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It’s all hands on deck with the current COVID-19 crisis our nation is facing. Pharmacies have been identified as essential healthcare providers. This has to be the most stressful time ever experienced for many of us in healthcare. Yet pharmacists and technicians show up to work every day, doing their part. Many state pharmacy associations are providing guidance to pharmacies in their state on how to safely conduct COVID-19 testing in their stores. Point-of-care testing is a newer clinical service that some pharmacies have adopted for such diseases as influenza, strep throat, and now COVID-19.
Immunizations And Point-of-Care Testing
Immunizations in the pharmacy are the clinical service that preceded point-of-care testing. Twenty years ago it was unheard of to get a flu shot at a pharmacy. Now, according to the National Community Pharmacists Association, 73% of community pharmacies now offer immunizations.
Immunizations play a vital role in the health of communities. By providing immunizations, pharmacies can not only help people stay well by preventing infectious diseases, the service also provides much needed revenue to pharmacies. As the race to find a vaccine for COVID-19 ensues, it is imperative for pharmacists to step up to the plate and do as much as we can to keep our communities healthy.
Pharmacy Immunization Capabilities and COVID-19 Response
As of June 26, 2020, the United States leads the world in the number of COVID-19 cases and deaths, with over 2.4 million confirmed cases and more than124,000 deaths. Putting this in perspective, this exceeds the number of annual deaths due to drug overdoses and influenza combined. Dr. Robert Redfield of the CDC (Centers for Disease Control and Prevention) estimates that 5% to 8% of Americans have been infected by the virus. New Zealand has now had several new cases of COVID-19, even after having been declared coronavirus free on June 8, which suggests that the virus will continue to infect populations until there’s a vaccine.
Providing immunizations could become a critically essential function of pharmacy if a vaccine for COVID-19 becomes available in the foreseeable future. Everyone who does not already have immunity will need to be vaccinated against COVD-19. I doubt that our healthcare system will be able to handle all that volume in a short period of time. COVID-19 necessitates taking all precautions to keep staff safe and healthy while offering a unique opportunity to promote and maintain the health of the community.
Establishing A Pharmacy Immunization Program
I set up my first immunization clinic at Park Pharmacy near Detroit in 2006 (we had three stores over an eleven year period, the last of which we sold to CVS in 2017). Over the years it evolved from just flu shots to flu, pneumonia and zoster, and finally we added a full line of other vaccines including travel vaccines. We met the demand of local doctor’s offices, churches, and the community at large. During the height of the H1N1 pandemic in 2009 we also vaccinated pediatric patients to meet demand from pediatric offices that could not handle the volume and referred many patients to us.
Having an established immunization practice gave Park Pharmacy an advantage over its competitors and allowed for natural expansion into other clinical areas. By word of mouth a group of psychiatrists heard about this service and started referring patients who needed their shots injected once a month. The agreement was that the pharmacist fills those prescriptions and injects the patient with the needed medication. Simultaneously, a collaborative practice agreement with local physicians to administer monthly naltrexone injections for opiate addiction was another easy add-on clinical service. Point-of-care testing was the next logical step. Building clinical programs into a pharmacy expands opportunities to serve the physician community and patients in a meaningful way. Employee morale also improves by giving pharmacists a chance to flex their clinical muscles.
Thorough preparation is key to a successful immunization practice. It is easiest to start with influenza. Spring is the ideal time to for a pharmacist to prepare for an influenza immunization clinic at their pharmacies. Preparation can take several months and orders must be placed with vendors to ensure shipping and receipt of product at the right time. As of yet, we don’t know how COVID-19 will affect the influenza vaccine supply.
Growing An Immunization Program
From there, the practice of immunizing at a pharmacy can easily grow to include more and more vaccines. A few things to consider when growing the practice are employee training and mental readiness. Any pharmacist or technician who administers vaccines should ideally take the immunization course offered by the American Pharmacists Association (APhA). If you are the manager of hospital outpatient pharmacies, your education department could potentially provide this training in house, but keep in mind it’s a 20-credit course with APhA and there is home-study and live training involved. Most newly graduating pharmacists have already been trained.
Details may include:
- A policy/procedure manual for each store.
- OSHA guidelines, post-exposure protocol, and a needle-stick injury log.
- A basic life support class, including CPR, for pharmacists and technicians.
- Personal discussions with each immunizing employee to ensure proper training and identify any mental barriers (e.g., some people are afraid of needles or don’t believe they should be administering vaccines).
- Working the immunization requests into the existing workflow.
- Making construction changes if needed.
- Getting a copy of APhA’s immunization handbook.
- Downloading immunization apps to pharmacists’ phones or tablets.
- Ordering supplies and opening accounts with various suppliers of immunization supplies, if needed.
- Proper marketing of the service.
A lot of work and effort goes into creating a successful immunization practice, but it’s totally worth it! I graduated from pharmacy school in May 2002. The prior winter, a student colleague and I embarked on a challenge called Operation Immunization by APhA. At that time most pharmacies were not offering immunizations, so we decided to focus our effort on an educational campaign. Since we were both pharmacy interns in an area where many people were not fluent in English, we decided to work on a bilingual brochure that stressed the value of vaccines and the seasonal flu shot. Our work garnered recognition at the 2002 APhA National Convention. That award still hangs in my office today. It brings me satisfaction to glance at it and know how far we have advanced the practice of immunizations in pharmacies since then.
Ghada Abdallah, R.Ph., is a clinical pharmacist at Beaumont Health in Royal Oak, Mich., and an independent pharmacy and business consultant. Prior to joining Beaumont she owned and operated her own pharmacies for 11 years. She is passionate about independent pharmacy, specifically in the areas of immunization, addiction, mental health, and end of life care.