With the expansion of pharmacy vaccination services across Australia, pharmacists are navigating an increasingly layered set of challenges.
Bill Wallace, PSA Pharmacist – Professional Support Adviser, outlines the most common vaccine-related questions that have come through this year.
1. Who can administer FluMist?
The introduction of intranasal influenza vaccine, FluMist, has prompted a wave of questions surrounding eligibility, prescribing and administration requirements.
Funding and eligibility differences between each state and territory are driving many of the inquiries.
‘We have had quite a few inquiries about whether [pharmacists] can administer FluMist to someone under 5 if they’ve got a prescription, which they can,’ said Mr Wallace.
State differences apply for initiation– Pharmacists in VIC, TAS, NT, and ACT are generally restricted to authorising and administering vaccines only to children aged 5 years and older. Whereas In NSW, WA, QLD, and SA, pharmacists can authorise and administer the influenza vaccine to children aged 2 and older.
Another recurring question is whether pharmacists who are not qualified immunisers can administer FluMist – given it’s administered nasally rather than via an intramuscular injection.
Mr Wallace noted that any vaccine administered by a pharmacist must be delivered by a qualified immuniser.
‘You need to be a qualified immuniser to meet the requirements for administering that particular medication. You’d be hard pressed to justify why you did it if something went wrong,’ said Mr Wallace.
The responsibility extends beyond simple administrative practices, and relates to professional accountability and emergency management responsibilities.
Mr Wallace noted that while serious reactions are rare, pharmacists still need to be prepared for any situation at hand.
‘If you weren’t qualified and a claim was made, your insurer and The Australian Health Practitioner Regulation Agency (Ahpra) would have many questions for you about your practice.’
2. Can pharmacists co-administer vaccines?
As Australia’s adult vaccination schedules get more complex, co-administration queries are becoming increasingly common.
‘Timing intervals and co-administration of vaccines is probably one of the more common clinical inquiries,’ Mr Wallace said.
Questions to the advice line often relate to whether vaccines can be given together, which vaccines require spacing, and whether they should be administered in one arm or both.
The National Centre for Immunisation Research and Surveillance guideline for vaccine co-administration and Australian Immunisation Handbook state that while most vaccines can generally be co-administered, separate injection sites should be used where possible, ensuring a distance of 2.5 cm between.
But Mr Wallace suggests pharmacists should also take additional care when reviewing Australian Immunisation Register (AIR) records and confirming patient histories to avoid inadvertent duplication
Particularly for older Australians, co-administration will be increasingly normalised for routine adult vaccinations (e.g. RSV, shingles, pneumoccocal, DTPa etc).
3. Can pharmacists vaccinate interstate?
Interstate practice continues to create a point of tension for pharmacist immunisers as requirements differ significantly between jurisdictions.
There are discrepancies between patient age eligibility, refresher requirements and additional accreditation, meaning pharmacists cannot automatically assume their qualifications transfer across all states and territories.
There are also differences between state and territory legislations which govern interstate pharmacists’ eligibility to administer vaccines, introducing barriers to interstate practice, according to the Immunisation Coalition.
‘Certain states, Tasmania, Victoria, and WA have slightly different training requirements … you need to ensure that you meet local state immunisation requirements prior to providing vaccinations,’ Mr Wallace said.
He stresses the importance of ‘checking what the differences are, and referring to resources like the local state pharmacist vaccination guidelines before administering vaccines’.
In some cases, pharmacists may need to complete an additional online module, although requirements vary. For example, the ACT has a Japanese encephalitis module that is required, and Victoria requires extra training to be able to provide certain travel vaccines.
Complicating matters further, immunisation requirements and eligibility for state and territory programs may change.
4. How do pharmacists maintain immunisation credentials?
Is it a matter of once a pharmacist immuniser, always a pharmacist immuniser?
Not quite.
According to Ahpra and state regulators, pharmacists must undertake annual immunisation-related CPD activities to maintain their currency.
‘Pharmacists must also maintain first aid every 3 years and CPR every 12 months,’ Mr Wallace said.
The PSA offers an online refresher training course which aligns with the current immunisation training. The training program consists of online modules to ensure a pharmacists’ accredited training remains up to date.
‘Some pharmacists did their vaccination courses a long time ago, with a much limited range of vaccines,’ he said.
‘There is also an Immunisation Practical Refresher Workshop that pharmacists can do if they’ve had a break in practice or want to refresh their technique.’
The online immunisation refresher course allows pharmacists to expand their training to cover all vaccines.
Looking for any answers to your queries? Hit up the Pharmacist Advice Line here.
