Perceived Benefit of Immunization-Trained Technicians in the Pharmacy Workflow

Vaccine administration by pharmacy technicians: Impact on vaccination volume, pharmacy workflow and job satisfaction

Background

Immunizing pharmacy technicians (IPTs) have become more prevalent in recent years, but their impact on community pharmacy practice has yet to be determined.

Objectives

Determine the impact of implementing IPTs on vaccination volume in a community pharmacy chain and assess pharmacy staff's perspectives on the clinical abilities of IPTs and their impact on pharmacy workflow and job satisfaction.

Methods

Retrospective data analysis comparing the number of vaccines administered in a supermarket pharmacy chain from September to March 2019-2020 and 2020-2021 in pharmacies with IPT(s) versus those without IPT(s). For the secondary objective, investigators developed and deployed two role-based mixed quantitative/qualitative surveys among pharmacy staff.

Results

Pharmacies with IPT(s) observed a greater mean increase in vaccination volume from 2019-2020 to 2020-2021 versus those without IPTs (+159.35 vs. +104.57, p = 0.011). Among IPT survey respondents, 50/75 (66.7%) felt more satisfied with their job after receiving immunization training. Among pharmacist respondents, 80/119 (67.3%) felt that IPTs positively impacted their job satisfaction and 61.7% felt that pharmacist clinical services were either somewhat positively affected, or positively affected.

Conclusion

Implementing IPTs can increase the volume of vaccines administered in a chain pharmacy and may positively affect job satisfaction and pharmacy workflow.

Evaluation of technician immunization administration

OBJECTIVES

To (1) assess technician and supervising pharmacists' attitudes and perceptions toward technicians administering immunizations after a technician training initiative, (2) describe the public health impact of technician-administered COVID-19 immunizations, and (3) describe best practices for technician-administered immunizations.

DESIGN

A mixed-methods study collected quantitative and qualitative data.

SETTING AND PARTICIPANTS

Kentucky technicians who completed an immunization administration training, and their supervising pharmacists.

OUTCOME MEASURES

Surveys were administered to Kentucky technicians who completed immunization administration training between January and September 2021. Surveys assessed the effectiveness of the training, integration of technicians in the immunization workflow, and impact of technicians in their organization's immunization efforts. Similar surveys were deployed to supervising pharmacists. Response frequencies were recorded for each question and descriptive statistics were calculated for each item included in the survey. Key informant interviews were conducted with technicians and pharmacists to further explore study concepts, assess needs, and discuss best practices for implementation. Interviews were audio recorded, transcribed verbatim, and analyzed using inductive thematic analysis.

RESULTS

Fifty-seven technicians and 37 pharmacists responded to the survey. Technicians were easily integrated into community pharmacy immunization workflow that allowed for increased immunization administration. Ninety-four percent of supervising pharmacists and 98% of technicians supported the use of technicians in the immunization workflow beyond the pandemic. Twenty-seven interviews were conducted. Major themes that emerged from the data included using the "right" technicians, role delineation and collaboration, policies, logistics, financial implications, and public health impact.

CONCLUSION

The utilization of pharmacy technicians in administration helped to accelerate the immunization process, alleviate the burden on pharmacists and other health care professionals, and ensure widespread vaccine distribution to combat the pandemic.

Implementation of a Pharmacy Follow-Up Program for Dispensed Opioid Medications

BACKGROUND

There have been multiple reported pharmacy initiatives to reduce opioid misuse and accidental overdose to address our nation's public health crisis. To date, there has not been a description in the literature of a community pharmacy follow-up initiative for dispensed opioids.

METHODS

A follow-up program was designed and implemented in community pharmacies as part of a previously developed opioid overdose and misuse prevention program (ONE Program). Five to twelve days after the dispensing of an opioid, pharmacy technicians called the patient to follow up on opioid safety topics. Pharmacy technicians used a questionnaire to inquire about medication disposal plans, if the patient was taking the medication more than prescribed, medication side effects, and if the patient needed a pharmacist consultation. The results from that questionnaire were documented.

RESULTS

During the first 18 months of the follow-up program, 1789 phone calls were completed. Of those contacted, 40% were still using their opioid medication, and over 10% were experiencing side effects which triggered a pharmacist consult. Patients were reminded of proper medication disposal methods, and most patients (78%) desired to dispose of unused medication at the pharmacy medication disposal box.

CONCLUSIONS

Follow-up phone calls post-opioid medication dispensing were shown to add value to a previously established opioid misuse and accidental overdose prevention program and allowed for the fulfillment of the Pharmacist Patient Care Process.

A qualitative evaluation of pharmacy technician opinions about administering immunizations

Introduction

Pharmacy technicians began administering immunizations in Idaho State as part of a new administrative rule in 2017. Rapid expansion of pharmacy technicians as immunizers occurred during the COVID-19 pandemic. Previous studies demonstrate the success of having technicians as immunizers but, the opinions of technicians themselves about immunizing have not been explored.

Methods

Key informant interviews were conducted to evaluate the opinions of certified and immunization-trained pharmacy technicians in the State of Idaho. A key informant interview script was utilized and included questions regarding satisfaction with current position, feelings about responsibility in the pharmacy, confidence administering immunizations to patients, changes patient interactions after becoming immunization-trained, support in the pharmacy, and opinion about expansion of immunization training for technicians to other states. The aim of this research was to gather the opinions of pharmacy technicians regarding the impact of administering immunizations on job satisfaction and career outlook.

Results

Fifteen pharmacy technicians were interviewed. All participants believed their role as immunizers improved job satisfaction and feelings of being a valuable part of the pharmacy team. Technicians also believed being able to immunize aided in pharmacy workflow, decreased wait time for immunizations at their respective pharmacies, and increased the number of immunizations being administered. Respondents also believed technicians should be allowed to administer immunizations nation-wide but also felt strongly that the decision to immunize should be up to each individual pharmacy technician.

Conclusion

Immunizing technicians in this study believe that this advanced role has had a positive impact on their job satisfaction, feeling valued in the workplace, and likelihood of staying in their current position. Immunizing has also led to positive engagement with patients and beliefs that they are providing an impactful service to their communities.

Perceptions of pharmacy technician students of the CARD (Comfort Ask Relax Distract) e-module introduced as part of vaccine injection training

Introduction

The scope of practice for pharmacy technicians is expanding to include vaccine administration in some provinces. Vaccine training courses and programs currently do not include education about mitigating immunization stress-related responses (ISRR) and improving the vaccination experience. We obtained feedback from pharmacy technician students about a new e-module that addresses this identified knowledge gap, whereby learners are educated about CARD (Comfort Ask Relax Distract), a vaccine delivery framework that reduces ISRR and improves the vaccination experience.

Methods

Mixed-methods design including second-year pharmacy technician students who elected to take an accredited vaccine injection training program. Students were given access to the CARD e-module after completing mandatory vaccine education components. Eight students answered a quantitative survey and 4 (50%) additionally participated in a focus group. Qualitative data were analyzed deductively using the Consolidated Framework for Implementation Research (CFIR).

Results

The study was conducted between April 28 and June 12, 2022. Students reported positive attitudes about the CARD e-module across quantitative and qualitative measures. Qualitative feedback spanned 4 CFIR constructs: intervention characteristics, outer setting, inner setting and individual characteristics. Students reported the e-module was well designed and that the content was relevant. They believed CARD facilitated provision of vaccinations using a person-centred approach that promotes vaccination. They felt that CARD could potentially add time to the vaccination appointment and that it would need to be acceptable to pharmacy leaders because of implications for training and vaccination delivery. They suggested that CARD education should be mandatory. CARD improved their confidence in delivering vaccinations, and they planned to integrate CARD into their practice.

Conclusion

The CARD e-module was well received by pharmacy technician students when coupled with usual vaccine injection training.

Pharmacy technician-administered immunizations: A five-year review

In October 2020, the U.S. Department of Health and Human Services (HHS) issued guidance authorizing trained pharmacy technicians in all states to administer immunizations. Given that this action is temporary, it will be necessary for states to adopt their own legislation or regulations to sustain these efforts beyond the coronavirus pandemic. At least 11 different immunization administration training programs have emerged for pharmacy technicians. An increasing number of publications have emerged on pharmacy technician immunization administration, demonstrating the ability to train technicians and have them safely administer immunizations in practice. Supervising pharmacists reported initial hesitancy but strong acceptance of delegating this task after experience in practice. States should look to expand and make permanent the authority of pharmacy technicians to ensure these benefits can continue to be realized after the HHS guidance expires.

Immunisation provider experiences with an automated short message service-based active surveillance system for monitoring adverse events following immunisation: A qualitative descriptive study

Objective

Currently, active surveillance systems to monitor adverse events following immunisation are limited to hospitals, and medical and immunisation clinics. Globally, community pharmacies represent a significant destination for immunisation services. However, until recently, pharmacies lacked active surveillance systems. We therefore wished to explore pharmacists’ experiences with SmartVax: an active surveillance system that has recently been integrated for use in Australian community pharmacies. Specifically, we wished to explore pharmacists’ perceived (1) benefits of using SmartVax, (2) areas for improvement in the system, and (3) issues with future/ongoing access to the system.

Methods

The present study forms the qualitative arm of a convergent mixed-methods pilot study. In the present study, we performed semi-structured interviews with pharmacist immunisers after a 21- to 22-week trial period with SmartVax. Thematic analysis of interview transcripts was performed independently by two researchers in QSR NVivo 12, using the framework method.

Results

Fifteen participants completed the semi-structured interviews. A broad range of perceived benefits were cited by participants, including the usability of SmartVax, the ease of patient follow-up facilitated by the system, and enhancement to the patient–pharmacist relationship. Participants voiced a desire for the system to have more granularity and a faster response time in the report generated for pharmacies. When asked about issues with future/ongoing access to SmartVax, cost concerns of the system were the prevailing theme.

Conclusions

The present study suggests that, among pharmacist immuniser end-users of SmartVax, the system is perceived to be easy-to-use, facilitates patient follow-up, and enhances the patient–pharmacist relationship.

The role of pharmacy technicians in vaccination services: a scoping review

BACKGROUND

A busy pharmacy workload may limit a pharmacist's ability to meet the needs of vaccine-willing patients and also contribute to missed opportunities to engage with vaccine hesitant individuals. Opportunities for pharmacy technicians to support vaccination services may play a role in addressing increasing patient vaccination needs.

PURPOSE

This research aims to review the role of pharmacy technicians in vaccination services that is supported by pharmacy practice research to date.

METHODS

In compliance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocols, systematic searches were performed in PubMed, Embase, International Pharmaceutical Abstracts, Scopus, and CINAHL. Articles published through June 2020, in French, English, and Spanish, were screened for eligibility. Two independent reviewers screened titles and abstracts for inclusion. Data extraction of included study methodologies and results was performed by one reviewer and verified by a second reviewer.

RESULTS

A total of 656 records were identified through the search of published literature. Full-text screening of 145 records identified 14 articles for inclusion. Most articles evaluated emerging pharmacy technician roles in patient screening (n = 8, 53%) and vaccine administration (n = 5, 36%). Implementation of both emerging roles demonstrated positive patient outcomes (n = 10, 72%). Screening activities were complicated by the complexity of the role, as well as its potential to increase overall time spent on vaccination services. Pharmacists and technicians advocated for accredited vaccine administration training owing to consistent benefits in pharmacy workflow efficiency, pharmacist clinical time, and pharmacy technician job satisfaction.

CONCLUSION

This review supports the effective deployment of pharmacy technicians in delivering vaccination services. Despite pharmacy technician vaccine administration roles being highly regulated, professional advocacy by pharmacists and technicians can use the advantageous training, workflow, and patient outcomes benefits presented in this review. Early adopters of professional practice advancements for pharmacy technician vaccine administration may expand vaccination service capacity efficiently and safely, thereby reaching more patients.

Pharmacy patient perceptions of pharmacy technicians as immunizers

OBJECTIVES

The objective of this study was to gather pharmacy patient perceptions about receiving immunizations from pharmacy technicians. Specifically, researchers sought to understand if pharmacy patients were comfortable with being immunized by a pharmacy technician, and also if knowing the technician personally, knowing that the technician was trained to immunize, the waiting time, or the patient age were factors that changed the patient comfort level.

METHODS

Qualitative, semi-structured, key informant interviews were conducted using a 12-item interview script. Participants were walk-in patients from 3 chain community pharmacies in a state in which technicians have not started to administer immunizations, but in which the practice is not prohibited.

RESULTS

A total of 46 pharmacy patients were interviewed and the following 4 themes emerged from the resulting transcripts: pharmacy patients support immunization by pharmacy technicians to increase the accessibility and decrease the waiting time, even for pediatric patients; patients value positive, trusting relationships with the pharmacy team, and knowing technicians had proper immunization technique training added to the patients' feelings of comfort; participants believed that allowing technicians to immunize would broaden the technician's responsibilities and balance the workload among the pharmacy team; and some patients still choose not to be vaccinated at a pharmacy.

CONCLUSION

This study sought to gather pharmacy patient perspectives about receiving immunizations from pharmacy technicians. The results showed that pharmacy patients support the additional role of pharmacy technicians as immunizers in general. Participants also provided information that can be applied by pharmacy leaders as more technicians begin to administer immunizations.