August 28, 2024
M&D Clinical Corner: National Immunization Awareness Month
The Clinical Corner is a monthly feature that highlights a variety of important pharmacist topics that is written by Dr. Jesica Mills, PharmD, ND, MBA, RPh, BCES, BCLS, BCNP.
- August is National Immunization Awareness Month, which is the perfect time to discuss any missed vaccines for children and for adults.
- As most children are going back to school, and need school physicals, this is the time to expect more questions about recommended vaccines, why they are recommended, catch-up schedules, and access to the vaccines.
Which Vaccines Do I Need?
- My personal favorite tool to quickly assess which vaccines are needed is the Adult Vaccine Quiz from the CDC. You can find it Here. This tool asks a simple list of questions, and then generates a list of recommended vaccines.
- The quiz for children up until age 18 is found Here
- Once the patient or the Healthcare Provider has completed the quiz, they can generate a list of recommended vaccines to discuss with their PCP or Pharmacist, and print off the form to take with them to the appointment.
Vaccine Schedules
- It is recommended to print and display the recommended vaccine schedules in a patient-facing or consultation area to have these discussions.
- Only 21.8% of adults are considered fully vaccinated
- Childhood rates fell below the 95% target set by Healthy People 2030 to 94%.
- You can find the vaccine recommendations for adults Here
- The recommendations for ages 7-18 years old (older kids and teens) Here
- The recommendations for kids at birth through 6 years old Here
- When considering when to give the next vaccine, and looking at the minimum time to space out vaccines, This information and charts was most helpful.
How to Implement Vaccines Into Your Workflow
- 90% of COVID vaccines were administered in a Pharmacy from Q1 of 2021 to Q2 of 2022. 90% of Americans live within 5 miles of a Pharmacy, and a previous study from the American Disease Prevention Coalition found that pharmacies have more locations, and more operating hours than physician practices in low-income communities. This is important for those who may not get paid time off work or accessible child care during business hours.
- The PREP act allows Pharmacists to immunize down to age 3 for routine childhood vaccines. State laws differ in the types of vaccines Pharmacists can administer, and who needs a prescription vs who has authority without needing a prescription. My favorite resource to learn about the specifications of each state is NASPA, found Here.
- Once you know the vaccines you can administer, and to whom, you need to make sure to keep the vaccines on hand. There are contacts for the public health department in your area that can help with access to vaccines, including the Vaccines for Children Program to help get federally purchased vaccines to administer. Decide the vaccines you want to have on-hand, and consider promoting the vaccines on a monthly basis (flu vaccines during the fall, RSV and pneumonia vaccines in the winter, DTaP vaccines in the spring, Shingles vaccines in the summer, etc). Go to this site to download and print all Vaccine Information Sheets (VIS) to have available for patients.
- Be sure to know the contraindications and precautions when considering and recommending the vaccines a patient needs. You can use this list to discuss what is (and isn’t) important things to consider with your patients.
- For a comprehensive set of patient hand-outs to educate and promote vaccines, you can go here
- Have a way for patients to schedule an appointment, based on your availability to vaccinate. Collect the required information on the intake form the patient completes to book the appointment. You can use online scheduling sites like acuity or calendly to provide instructions for patients, intake forms, and collect their data to contact them.
- I highly recommend scheduling an automatic follow-up email to go to them asking if they had any reactions, as well as how satisfied they were with their appointment and experience. I include a link to the Google My Business link, so patients can leave a Google rating. I also include information on our patient referral program to encourage them to share their experience and recommend our Pharmacy to a friend.
- You can create an appointment type for each of vaccine you offer, with specific intake forms and the information you need to know. Have a QR code that goes to that link displayed in the store, so if a patient walks in, they can schedule an appointment and fill out the intake form for you to have documented online.
- With the list of patients that have gotten their vaccines at your pharmacy from the online scheduler, you can then take the emails and contact information and reach out when you get your flu shots in for the following year. You can also let them know about your tips for staying well during flu season, any supplements you carry to help balance the immune system, and any services that would be helpful to them (like delivery) or point of care testing.
- Use your pharmacy system to detect and identify those who are needing vaccines, and set up contact triggers. When a patient is above a certain age, set a trigger at the point of sale/point of contact to ask about their shingles vaccine status. Make sure your system is also reporting vaccines to the state Immunization Registry. If you don’t have these alerts set up, and you aren’t sure if your system is reporting to the state, contact your software provider. There are grants to help increase interoperability available through many state health departments.
- Be sure to register with your state’s Immunization Registry so you can pull vaccine records for patients. If you aren’t sure of who to contact, go here
Items to Help the Patient Experience
- Having a dedicated space that is private and calm is the best way to help patients utilize you for vaccines. Have this location stocked with gloves, bandages, alcohol wipes, and something that patients can focus on visually (poster of a comic/meme, magazine, TV) for those who become nervous around needles.
- I recommend having kid-friendly bandages with popular cartoon characters, stickers, suckers, and a small basket of toys (fidget spinners, stress balls, plastic rings, candy) that they can choose from as a way to let them leave with a good memory.
- For those who are older, I recommend having a chair with arms that they can use as support when getting up and down. I also recommend a chair that is easy to clean with sanitizing wipes (avoiding fabric). I highly recommend keeping a digital timer that is pre-set to 15 minutes that can be handed to the patient to return when it goes off.
- One tactic to help vaccine uptake- offer to donate to a charity of their choice. During flu season, print a list of local and/or national charities, and allow the patient to choose which charity gets $1 donated from your pharmacy with their vaccine.
- If you also carry supplements that help with immune function, you can offer the flu shot and the health shot. The flu shot is the typical flu vaccine, the “health shot” can be a communion cup/small glass that contains elderberry tincture (think Sambucol) or any liposomal products like vitamin c, vitamin d, or liquid multivitamins/minerals. Offer a “health shot” when they are getting their flu shot to allow patients to sample your supplements and help educate on the benefits of supplementation.
- For those patients who have a reaction, such as light-headed or feeling faint, I recommend having a sugar-containing beverage (like Sprite or Ginger ale), and a salt-containing snack (like crackers or chips) that you can offer. Make sure you have quick access to epinephrine, benadryl, a phone to communicate to other employees and emergency personnel, a blood pressure monitor, and a thermometer. Consider having an AED as well. You can find grants to purchase an AED here.
Vaccine Hesitancy and How To Address It
- The most common reasons people are hesitant to get a vaccine have been side effects, safety concerns, distrust of government/politics/big pharma, and thinking that the illness the vaccine is for would not be deadly/unsurvivable.
- For side effects- educating the patient on the realistic and common side effects to expect, and for how long they can experience them is an effective approach. This enables them to schedule a vaccine that can cause arm soreness or malaise for a Friday when they have the weekend off.
- Due to the cortisol pattern of being highest in the morning, and lowest in the afternoon, and the effect that high cortisol has in blunting the immune system response, the best time to get a vaccine is in the afternoon (around 2-4pm).
- Empower patients with self-care tips to help prevent or shorten an expected side effect- like using a heating pad or ice pack for injection site soreness, using tylenol or ibuprofen for pain or fever, and moving the arm the injection went into to reduce the amount of stiffness.
- For safety- empower your patients with the knowledge that VAERs exists. Let them know that all reactions that get reported to healthcare providers are to be reported on VAERs, and that is how we conduct safety surveillance. Let them know that you care if they have any reactions, and to please report them to you. Use an automatic email that asks for common adverse reactions as well as a blank space for patients to report any reaction. Let them know you take reactions and reporting them very seriously, and let them know any reactions you have (and haven’t) seen, how rare or common the side effect they are asking about is, and allow them to feel seen, heard, and cared for. Build trust with your patients.
- For those who are not aware of the potential of lasting complications from the illness the vaccine is for, like Shingles causing post-herpetic neuropathy, make sure to educate them on the concerns if they did contract that illness. Who in their family they would have to avoid, the missed time from work while they were sick, the daily activities they would be unable to do if they were sick, etc.
- For those who have a distrust of the government/big pharma/politics and are sure there is an agenda that is being pursued with vaccines, try making them feel seen and heard, agree to disagree respectfully, ask them questions that can guide them to a different perspective (what other medicines aren’t safe that are going to be used in this agenda?), and continue to offer it in the future in case they change their mind. Ask what they are doing to stay immune from the illness, or what their plan is if they get sick. Having respectful and open-ended questions that lead to conversations can and will build trust. Offer to research any items that they are saying they are concerned about, and be willing to have a conversation with them after you’ve researched it.
References:
https://www.cdc.gov/mmwr/volumes/71/wr/mm7116a1.htm
https://www.cdc.gov/vaccines/?CDC_AAref_Val=https://www.cdc.gov/vaccines/schedules/index.html
