A shot in the arm for pharmacy

Results from a nationwide survey last year revealed that adults get immunized in pharmacies more frequently than anywhere else, other than physician offices. This should come as no surprise considering the convenient hours, ease of access and frequency of visits to pharmacies. But what is the legal status of pharmacy-based immunization, and what are the roles of the pharmacist?



Status of pharmacist immunizers

Thirty years ago, less than 10 states authorized pharmacists to administer influenza vaccines. By the end of the last decade, all 50 states, plus the District of Columbia and Puerto Rico, allowed pharmacists to immunize. As the numbers of authorizing states has grown, the number of pharmacists getting trained to immunize also has grown. According to the American Pharmacists Association, more than 200,000 pharmacists in the United States were trained to administer vaccines.

State law governs healthcare practice, including immunization practice, and each state has different regulations regarding immunizations. As a general rule, pharmacists have the authority to immunize based on a protocol with a physician — similar to nurses and physician assistants — or by prescription; however, the specifics vary by state, especially with regards to the age of the patient, the immunization process and the particular vaccine. Protocols are basically contracts that specify who has delegated the activity (i.e., a physician), identifies the pharmacist who is authorized by the protocol, states what types of vaccines the pharmacist is authorized to administer and defines procedures and criteria for pharmacists to follow, including when to refer the patient elsewhere and what to do in emergency situations.

Currently, 44 states/territories allow pharmacists to administer any vaccine; South Dakota allows only influenza and zoster (shingles); New York and Florida allow only influenza, pneumonia and zoster; and five other states allow some combination.



The role of the pharmacist

APhA adopted “Guidelines for Pharmacy-Based Advocacy” in 1996, establishing the role of pharmacists in the immunization process. These guidelines were reviewed in 2012 and contain five points:

• Prevention — Pharmacists should protect their patients’ health by being vaccine advocates;


• Partnership — Pharmacists who administer immunizations do so in partnership with


• their community;


• Quality — Pharmacists must achieve and maintain competence to administer immunizations;


• Documentation — Pharmacists should document immunizations fully and report clinically significant events appropriately; and


• Empowerment — Pharmacists should educate patients about immunizations and respect patients’ rights.

APhA identified pharmacists as having three main roles in immunizations. The first is acting as an advocate, and educating and motivating patients to get their flu shot, for example. The second role is as a facilitator — hosting others who vaccinate in the pharmacy. Some pharmacies have done this by inviting nurse practitioners or physician assistants in for a scheduled vaccination clinic. The third role of the pharmacist is as the actual immunizer. Currently close to 20% of adults get their influenza vaccine at the pharmacy, and this number is likely to grow as health care changes.

What does the future hold? Aside from such common immunizations as influenza and pneumonia, we will increasingly see pharmacists immunizing for other diseases — such as zoster, pertussis, tetanus-diptheria, typhoid, chicken pox, hepatitis, meningitis and more. Some pharmacies have travel clinics specifically to immunize patients against travel-related disease, and as new vaccines are developed, such as the HPV vaccination, more collaborative opportunities are created for pharmacists to work with other healthcare practitioners to protect the health of patients.

Ann W. Latner, JD, a former criminal defense attorney, is a freelance medical writer in Port Washington, N.Y.