Pharmacists administering vaccines

angeldelight · 24-09-2011 05:19PM

jimdeans wrote: »

What do you mean deal with? What have you been trained to do to a patient who has an anaphylactic reaction?

As I mentioned above I have chosen not to take part in vaccination training, so hopefully one of the pharmacists who have been trained will be along shortly and could elaborate on it. I just know from seeing the materials about the training that managing anaphylaxis was one aspect of it.

I would also be confident that no pharmacist would take part in the vaccination servcice without feeling comfortable that they can safely provide the service. Nobody wants anyone to come to harm and it would take more than the price of the vaccination for a pharmacist to think ah sure feck it hopefully I don't have to deal with that. They all have their businesses and patients to think about, I don't believe anybody would act that recklessly.

smtdos · 24-09-2011 05:24PM

I've done the training.

Aside from the vaccination technique, we we're also trained in the use of an AED, giving CPR and administering an Anapen to patients in anaphylaxis.

To the GP's: How many times have you had someone go into anaphylaxis after a vaccine?

I suspect never.

jimdeans · 24-09-2011 05:25PM

angeldelight wrote: »

As I mentioned above I have chosen not to take part in vaccination training, so hopefully one of the pharmacists who have been trained will be along shortly and could elaborate on it. I just know from seeing the materials about the training that managing anaphylaxis was one aspect of it.

I would also be confident that no pharmacist would take part in the vaccination servcice without feeling comfortable that they can safely provide the service. Nobody wants anyone to come to harm and it would take more than the price of the vaccination for a pharmacist to think ah sure feck it hopefully I don't have to deal with that. They all have their businesses and patients to think about, I don't believe anybody would act that recklessly.

I'm not saying anyone would act recklessly. I'm just asking the type of questions people should ask when somebody who has pretty much the same clinical skill set as me (ie pretty much none) starts administering vaccines.

If we apply any kind of rigor to the process of accreditation, then I just don't think "well, we wouldn't do it if we didn't think we can" and "Boots already do it" are robust enough responses.

Just to clarify, I have no major objection to this. I think there could be problems with continuity of care and keeping a register, as well as the allergic reaction element.

BUt asking the hard questions is not the same as being against something.

jimdeans · 24-09-2011 05:28PM

smtdos wrote: »

I've done the training.

Aside from the vaccination technique, we we're also trained in the use of an AED, giving CPR and administering an Anapen to patients in anaphylaxis.

To the GP's: How many times have you had someone go into anaphylaxis after a vaccine?

I suspect never.

Now we're talking. Very informative answer. Seems like reasonable training? Though I don't know enough about the definitive treatment. BUt it's reassuring to me.

Is the frequency of the reaction relevant to the debate? obviously in a very crude way it is (ie if it was 1 in 10 patients that would be a massive strain). Apologies if you weren't framing the question in the context of the debate. But it can and does happen, and it needs to be sorted quickly. So you need to be able to deal with it.

As an aside, does your "I suspect never" comment mean you think no-one has ever gone into anaphylaxis in a GP surgery? Surely that must happen occasionally?

foreverandever · 24-09-2011 05:34PM

I actually don't think the anaphylaxis is the biggest problem, it isn't that common and with a bit of training the pharmacists should be able to deal with it. How much is a private patient to be charged for the vaccine does anyone know?

smtdos · 24-09-2011 05:36PM

I must say that it was one of the best training courses I've been on.

To be fair, there was a trained nurse/paramedic to every 6 pharmacists.

A few were nervous about providing a vaccination service due to the risk of anaphylaxis. Personally, having done the training I would be confident in dealing with such a situation. Between CPR, an AED and Adrenaline (all of which I can now administer) I'm not sure what more a GP could do to help before the patient gets to a hospital.

Completely agree that the hard questions need to be asked. Hopefully this thread will make the issue more transparent.

smtdos · 24-09-2011 05:40PM

foreverandever wrote: »

I actually don't think the anaphylaxis is the biggest problem, it isn't that common and with a bit of training the pharmacists should be able to deal with it. How much is a private patient to be charged for the vaccine does anyone know?

My understanding is that it'll be for medical card patients for the time being.

But I can see pharmacies charging anything less than the cost of a GP appointment for private patients

foreverandever · 24-09-2011 05:48PM

smtdos wrote: »

My understanding is that it'll be for medical card patients for the time being.

But I can see pharmacies charging anything less than the cost of a GP appointment for private patients

I wonder how pharmacists would feel if doctors decided to start dispensing a relatively simple drug? Say you could fill your prescription of augmentin at the GP rather than go down to the pharmacy... pretty sure they wouldn't like it!

bleg · 24-09-2011 06:17PM

jimdeans wrote: »

Why can't pharmacists understand that it's not "outrage over patient safety". It's people asking questions. I'm a virologist, so I could say I know shedloads about flu and therefore I can administer the vaccine.

But I'd expect to be asked some VERY searching questions if I annonced plans to do so.

But it's already happening in Ireland. Pharmacists are giving it today. You're 12 months too late.

Also, this (obviously) wasn't a unilateral announcement, it was done in consultation with the appropriate groups.

jimdeans · 24-09-2011 06:40PM

bleg wrote: »

But it's already happening in Ireland. Pharmacists are giving it today. You're 12 months too late.

Also, this (obviously) wasn't a unilateral announcement, it was done in consultation with the appropriate groups.

Doesn't matter. It's been raised on this here forum now, and it's the first time I've heard about it. So I ask the questions, as a member of the public. Thankfully, a sensible pharmacist was able to give a very reassuring answer to the questions asked.

But there shouldn't be a moratorium on when we're allowed question a practice.

Who are the appropriate groups, and where is the joint announcement or whatever it is?

jimdeans · 24-09-2011 06:43PM

smtdos wrote: »

I must say that it was one of the best training courses I've been on.

To be fair, there was a trained nurse/paramedic to every 6 pharmacists.

A few were nervous about providing a vaccination service due to the risk of anaphylaxis. Personally, having done the training I would be confident in dealing with such a situation. Between CPR, an AED and Adrenaline (all of which I can now administer) I'm not sure what more a GP could do to help before the patient gets to a hospital.

Completely agree that the hard questions need to be asked. Hopefully this thread will make the issue more transparent.

I think maybe the earlier recognition of an attack? But maybe the docs on here could clarify.

I also understand, from a brief perusal of the web, that some people get allergic reactions but don't need adrenaline.

But at the end of the day, the major issue for me as a joe bloggs out there is the safety of it if my airways start swelling, and I think smtdos does a good job in alleviating the concerns that some people may have. Sounds like pretty decent training.

Sid_Justice · 24-09-2011 06:43PM

Defensive people are defensive on the internet.

Sid_Justice · 24-09-2011 06:45PM

smtdos wrote: »

I must say that it was one of the best training courses I've been on.

To be fair, there was a trained nurse/paramedic to every 6 pharmacists.

A few were nervous about providing a vaccination service due to the risk of anaphylaxis. Personally, having done the training I would be confident in dealing with such a situation. Between CPR, an AED and Adrenaline (all of which I can now administer) I'm not sure what more a GP could do to help before the patient gets to a hospital.

Completely agree that the hard questions need to be asked. Hopefully this thread will make the issue more transparent.

You're completely right. You've done a weekend course on performing BLS and using epi pens, you're obviously as qualified as a GP to deal with problems arising from vaccine admission.

jimdeans · 24-09-2011 07:03PM

Sid_Justice wrote: »

You're completely right. You've done a weekend course on performing BLS and using epi pens, you're obviously as qualified as a GP to deal with problems arising from vaccine admission.

For the benefit of us non medics, who would be considering where to go for our vaccines, what would a GP do differently? Coz if I have anaphylaxis again I want it sorted pronto/Nothing like feeling your airway start to swell up to put the fear of god into you!

bleg · 24-09-2011 07:41PM

By the way I'd just declare that I'm a pharmacist (non-community) unless it wasn't evident already.

foreverandever · 24-09-2011 07:50PM

jimdeans wrote: »

For the benefit of us non medics, who would be considering where to go for our vaccines, what would a GP do differently? Coz if I have anaphylaxis again I want it sorted pronto/Nothing like feeling your airway start to swell up to put the fear of god into you!

Doctors are trained medical professionals and alot of GP trainees have to spend some time working in A&E. They are used to dealing with emergency situations and more importantly medical situations. Just because a pharmacist did one weekend of simulated scenarios doesn't mean when the situation comes around they'll be able to act efficiently. I think that's what the previous poster meant when he said they were not as qualified as a GP

DublinWriter · 24-09-2011 07:55PM

foreverandever wrote: »

Doctors are trained medical professionals and alot of GP trainees have to spend some time working in A&E. They are used to dealing with emergency situations and more importantly medical situations. Just because a pharmacist did one weekend of simulated scenarios doesn't mean when the situation comes around they'll be able to act efficiently.

Although Pharmacists spend slightly longer in college, I know plenty of GPs, dentists and non-GP medical doctors that really don't like administering jabs and on the GP side, can be very hit and miss about getting a blood sample.

It's one of those tacit skills that can't be fully learned academically.

foreverandever · 24-09-2011 08:01PM

DublinWriter wrote: »

Although Pharmacists spend slightly longer in college, I know plenty of GPs, dentists and non-GP medical doctors that really don't like administering jabs and on the GP side, can be very hit and miss about getting a blood sample.

It's one of those tacit skills that can't be fully learned academically.

Of course, sure phlebotomists aren't medical doctors and they take blood regularily and probably better than many doctors. But would I go to them for medical treatment? No I wouldn't.

DublinWriter · 24-09-2011 08:11PM

foreverandever wrote: »

Of course, sure phlebotomists aren't medical doctors and they take blood regularily and probably better than many doctors. But would I go to them for medical treatment? No I wouldn't.

In that case, I'd probably trust a pharmacist a little more. Have you any idea of the amount of study that they have to undertake to qualify?

jimdeans · 24-09-2011 08:15PM

foreverandever wrote: »

Doctors are trained medical professionals and alot of GP trainees have to spend some time working in A&E. They are used to dealing with emergency situations and more importantly medical situations. Just because a pharmacist did one weekend of simulated scenarios doesn't mean when the situation comes around they'll be able to act efficiently. I think that's what the previous poster meant when he said they were not as qualified as a GP

I'll defer to your superior knowledge on that. I'd just say that when I had the anaphylaxis, I was on the road to recovery as soon as I got jabbed with the adrenaline. There was a lot of watching me and talking about me, and really great reassurance/professionalism. But my feeling is that they could have hit me with the adrenaline and not really known what was going on, and I'd have had the same outcome.

But I'm just playing devil's advocate. I know there's much more to it. But I just wonder if outcomes are vastly different, once someone jabs the person with adrenaline. The A+E doc told me the steroids would take an hour to kick in and they were meant for action "when the adrenaline wears off".

What kind of outcomes do people have when they self-inject those pens that the hospital gives out when you've got an ongoing allergy problem?

foreverandever · 24-09-2011 08:16PM

DublinWriter wrote: »

In that case, I'd probably trust a pharmacist a little more. Have you any idea of the amount of study that they have to undertake to qualify?

Yes pharmacists do alot of study to qualify. I just don't know where in their training they are taught how to give intramuscular injections and dealing with scenarios where things go wrong such as anaphylaxis or other adverse drug reactions? I'm pretty sure even in hospitals it's the nurses and doctors who administer the drugs to the patients?

bleg · 24-09-2011 08:21PM

foreverandever wrote: »

Doctors are trained medical professionals and alot of GP trainees have to spend some time working in A&E. They are used to dealing with emergency situations and more importantly medical situations. Just because a pharmacist did one weekend of simulated scenarios doesn't mean when the situation comes around they'll be able to act efficiently. I think that's what the previous poster meant when he said they were not as qualified as a GP

But it's already happening in Ireland and other jurisdictions.

foreverandever · 24-09-2011 08:25PM

bleg wrote: »

But it's already happening in Ireland and other jurisdictions.

Just because something is happening already it doesn't mean it's a good thing.

bleg · 24-09-2011 08:30PM

Ok... It's happening and there have been no problems.

jimdeans · 24-09-2011 08:33PM

bleg wrote: »

But it's already happening in Ireland and other jurisdictions.

You keep banging this drum. People understand the point. But there's lots of things in science that get looked at, even though they're common practice. My lab is currently involved in a study looking at responses to different combinations of treatments for HIV, even though some of these treatments have been used for a number of years.

A quick google suggests an incidence of anaphylaxis after vaccination of 1 per 2 million (in children and adolescents), and 1-6 per million in adults. So how many cases of anaphylaxis do you think boots have seen? Will it be enough to come to a conclusion about training etc? I don't know the answer. But where is their data?

foreverandever · 24-09-2011 08:38PM

When I've seen data that say the uptake in flu vaccines is better to the uptake when just doctors were administering it I'll agree that it's a good system. Until then I see no reason for it and I do believe it'll be creating extra work for doctors while taking away some of their income which I know if doctors did to pharmacists there would be outrage.

Nonoperational · 24-09-2011 09:10PM

Wouldn't see any problem with this really. The only thing I can think of is that pharmacists may be more prone to freezing (due to lack of experience of emergency situations) if someone did go into shock and might not have the same experience as a GP delaying prompt treatment. There's basically zero procedural skills training in the pharmacy degree. The argument that they are under used by the HSE etc etc is banged out all the time but in reality what more can/should they do? What's the point in them giving vaccines if it's not saving the government money. If a nurse will do it for less why have pharmacists do it? Their job is to dispense and that will always be their number one concern. Most pharmacists don't even have BLS either but the vaccination course takes care of all that.

Expanding the role of any professional is great as long as it's done safely and within that persons skill set.

In reality anaphylaxis is so rare it's not going to be an issue. Added to that most patients who are getting the jab will probably have got it before. It's not surgery that's being performed. Quick jab in the arm and off they go. If the worst happens then a shot adrenaline and ABCDE and a call to 999 is as much as most GPs would do too.

Hopefully it will be expanded a bit if it works out. Things like private travel vaccination clinics would be interesting...

Sid_Justice · 24-09-2011 09:32PM

DublinWriter wrote: »

In that case, I'd probably trust a pharmacist a little more. Have you any idea of the amount of study that they have to undertake to qualify?

Why? That's a really illogical attitude. We're talking about taking bloods (which is faik, completely different to giving a vaccine,but anyway) which we've all agreed is a SKILL. Who would you think would be better at performing this skill? A gp who has done it on and off for at least 5 years? or someone that did a weekend course.

Pharamcists aren't taking bloods, so i don't know what i got side tracked on this.

foreverandever · 24-09-2011 10:17PM

gpf101 wrote: »

.
Hopefully it will be expanded a bit if it works out. Things like private travel vaccination clinics would be interesting...

How do you mean private? GPs already provide this service so why would others need to?

bleg · 24-09-2011 10:47PM

What training, in your view, do pharmacists need?

Are you just fundamentally opposed? If so then why?

Pharmacists administering vaccines

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