The Progression of Immunization - Episode 7
Certification, Technicians' Training, Staying Current
Troy Trygstad, PharmD, MBA, PhD; Brian Hille, BSPharm, RPh; John Beckner, BSPharm, RPh; Ned Milenkovich, PharmD, JD; and Mindy Smith, BSPharm, RPh, consider the certification requirement for pharmacist and pharmacy technicians and the tools available for pharmacists to stay current on requirements.
Troy Trygstad, PharmD, MBA, PhD: All of us who grew up in this era of emerging practice with vaccinations who practice have gone through immunization training. What does the training look like for your pharmacy technicians: the same, identical, different?
Brian Hille, BSPharm, RPh: We use a course that was developed through Washington State. I’m sure there will be other courses that will be created with time, but it’s very focused on actually administering a vaccination. And so, they receive…if you look at the APhA training, the very last part of the day is kind of what they receive as far as the technician, as far as their training, because they don’t need the rest of the education that the pharmacist receives. They just need to be able to know the mechanism of it.
Troy Trygstad, PharmD, MBA, PhD: So, I graduated from pharmacy school in 2002. I don’t recall a lot of immunization training. In 2018 today, John, what does the curriculum look like in the typical school of pharmacy? We just had a long conversation about the importance of it to the professionals, to patients, making it ubiquitous. What does it look like in pharmacy school curriculum today?
John Beckner, BSPharm, RPh: I think the pharmacy schools have come to the realization that that’s probably the most common patient care service that’s being offered, and they’ve incorporated it into their curriculum. I think most of the pharmacy schools have it. It has really become an integral part of pharmacist training. I think it’s typically in the early years of pharmacy school, so when they go out into their internships and clinical rotations, they’ve already been trained to do that. So, if they’re doing the rotations in a state that allows interns to administer, they’re able to do that, because they’ve already gone through the training in pharmacy school.
Troy Trygstad, PharmD, MBA, PhD: New students, graduating residents. Impressed?
Brian Hille, BSPharm, RPh: Oh, yes. It’s such a standard of practice anymore. We still have a certificate training course that we use within our company, but it just does not get used very often, because everybody has been trained. All the pharmacists are really expecting to be practicing this way in their internship. They welcome opportunities to be able to do some more advanced things. John mentioned going on-site for a flu clinic to create opportunities for students to really participate in those kinds of events. It has become a very standard practice.
John Beckner, BSPharm, RPh: And the APhA program has been taken over by the states over the years, but it’s certainly the gold standard. You do that training. You feel confident that you can go out and provide that service.
Troy Trygstad, PharmD, MBA, PhD: Your company has got some interesting pilot testing going on. Do you want to describe those tests of administration?
Brian Hille, BSPharm, RPh: Yes. John mentioned one. In the state of Idaho right now, it is a lone wolf, and we have the ability to be able to have our technicians actually perform the physical administering of a vaccination. And so, people hear that, and sometimes they think, “Oh well, you’re taking the pharmacist’s job away and the concern with that.” We actually have seen just the opposite. We piloted very early on, have just over 20 pharmacists who went through the training, put them back into their pharmacies. The pharmacists enjoyed the assistance so much, and it was so effective that every one of our pharmacies in the state of Idaho has at least 1 technician that’s trained. And my past 2 years, my entire family has had their flu shots and all their vaccinations given by a technician. But they do the mechanical piece of it, which is very well suited for a technician to do. The pharmacist still does the making sure they’re doing the right screening questions and the selection of the product.
Troy Trygstad, PharmD, MBA, PhD: Importantly, what we just discussed, the patient walks up to the counter and says, “I don’t want a flu vaccine this year. It got me sick last year.” Is it more important that we’re spending pharmacist time on that or using an opposable thumb?
Brian Hille, BSPharm, RPh: That’s right, opposable thumb.
Troy Trygstad, PharmD, MBA, PhD: That’s the theory of the case in Idaho and with Albertsons. What’s the next step with that program?
Brian Hille, BSPharm, RPh: Well, hey, I’d love to see adoption across more states, obviously. Right now, they’re permitted to administer immunizations today, which is a great place for us, and we use them extensively. I could see that this could go other places where technicians start taking on bigger roles, or we start actually using technicians the way the law allows us to. And certainly, anything of taking prescriptions over the phone—there are opportunities to use techs better than we do today.
Troy Trygstad, PharmD, MBA, PhD: So let me ask the panel, then. When we’re talking about information and staying up-to-date, let’s start with Ned and move from west to east here. I’m a pharmacist out there practicing: What’s my first or go-to source of information to help me navigate through all of this, from your perspective?
Ned Milenkovich, PharmD, JD: Well, each individual state law is going to be different, so I think you need to understand what the laws and the rules are in your state and what the board of pharmacy has promulgated in that regard. When it comes to clinical resources, I think APhA has a wonderful program. There are other programs out there, training programs—we’ve touched on them earlier—that the pharmacists should avail themselves of and just continually keep up with their clinical training. If you’re not immunizing and you want to get into it, I think as John mentioned earlier, there’s information everywhere. You just have to plug in, and it’s there for you. If you’re already doing it, just make sure you’re staying in touch with all of the latest and greatest clinical literature and things that you need to do to continue to be a good practitioner.
Troy Trygstad, PharmD, MBA, PhD: And John, let’s pretend you’re back at your practice in Virginia. You show up Monday morning 1 hour early for your shift, and it’s September 1. How are you going to best use that hour to get up-to-date on flu vaccinations but also vaccination information generally?
John Beckner, BSPharm, RPh: Well, first and foremost, I’m going to make sure I’m up-to-date on our state regulations and laws and making sure there haven’t been any changes with regard to that since the last flu season. But I guess my primary source of information, if I am a practitioner, is go to the CDC. I think their website has a plethora of information from A to Z regarding immunizations and vaccinations. Immunization action coalition is another resource and there are great resources on APhA. We have a web page or website devoted to immunizations at NCPA [National Community Pharmacists Association].
Troy Trygstad, PharmD, MBA, PhD: Mindy, I’m putting you back in the pharmacy next Wednesday. So, you’re going to go from wherever you’re at now to being on par with everybody else. Where are you going?
Mindy Smith, BSPharm, RPh: Thanks. So, probably CDC, but I also know that our National Pharmacy Association, APhA, and CPA have these great resources. If I’m a PrescribeWellness pharmacy, we also have a data bank of resources that we culminate from information that’s available from the state but also the national associations, and we try to keep it simple—always try to keep it simple. So, that would be my go-to resource, but I also would then rely on data and information that I have on that individual patient, too, because you have to go down to the patient level, as well, and make clinical decisions to take care of each individual who walks in.
Troy Trygstad, PharmD, MBA, PhD: Brian, what does Albertsons use?
Brian Hille, BSPharm, RPh: Well, there’s not much to add to what everybody said…the ACIP [Advisory Committee on Immunization Practices] guidelines and having that chart printed up and in the pharmacy that shows your adult and adolescent immunizations and the decisions that need to be made. IAC, the Immunization Action Coalition—I’ll just use an acronym there—they have excellent resources, and so do pharmacy associations. There’s just a plethora of information. You just want to make sure you stay with the reputable ones—I think that is probably the big thing—and I really like APhA’s information. But immunization action coalition and the ACIP, I think, are go-to resources.
John Beckner, BSPharm, RPh: One other thing. If you’re a pharmacy and you’re providing travel health and travel vaccinations, Tropimed and Travax are 2 great resources, as well.