University of Manitoba, Faculty of Health Sciences, College of Pharmacy ... Manitoba's College of Pharmacy, College of Nursing, College of Medicine, the.
Implementing a Sustainable Pharmacy Immunization and Injection Training Program Through Interprofessional Collaboration Christopher Louizos, Grace Frankel, Casey Sayre, Christine Leong, Dana Turcotte, Neal Davies University of Manitoba, Faculty of Health Sciences, College of Pharmacy Winnipeg, Manitoba, Canada
Introduction
Results
• In recent years, more and more Canadian provinces are granting pharmacists the ability to inject drugs and administer vaccines. (1) • Experience from the United States has shown that allowing pharmacists to immunize is “clinically sound, cost-effective, readily accessible and supportive of public health goals.” (2) • On January 1, 2014 Manitoba passed a new Pharmaceutical Act, known as Bill 41. This new Act allowed Manitoba pharmacists to administer vaccines and other drugs. (3) • There was a need for a training program to certify both practicing pharmacists and pharmacy students in administering injections - this poster describes the development of a certificate program developed to fill that need. • The program was developed through an inter-professional Immunizations and Injections Program Group (IIPG). The IIPG included representatives from pharmacy and nursing, with medicine assisting with the later stages of the program.
The resulting training program consisted of two parts: an online program that served as a pre-requisite to the Practical Skills Workshop, and the Workshop itself. Table 1 outlines the program in its entirety. Part 1: Pre-requisites to the Practical Skills Workshop •To attend the Practical Skills Workshop, participants were required to have certification in Standard/Emergency First Aid with CPR Level C, and also pass the online didactic modules from EPIC hosted on www.advancingpractice.com. The EPIC (CCCEP #1066-2015-1324-B-P) program was developed by Advancing Practice (4) and was selected by the IIPG for its thorough content, user friendly interface, French language option, and 24 hour availability. •The online module developed by the ad-hoc committee was known as the Manitoba Module: Administration of Injections (CCCEP #1193-2013-853-I-P). This module covered Manitoba-specific content such as legislation, and was added as a 15th module in EPIC. •The College of Pharmacy’s 3rd year students were also required to pass an inclass quiz in order to ensure competency. Table 1: Overview of Immunizations and Injections Program Part 1: Classroom and Didactic portion Requirements (Pre-requisites to the Practical Skills Workshop) A. Emergency First Aid and CPR Level C B. Online Didactic Modules (Advancing Practice) 1. The Immune System and Vaccines 8. Administration of Immunizing Agents 2. Vaccine-Preventable Diseases 9. Adverse Events Following Immunization 3. Vaccine Development and Evaluation 10. Documentation 4. The Types of Immunizing Agents and their 11. Populations Requiring Special Considerations Composition 12. The Canadian Immunization System 5. Population Health 13. Immunization Issues 6. Communication 14. Legal and Ethical Aspects of Immunization 7. Storage and handling of Immunization Agents 15. Manitoba Module – Administration of Injections Part 2: Immunization and Injections Practical Skills Workshop
Methods • The IIPG consisted of stakeholders from pharmacy, nursing and medicine. More specifically, the organizations involved were the University of Manitoba’s College of Pharmacy, College of Nursing, College of Medicine, the College of Pharmacists of Manitoba (CPhM), Pharmacists Manitoba, the Canadian Society of Hospital Pharmacists (CSHP), and finally Manitoba Health. The IIPG completed the following:
Step 1
Step 2
Step 3
• Internal scan of existing Immunizations and Injections programs available within the University of Manitoba’s Faculty of Health Sciences • External scan of existing Immunizations and Injections programs available in Canada
• An Ad-Hoc Committee (College of Pharmacy, the College of Nursing, and CPhM) was tasked to create a detailed Practical Skills Workshop (Table 1, Part 2)
• The Ad-Hoc Committee was also tasked to create an additional online module (Table 1, Part 1 Module 15) to address the legal requirements and practice direction for Pharmacists in Manitoba
Step 4
A. Didactic portion (Pharmacy) - Introduction and overview - Regulations - Informed Consent - Patient Assessment - Vaccination Myths
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Discussion • As a result of governmental delay, many pharmacists and pharmacy students participated in the certificate program up to 17 months prior to the passing of the new Pharmaceutical Act in Manitoba. • This resulted in the necessity to create refresher sessions. Practicing pharmacists partnered with nurses to allow an opportunity to re-train and refresh skills. • The College of Pharmacy took a slightly different approach for students, partnering with the College of Medicine’s Immunization program. Students in their 4th year of Pharmacy participated in a mandatory refresher and were given the opportunity to participate in immunization clinics. • These clinics were scheduled throughout the year and allowed 4th year Pharmacy students to practice in a collaborative environment with 2nd year medical students. • To gain further experiential confidence, the students were given the opportunity to participate in College of Pharmacy outreach influenza immunization clinics at the College of Nursing, the College of Pharmacy and at another local institution, the University of Winnipeg. Students immunized faculty/staff, students and the public at these clinics. Students were involved in proper patient triage, immunization preparation and injection, and postinjection patient monitoring. In 2015 alone the Pharmacy students administered over 500 doses of the influenza vaccine. • Feedback has been overwhelmingly positive on this experience. • The Points for Interprofessional Education System (PIPES) score for this activity is 55 points (Orange 45-55).
Preparing Medications Summary Post-injection Monitoring Anaphylaxis/Adverse Event Management Needle Stick Injuries Documentation
B. Didactic portion (Nursing) - The 7 Rights - Landmarking C. Skills Part 1(Nursing) - Routine practices review - Sharps handling review - Reconstitution and withdrawal - 7 Rights and Patient Assessment D. Skills Part 2 (Nursing) - Subcutaneous Injections - Intradermal Injections E. Skills Part 3 (Nursing) - Intramuscular Injections
• Selection of an existing Immunizations and Injections program • Education Program for Immunization Competencies (EPIC) was selected as the foundational knowledge modules necessary for all participants (Table 1, Part 1 Modules 1-14)
• In addition to practicing on each other, participants also used a Limbs and Things® injection trainer. This trainer was chosen because of its ability to accurately demonstrate all three injection types. • The program has run numerous training sessions since its inception in August 2012, and so far has certified 204 Pharmacy students and 485 practicing Pharmacists. In Manitoba, a total of 665 Pharmacists have received CPhM authorization to administer drugs and vaccines by injection.
Pharmacy students participating in the Immunizations and Injections re-fresher program and clinics
Conclusions • The IIPG has successfully implemented a model for an Immunizations and Injections certificate program that is embedded into the Pharmacy program curriculum and for use by practicing pharmacists. • We look forward to the continuing success of this training program in helping to certify both present and future pharmacists.
F. Practice and Technique Assessment (Nursing/Pharmacy)
Part 2 – Practical Skills Workshop •After all the pre-requisite requirements were met, participants would be required to attend a Practical Skills Workshop, which involved the teaching and assessment of administration of intradermal, subcutaneous, and intramuscular injections. •The Workshop was a joint teaching venture between pharmacists and nurses, both acting as facilitators and evaluators. Participants were evaluated (pass/fail) on their technique in pre-injection procedures, the injection itself, and post-injection procedures. A trained Pharmacy or Nursing facilitator supervised all injections performed by participants on each other.
References 1. Canadian Pharmacists Association. Pharmacists Expanded Scope of Practice in Canada. Updated April 2015. Available at: http://www.pharmacists.ca/index.cfm/pharmacy-in-canada/scope-of-practice-canada/ [Accessed May 28, 2015] 2. American Pharmacists Association and Academy of Managed Care Pharmacy. Pharmacist-provided immunization compensation and recognition: White paper summarizing APhA/AMCP stakeholder meeting. J Am Pharm Assoc. 2011;51:704-712 3. Legislative Assembly of Manitoba. The Pharmaceutical Act (Bill 41). S.M. 2006, c. 37. Winnipeg, Manitoba, Canada. Available at: http://web2.gov.mb.ca/laws/statutes/2006/c03706e.php 4. Advancing Practice. Education Program for Immunization Competencies. 2015. Available at: http://www.advancingpractice.com/p-85education-program-for-immunization-competencies.aspx [Accessed May 28, 2015] 5. Marra F, Kaczorowski JA and Marra C. Assessing pharmacists’ attitudes regarding delivery of the pandemic influenza vaccine in British Columbia. Canadian Pharmacists Journal 2010;143:278-284
Acknowledgments The authors would like to thank the Immunizations and Injections Program Group (IIPG), Alby Kusno (Pharmacy Summer Student), the adhoc committee, facilitators, and interested stakeholders who continue to make the training of pharmacists and pharmacy students in Manitoba feasible.
