Critically important to the success of population health are vaccines that immunize children and adults against diseases like the flu, hepatitis B, measles, mumps, pneumonia and tetanus.
With this growing need for effective immunization programs to manage population health, the American Pharmacists Association has released a 26-page resource guide for pharmacists. The resource guide, , explains how pharmacists can apply the five-step patient care process to patient-centered regular and seasonal vaccine services for their pharmacies.
“The document provides a guide for implementing immunization services within the pharmacists’ patient care process that will ultimately lead to increased access to and the administration of vaccine,” the APhA said in announcing the guide. “This benefits the health of our communities.”
Below is an overview of the five steps in the patient care process and how they can be applied to pharmacy-based immunization services.
1. Collect personal health information from each patient
Pharmacists must collect the right personal health information from each patient to determine what vaccines they may need and health factors that may determine what vaccines to avoid or precautions to take when administering the vaccines. The right personal health information to be collected includes the following 11 data points: age; health conditions; occupation; travel; lifestyle; current health status; present and past medical history; allergies; medications; vaccination history; and pregnancy status (for woman). Pharmacists can collect the personal health information from each patient using an immunization checklist. They can collect and verify the information from multiple sources, including:
- A patient’s personal immunization record
- A state immunization information system
- A pharmacy management system
- A patient’s primary care physician
- A patient-provided immunization history
2. Assess the information to determine each patient’s vaccine needs
Using the information collected from each patient, pharmacists should assess the information to learn which vaccines are indicated without restrictions, which are contraindicated and which can be administered with specific precautions. The starting point is the age of the patient, which determines which vaccines are recommended by the Centers for Disease Control and Prevention. The CDC publishes and updates age-based vaccine schedules: the first for people from birth through age 18; the second for people age 18 or older. Pharmacists should assess the other health information variables to identify the recommended vaccines. For example, knowing the patient’s vaccination history will help decide which vaccinations were missed and need to be done and which ones were given and should be avoided.
3. Develop an individual immunization plan for each patient
After collecting and assessing the 11 personal health information data points, pharmacists should develop individualized patient-centered immunization care plans for each patient. Pharmacists should craft the plans in consultation with the patient, his or her caregiver and the patient’s physician or other health care practitioner or provider, when appropriate. “Research indicates that a health care provider’s recommendation is the strongest predictor of whether patients get vaccinated,” the resource guide said. Among the important features of the immunization care plans are:
- Recommended vaccines and vaccine schedule for the patient
- Medical rationale and support for recommended vaccines
- Health plan coverage and patient financial responsibility for recommended vaccines
- Availability of recommended vaccines
- Scheduled follow-up visits with the patient
4. Implement the individualized immunization plan for each patient
Like developing vaccine plans for each patient, pharmacists should execute each plan in consultation with the patient, his or her caregiver and the patient’s physician or other health care practitioner or provider, when appropriate. Pharmacists must verify their state authority to administer vaccines and follow all reporting and compliance requirements. That likely will include educating patients on the recommended vaccines in the care plan and providing patients with Vaccine Information Statements that detail the medications they are about to receive. Pharmacists should make sure they have the recommended vaccines in stock or are able to refer patients to other immunization providers for the recommended vaccines. The final stage of implementation is administration of the vaccines themselves. Pharmacists must be properly trained to deliver the vaccines and follow the required steps to administer the vaccines to patients safely and effectively.
5. Put systems in place to monitor, evaluate and follow up with each patient
Pharmacists who administer vaccines to patients in their pharmacies should have in place systems to monitor and manage adverse reactions to the medications. Those reactions can range from injection-site reactions to anaphylactic shock. Such reactions must be documented in patient records, reported to the federal Vaccine Adverse Event Reporting System and shared with patients’ primary care physicians. Pharmacists also should have systems in place to prompt follow up consultations with patients who may have declined initial vaccine recommendations, patients who may have delayed vaccines because of temporary medical illnesses and patients who many need another vaccine as part of a multiple-injection immunization process.
In sum, the five-step pharmacist’s patient care process—collect, assess, plan, implement and follow-up—can be applied effectively to a pharmacy-based immunization service to create more clinical value for patients and to improve the population health of a community.
Related: Learn more about Studiomaca’s vaccine supply, purchasing and distribution for pharmacies