least one of three levels of involvement in vaccine advocacy:
(1) Pharmacist as educator (educating patients, caregivers, and other health care professionals about vaccines, and both serious communicable and preventable diseases; serve as immunization champions);
(2) Pharmacist as facilitator (hosting others who immunize);
(3) Pharmacist as immunizer (protecting vulnerable patients, consistent with state law).
(b) Pharmacists should focus their immunization efforts to meet the immunization needs of the patient and protect the public from vaccine preventable diseases.
(c) Pharmacists should utilize the JCPP, Pharmacist Patient Care Processs, NVAC and CDC established standards to routinely determine the immunization status of patients, make appropriate recommendations, administer the indicated immunization or refer patients to an appropriate provider for immunization, and document the vaccination.
(d) Pharmacists should protect themselves and prevent infection of their patients by being appropriately immunized themselves.
Guideline 2 – Partnership – Pharmacists will be a member of the immunization neighborhood by collaborating, coordinating, and communicating with immunization stakeholders to protect the community from vaccine-preventable diseases.
(a) Pharmacists should support the immunization advocacy goals and other educational programs of health departments in their city, county, and state, in additional to the nation’s vaccine plan.
(b) Pharmacists should collaborate with prescribers and health departments within their communities.
(c) Pharmacists should assist their patients in maintaining a medical home, including care such as immunization administration. Pharmacists should identify gaps in immunization history,administer indicated immunizations when appropriate, and communicate vaccinations to identified medical homes.
(d) Pharmacists should consult with and report immunization delivery, as appropriate, to primary-care providers, state immunization registries, and other relevant parties.
(e) Pharmacists should identify high-risk patients in hospitals and other institutions and assure that appropriate vaccinations are administered before discharge. If administration is not appropriate before discharge, the pharmacist should develop and implement a plan for vaccination post-discharge.
(f) Pharmacists should identify high-risk patients in nursing homes and other facilities and assure that needed vaccinations are administered either upon admission or in drug regimen reviews.
(g) Pharmacists should collaborate with local health departments, universities, faith-based organizations and businesses to identify patients traveling to destinations where administration of vaccines are recommended (e.g. yellow fever vaccine) and facilitate the administration of needed vaccines and other services.
Guideline 3 – Quality – Pharmacists must achieve and maintain competence to administer immunizations.
(a) Pharmacists should administer vaccines only after being properly trained and evaluated in disease epidemiology, vaccine characteristics, injection technique, and related topics.
(b) Pharmacists should administer vaccines only after being properly trained in emergency responses to adverse events and should provide this service only in settings equipped with epinephrine and related supplies.
(c) Before immunization, pharmacists should review the vaccine screening questionnaire with patients and/or their families/caregivers about contraindications and inform them in specific terms about the risks and benefits of immunization.
(d) Pharmacists should maintain ongoing processes and receive continuing education and training on current immunization recommendations, schedules, and techniques at least annually, and meet all state regulations for licensure.
Guideline 4 – Documentation – Pharmacists should document immunizations fully and report clinically significant events appropriately.
(a) Pharmacists should maintain perpetual immunization records and offer a personal immunization record to each patient and their primary care provider whenever possible.
(b) Pharmacists should send the immunization record information to the proper immunization registry.
(c) Pharmacists should report adverse events following immunization to appropriate primary care providers and to the Vaccine Adverse Event Reporting System (VAERS).
(d) Pharmacists should report vaccine administration errors using the Institute for Safe Medication Practices (ISMP) National Vaccine Errors Reporting Program (VERP).
Guideline 5 – Empowerment – Pharmacists should educate patients about immunizations and respect patients’ rights.
(a) Pharmacists should advocate for appropriate vaccine use through information campaigns for health care practitioners, employers, and the public about the benefits of immunizations.
(b) Pharmacists should educate patients and their caregivers about the benefits of, and risks from, vaccines in language that is culturally sensitive and at an appropriate educational level.
(c) Pharmacists should act as an immunization resource in an effort to clarify misinformation related to immunizations.
(d) Before immunizing, pharmacists should document any patient education provided and informed consent obtained, consistent with state law.