An Update on Technicians as Immunizers

In 2017, Idaho became the first state to allow pharmacy technicians to administer immunizations.¹ According to the Idaho legislative rule, the technician must be nationally certified, hold a current certification in basic life support, and have completed an Accreditation Council for Pharmacy Education—accredited course on appropriate immunization administration technique. Notably, the pharmacist can delegate only the technical task of physically administering the injection. The pharmacist is still required to perform all of the clinical elements of the immunization, such as prescription, verification, and patient counseling.

In 2016, Kyle Frazier, PharmD, and I, both at Washington State University (WSU) College of Pharmacy, created the first immunization training program specifically for pharmacy technicians.² This program was piloted with 25 pharmacy technicians from the Albertsons Corporation. The pilot study results showed that “pharmacy technicians demonstrated knowledge of vaccination procedures and self-reported improved confidence in immunization skills and administered immunizations after participating in a 4-hour training program.”^3-6 The trained technicians administered nearly 1000 vaccinations in the first 6 months after completing the training program.

The WSU course includes a 2-hour self-study program combined with a 4-hour live program. It is Accreditation Council for Pharmacy Education—approved and includes 6 hours of technician continuing education credit.² More than 500 pharmacy technicians have now completed this training program. The majority of participating technicians have been from Idaho; however, technicians from Washington State, Oregon, New Mexico, and Arizona have also taken the course. This course has also begun to receive national attention, with the program developer receiving the 2019 American Pharmacists Association Immunization Champion Award for Individual Practitioner.⁷

With the growth of training pharmacy technicians to administer immunizations, additional research has revealed what pharmacists think about having an immunizing pharmacy technician in their practice. In a poster presented at the American Pharmacists Association Annual meeting in 2018, Bertsch and colleagues described a qualitative key informant interview study conducted with pharmacists who supervise one of the pharmacy technicians who were involved in the pilot study. Those who were interviewed believed their technicians were capable of administering immunizations. The results also showed that adding an immunizing technician into the workflow was most successful when the pharmacists and technicians were both excited about the change and had a high degree of trust in each other.⁸

As more pharmacists and technicians adopt the new mindset of the immunizing technician, states are following suit. Rhode Island joined in the technician immunization movement in 2018. According to the state’s administrative rule 1.11.1B8b, “A technician II who has completed a recognized certificate training course on appropriate immunization administration technique and holds a current basic cardiopulmonary resuscitation training certificate, shall be permitted to administer vaccinations under the direct supervision and with the authorization of an immunizing pharmacist when;

(1) The immunizing pharmacist has completed all of the requirements pursuant to §1.11 of this Part prior to administration of the vaccination.

(2) The immunizing pharmacist is on the premises for postimmunization monitoring of the patient.”⁹

Plans are already in place to expand the WSU training program into the state of Rhode Island. Several major chain corporations already have courses scheduled to train Rhode Island pharmacy technicians using the program that has successfully educated the Idaho technicians.

Another expansion has occurred within the federal pharmacy system. No federal law addresses the scope of practice of pharmacy technicians. Typically, individual states define the scope of practice of various health care professionals, including pharmacy technicians. Federal facilities can expand a specific scope of practice by defining credentialing requirements through local policies and procedures. One example of this type of policy could be if a pharmacy technician is certified with a state or national pharmacy technician certification and completes the pharmacy vaccine administration training. Then the pharmacy technician may be able to administer vaccines, under immunization-certified pharmacist supervision. Recently, the Pharmacy Expanding Vaccine Access workgroup of the Commissioned Corps of the US Public Health Service (USPHS) Pharmacist Professional Advisory Committee announced that credentialed USPHS pharmacists have the ability to provide federal pharmacy technicians the opportunity to obtain a WSU Pharmacy Technician Vaccine Administration Certification.¹⁰

A shining example of the success of training pharmacy technicians who administer immunizations has been seen with Lieutenant Commander Doctor (LCDR) Greg Sarchet, PharmD, BCPS, NCPS. LCDR Sarchet works at Whiteriver Indian Hospital in Whiteriver, Arizona, overseeing several pharmacy technicians who now administer immunizations. In an exciting step forward, these technicians are administering immunizations to patients of all ages, including pediatric patients. The technicians also travel with pharmacists to perform patient home visits, which may include pediatric catch-up vaccines from missed well-child visits. As a result of these efforts, LCDR Sarchet was selected to receive the 2018 CDC Childhood Immunization Champion Award for his dedication to increasing immunization rates among Native American children.¹¹

Although the myriad ways pharmacy technicians are incorporated into immunization programs continues to grow, there is still much work to be done. For this work to have a national impact on immunization rates, focus must remain on continued growth and expansion of certifications across the nation.

Kimberly C. McKeirnan, PharmD, BCACP, is a clinical assistant professor in the department of pharmacotherapy at the Washington State University College of Pharmacy and Pharmaceutical Sciences.

REFERENCES

• Public Hearing: Rules of the Idaho State Board of Pharmacy Docket Number 27-0101-1603. October 31, 2016. Rule 330.03, 264.
• Pharmacy technician immunization training. Washington State University website. pharmacy.wsu.edu/pharmacy-technician-immunization-training/. Accessed February 9, 2019.
• WSU, Albertsons create first U.S. program allowing pharmacy technicians to administer immunizations [news release]. Spokane, WA: Washington State University; April 18, 2017. news.wsu.edu/2017/04/18/pharmacy-technicians-to-immunize/. Accessed January 20, 2019.
• McKeirnan KC, Frazier KR, Nguyen M, MacLean LG. Training pharmacy technicians to administer immunizations. J Am Pharm Assoc (2003). 2018;58(2):174-178.e1. doi: 10.1016/j.japh.2018.01.003.
• Berger K. Vaccines administered by certified pharmacy technicians in Idaho. Pharmacy Times website. pharmacytimes.com/contributor/karen-berger/2018/03/vaccines-administered-by-certified-pharmacy-technicians-in-idaho. Published March 27, 2018. Accessed February 9, 2019.
• McKeirnan K. Idaho leading the way in advancing technician roles in immunizations. Pharmacy Times website. pharmacytimes.com/contributor/kimberly-mckeirnan-pharmd/2018/03/idaho-leading-the-way-in-advancing-technician-roles-in-immunizations-. Published March 30, 2018. Accessed February 14, 2019.
• APhA celebrates pharmacists’ contributions to increasing U.S. immunization rates and improving health [news release]. Washington, DC: American Pharmacists Association; February 5, 2019. pharmacist.com/press-release/apha-celebrates-pharmacists-contributions-increasing-us-immunization-rates-and-1?is_sso_called=1. Accessed February 14, 2019.
• Bertsch T, McKeirnan K, Frazier K, VanVoorhis L, Shin S, Le K. Pharmacists’ perspectives on working with immunizing technicians. Presented at: American Pharmacists Association Annual Meeting; March 16-19, 2018; Nashville, TN. Poster 198. aphameeting.pharmacist.com/sites/default/files/files/Poster Presentations.pdf.
• Pharmacists, Pharmacies, and Manufacturers, Wholesalers, and Distributors (216-RICR-40-15-1) Rhode Island Department of State. 1.11.1B8b. (2018) https://rules.sos.ri.gov/regulations/part/216-40-15-1. Accessed February 9, 2019.
• PEVA: Pharmacy Expanding Vaccine Access. Commissioned CORPS of the U.S. Public Health Service / Pharmacist Professional Advisory Committee website. dcp.psc.gov/OSG/pharmacy/pevahomepage.aspx. Updated January 7, 2019. Accessed February 9, 2019.
• NIIW (National Infant Immunization Week) Champion Award Winners. CDC website. cdc.gov/vaccines/events/niiw/champions/profiles-2018.html. Updated April 23, 2018. Accessed February 9, 2019.