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Pharmacists Given Injection Authority

As a result of the H1N1 flu pandemic, changes were made to the Health Professions Act that now allows qualified pharmacists to administer vaccinations and other injections to patients in British Columbia. This new change in health care policy is an emerging trend as pharmacists in Alberta, Manitoba and New Brunswick has already been granted this ability, while it is currently being discussed in Nova Scotia and Ontario. This new expanded role has led to the College of Pharmacists of British Columbia to offer an accredited training program that will provide pharmacists with the knowledge and practical training to be effectively qualified to offer injections. The new role is within the realm of expertise of pharmacists since, in addition to the accredited injection training program, pharmacists are educated in anatomy, physiology, pathophysiology, pharmacokinetics and pharmacology. In this paper, I will analyze the impact of this change in health care policy on the profession of pharmacy and relate this to how I, as a pharmacist will adapt to and respond to this new role.

Prior towards this change in health care policy, pharmacists were traditionally responsible for the acquisition, storage and distribution of vaccines. But, with this new responsibility, there is more emphasis on pharmacists to advocate the benefits of vaccinations. As a result, the impact on the profession of pharmacy will allow the pharmacist to play a major role in preventive health care. The extent of this role will likely be determined by how effective pharmacists are at providing leadership during the H1N1 vaccination program. This is because vaccinations are one component under the branch of preventive health care and the measures taken to increase the compliance with vaccines can be extrapolated to help prevent diseases in general. What could be achieved during this pandemic is the realization that pharmacists are in a very unique position to excel in a preventive health care role and correspondingly, new laws could provide additional responsibilities, such as the ability to ordering screening tests for at risk patients.

The ability to give vaccinations fits in naturally within the pharmacists’ scope of practise. As a pharmacist, I am the most accessible health care professional since pharmacies are open late and they are situated throughout the various regions of British Columbia. And because of this accessibility, a united effort among pharmacists can make significant gains towards providing herd immunity. My access to my patient’s drug profiles is a major benefit and would allow me to identify at risk patients based on their medications and screen them for immunization needs. Rather than waiting for patients to come to me, I believe that a more proactive approach is needed in order to help maintain the patient’s health. One way that pharmacists could adapt to a more proactive approach in promoting immunizations is to offer hand outs listing all the possible vaccinations and the recommendations, along with the prescription. But to severely increase the immunization rates, pharmacists must increase their involvement in public education. The most recent statistics showed that only 31.7% of Canadians aged 12 or older have reported that they have been vaccinated against influenza in 2008(1). Public education campaigns in the form of community presentations can help inform patients about the benefits of vaccinations compared to the likelihood of side effects as well as address any concerns that they may have. With more knowledge, the patients can make more informed decisions and it is likely that the immunization rates will increase as a result. However, the current H1N1 vaccination program in British Columbia has provided an insight into the possible barriers that are limiting the potential of this new policy. First of all, as of October 21, 2009, only around 150 out of a possible 2800 pharmacists have completed the training program(2). There appears to be a lack of widespread embracement of this new responsibility and common concerns include a lack of time and liability issues. Pharmacists do not have to respond to this by providing vaccinations; they could also adapt a role as collaborators or facilitators. In this role, they will be hosting other medical professionals who will do the actual injections and this will help circumvent any liability issues. Being a facilitator is equally as important, as pharmacists’ increases accessibility to vaccines and has a major role in presiding over the clinic to ensure proper storage and preventing any possible drug therapy problems. For the pharmacists who lack time to provide vaccinations, they could help create unity amongst this new role by including vaccinations are part of their counselling. Some clinics have operated as little as 50 per cent capacity(3) and this low turn out is due in part to the false information as well as media bias regarding vaccinations. Since pharmacists are the medication experts, we should respond by having a more prominent role in debunking common concerns such as “the mercury in vaccines causes autism” and “the risk of side effects from vaccines are far greater than the chances of experiencing an adverse reaction after receiving a flu shot”. One way that pharmacists can adapt to the media bias is to designate pharmacists to handle media relations and provide a response to the many articles that are persuading individuals not to take vaccines because of serious safety issues, when in reality out of 6.6 million H1N1 doses distributed, 36 individuals reported serious adverse reactions and even so, they may be caused by underlying medical conditions(4). Of course, on a smaller scale, individual pharmacists must be self directed learners and analyze up to date information regarding the vaccination concerns to be able to answer questions from their patients. Lastly, there seems to be some concern over the whether pharmacists are qualified to perform vaccinations. This seems to stem over the lack of knowledge over the qualifications to become a pharmacist. To change this perspective, pharmacists can address their qualifications during the public education presentations about vaccinations. If there are many presentations through the British Columbia, and in each presentation, the pharmacist summarizes his education background; this ignorance of the general public can be shattered and more patients would embrace this new role of pharmacists.

In conclusion, the ability of pharmacists to give vaccinations has tremendous implications on the practise of pharmacy. If there is a united movement among pharmacists to embrace this role, as immunizers, public educators or facilitators, there is potential for pharmacists to have a major role in preventive health care. That is because the new roles that the pharmacists have are the fundamentals behind preventive health care. Pharmacists need to be proactive and screen for at risk patients and advocate for awareness of common diseases, and if pharmacists are able to surmount the barriers that were mentioned in this essay, then there is potential for the role of pharmacists to evolve from administering vaccinations to having the authority to order diagnostic tests as well.

References

  1. Statistics Canada. Influenza immunization: Fact sheet on influenza immunization [document on the Internet]. Government of Canada [updated 2009 August 18; cited 2009 Nov 22]. Available from: http://www2.news.gov.bc.ca/news_releases_2009-2013/2009HSERV0026-000515.htm
  1. B.C pharmacists to give injections for vaccines. Ministry of Health Services [news release on the Internet]. 2009 Oct 21 [cited 2009 Nov 22]; para 3. Available from: http://www2.news.gov.bc.ca/news_releases_2009-2013/2009HSERV0026-000515.htm
  1. Low turnouts lead to H1N1 vaccine availability for everyone in B.C. The Vancouver Sun [newspaper on the Internet]. 2009 Nov 19 [cited 2009 Nov 22]; para. 2. Available from: http://www.vancouversun.com/health/turnouts+lead+H1N1+vaccine+availability+everyone/2242326/story.html
  1. Adverse reactions seen in 36 Canadians after H1N1 shot: official. The Globe and Mail [ newspaper on the Internet]. 2009 Nov 17 [cited 2009 Nov 22]; para 3. Available from: http://www.theglobeandmail.com/news/national/adverse-reactions-seen-in-36-canadians-after-h1n1-shot-official/article1366564/

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