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Pharmacy-Based Immunization Delivery

Immunization

APhA’s Pharmacy-Based Immunization Delivery certificate training program is based on national educational standards for immunization training from the Centers for Disease Control and Prevention. This practice-based curriculum represents a fusion of science and clinical pharmacy. The program, which emphasizes a health care team approach, seeks to foster the implementation of interventions that will promote disease prevention and public health. The purpose of this certificate training program is to prepare pharmacists with comprehensive knowledge, skills, and resources necessary to provide immunization services to patients across the life span

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HHS PREP Act and APhA's 20-hour Immunization Program

Under the Authority granted to it by the Public Readiness and Emergency Preparedness (PREP) Act, the U.S. Department of Health and Human Services (HHS) has authorized pharmacists to order and administer (and interns to administer) COVID-19 vaccines that have been approved or licensed by the Food and Drug Administration (FDA) to all individuals age 3 or older. Pharmacist interns must do so while acting under the supervision of a qualified pharmacist. Additionally, HHS has authorized licensed pharmacists (and interns) to provide all vaccines recommended by the CDC’s Advisory Committee on Immunization Practices (ACIP), and approved or licensed by the FDA, to all children ages 3 to 18 during the COVID-19 pandemic, regardless of state laws and regulations to the contrary.

Both of these authorizations by HHS require that pharmacists (and interns) complete a practical training program of at least 20 hours that is approved by the Accreditation Council for Pharmacy Education (ACPE). This training program must include hands-on injection technique, clinical evaluation of indications and contraindications of vaccines, and the recognition and treatment of emergency reactions to vaccines.

The APhA Pharmacy-Based Immunization Delivery Certificate Training Program provides 20 hours of training, including hand-on injection technique, clinical evaluation of indications and contraindications of vaccines, and the recognition and treatment of emergency reactions to vaccines. The APhA Pharmacy-Based immunization Delivery Certificate Training Program meets the 20 hour training requirement contained in the two HHS authorizations.

Activity Preview

APhA’s Pharmacy-Based Immunization Delivery certificate training program is based on national educational standards for immunization training from the Centers for Disease Control and Prevention. This practice-based curriculum represents a fusion of science and clinical pharmacy. The program, which emphasizes a health care team approach, seeks to foster the implementation of interventions that will promote disease prevention and public health.

The purpose of this certificate training program is to prepare pharmacists with comprehensive knowledge, skills, and resources necessary to provide immunization services to patients across the life span

Activity Type: Practice-based

Target Audience: Pharmacists in all practice settings

Learning Level: Level 3

Goals and Learning Objectives

Educate pharmacists about:

  • The impact of vaccines on public health.
  • Pharmacists’ roles in immunization.
  • Immunologic principles of vaccine development and immunizations.
  • Vaccine-preventable diseases and the vaccines used to prevent them.
  • Strategies for improving immunization rates.
  • Requirements for pharmacists who provide immunization services.

Prepare pharmacists to:

  • Read an immunization schedule and identify appropriate vaccines for individuals across the life span and with special needs.
  • Educate patients about the benefits of vaccines and dispel myths about vaccines.
  • Safely administer vaccines to patients via subcutaneous, intramuscular, intranasal, and intradermal routes.
  • Operate an immunization service in compliance with legal and regulatory standards.
  • Partner with immunization stakeholders to promote immunizations and the immunization neighborhood.

Direct pharmacists to resources necessary to:

  • Promote public health through immunizations.
  • Access regularly updated information about vaccines and their use.
  • Effectively communicate with patients and other stakeholders about resources.
  • Operate an immunization service in compliance with legal and regulatory standards.

This ACPE activity does not provide a certification in this topic but rather advanced professional training which upon successful completion the learner will be able to download a certificate of achievement.

Self-Study Learning Objectives

 

The self-study learning activity is designed to ensure that all participants understand vaccine-preventable diseases and the role of pharmacists and student pharmacists as vaccine advocates and administrators.  There are 23 core learning modules and several optional modules that present in-depth information on immunology, practice implementation, and legal and regulatory issues with appropriate references to the Centers for Disease Control and Prevention (CDC) resource publication, Epidemiology and Prevention of Vaccine-Preventable Disease.
 

Core Modules

Module 01 - Immunizations and the Role of Pharmacists

At the completion of this activity, participants will be able to:

  • Describe the impact that vaccines have had on public health
  • Explain how pharmacists and student pharmacists can help to improve vaccination rates
  • Identify opportunities for pharmacists and student pharmacists to be immunization advocates

Module 02 - Introduction to Immunology

At the completion of this activity, participants will be able to:

  • Identify the differences between active and passive immunity
  • Explain how vaccines elicit an immune response via the adaptive immune process
  • Discuss the rationale for timing of vaccine administration and intervals between doses, including spacing between other vaccines and antibodies
  • Describe principles of herd immunity

Module 03 - Vaccine Types and Technologies

At the completion of this activity, participants will be able to:

  • Identify vaccines that are live and inactivated
  • Describe the characteristics and distinctions between live and inactivated vaccines
  • Discuss the rationale for timing of vaccine administration and intervals between dosing

Module 04 - Immunizations and the Pharmacists’ Patient Care Process

At the completion of this activity, participants will be able to:

  • Apply the Pharmacists’ Patient Care Process to immunization services
  • Identify how and when to assess patients for vaccination needs
  • Determine appropriate screening questions to identify precautions and contraindications to vaccinations

Module 05 - Immunization Recommendations and Schedules

At the completion of this activity, participants will be able to:

  • Differentiate between immunization recommendations, vaccine product approvals, and emergency use authorizations
  • Locate and apply the Advisory Committee on Immunization Practices (ACIP) recommendations
  • Explain how to read and interpret the CDC’s immunization schedules for children, adolescents, and adults

Module 06 - Influenza

At the completion of this activity, participants will be able to:

  • Describe the transmission and clinical features of influenza
  • Compare and contrast symptoms of the common cold and influenza
  • Identify age-appropriate influenza vaccination options for a patient
  • Describe efficacy and safety information related to influenza vaccinations

Module 07 - Pneumococcal

At the completion of this activity, participants will be able to:

  • Describe the causes, clinical features, and potential complications of pneumococcal disease that can be prevented with vaccination
  • Identify target groups who should receive the pneumococcal vaccination based on risk factors and on recommendations by the Advisory Committee on Immunization (ACIP)
  • List the pneumococcal vaccines approved for use in the U.S. and how they differ

Module 08 - Meningococcal

At the completion of this activity, participants will be able to:

  • Describe the causes, clinical features, and potential complications of meningococcal disease that can be prevented with vaccination
  • Identify target groups who should receive meningococcal vaccination based on risk factors, including outbreaks, and ACIP recommendations
  • List the meningococcal vaccines approved for use in the U.S. and the ways they differ
  • Identify the recommended groups and discussion points to include during shared clinical decision-making for meningococcal B vaccines

Module 09 - Human Papillomavirus

At the completion of this activity, participants will be able to:

  • Describe the clinical features and potential complications of human papillomavirus disease
  • Identify target groups who should receive the human papillomavirus vaccine based on ACIP recommendations
  • Develop patient education strategies for potential human papillomavirus vaccine recipients

Module 10 - Tetanus, Diphtheria and Pertussis

At the completion of this activity, participants will be able to:

  • Describe the clinical features and potential complications of tetanus, diphtheria, and pertussis infections
  • Compare and contrast vaccines to prevent tetanus, diphtheria, and pertussis
  • Identify target groups who should receive the vaccines containing tetanus, diphtheria, and pertussis based on ACIP recommendations

Module 11 - Varicella and Zoster

At the completion of this activity, participants will be able to:

  • Describe the clinical features and potential complications of disease due to varicella zoster virus
  • Identify target groups who should receive the varicella and zoster vaccines based on ACIP recommendations
  • List the varicella and zoster vaccines approved for use in the U.S. and the ways they differ

Module 12 - Hepatitis A & B

At the completion of this activity, participants will be able to:

  • Describe the causes of, clinical features, and potential complications of hepatitis A and hepatitis B
  • List the characteristics of the hepatitis A and hepatitis B vaccines, including the combination vaccine
  • Identify target groups who should receive the hepatitis A and hepatitis B vaccines based on risk factors and ACIP recommendations
  • Describe the causes of recent hepatitis A and hepatitis B outbreaks and the way such outbreaks can be prevented and managed
  • Explain the pre- and post-testing recommendations for the hepatitis B vaccine

Module 13 - Measles, Mumps and Rubella

At the completion of this activity, participants will be able to:

  • Describe the causes of, clinical features, and potential complications of measles, mumps, and rubella
  • List the characteristics and contraindications of the measles, mumps, and rubella (MMR) vaccine
  • Identify target groups who should receive the MMR vaccine based on risk factors and ACIP recommendations
  • Discuss the impact of recent measles and mumps outbreaks

Module 14 - Additional Pediatric Vaccine-Preventable Diseases (Polio, Hib, and Rotavirus)

At the completion of this activity, participants will be able to:

  • Describe the clinical features and potential complications of rotavirus, Haemophilus influenzae (Hib), and polio infections
  • Identify recommended groups who should receive the rotavirus, Hib, and polio vaccines based on ACIP recommendations
  • Incorporate combination vaccines into recommended vaccination plans for pediatric patients

Module 15 - COVID-19

At the completion of this activity, participants will be able to:

  • Describe the causes of, clinical features, and potential complications of COVID-19
  • Recognize groups at high risk for COVID-19 disease or exposure
  • List the COVID-19 vaccines available in the U.S.
  • Differentiate a third dose from a booster dose
  • Describe the safety concerns and adverse reactions with the vaccines, including when coadministered with other vaccines
  • List the documentation required following COVID-19 vaccine administration

Module 16 - Educating Patients About Vaccines

At the completion of this activity, participants will be able to:

  • Define vaccine hesitancy and strategies to build patient confidence in vaccines
  • Address vaccine misinformation and safety concerns
  • Use a shared decision-making approach when recommending vaccines to patients
  • Communicate risks and benefits of vaccines
  • Provide postvaccination counseling

Module 17 - Vaccine Storage and Handling

At the completion of this activity, participants will be able to:

  • Explain the importance of maintaining the cold chain for vaccines
  • Describe recommendations from the CDC regarding proper storage and handling of vaccines

Module 18 - Vaccine Administration Overview

At the completion of this activity, participants will be able to:

  • Describe how to prepare vaccines for administration
  • Explain how to administer intramuscular and subcutaneous vaccines to adults and children
  • List steps for preventing errors with vaccine administration

Module 19 - Managing Vaccine Reactions

At the completion of this activity, participants will be able to:

  • Compare and contrast local, systemic, and allergic reactions to a vaccine
  • Describe the process to appropriately manage vaccine reactions
  • Recognize and treat anaphylaxis owing to a vaccine

Module 20 - Standing Orders and Protocols

At the completion of this activity, participants will be able to:

  • Explain the purpose of standing orders and protocols
  • Describe information that should be included in standing orders and protocols for immunization services.
  • List resources for more information about standing orders and protocols for immunization services

Module 21 - Documentation and Liability

At the completion of this activity, participants will be able to:

  • Describe information that should be included in documentation for vaccinations
  • Discuss the use of immunization information systems
  • Describe national reporting systems for adverse events and errors associated with vaccines
  • Explain liability risks and legal protections for authorized immunizers

Module 22 - Administrative and Operational Issues

At the completion of this activity, participants will be able to:

  • Describe the components of the Occupational Safety and Health Administration (OSHA) Bloodborne Pathogens Standard
  • Explain how to implement reminder and recall systems for multidose vaccine series

Module 23 - Payments for Immunization Services

At the completion of this activity, participants will be able to:

  • List opportunities to obtain compensation and reimbursement for vaccination services
  • Identify codes that are used when billing third-party payers for vaccinations
  • Describe the process and rules around billing for immunizations

Ancillary Modules

Module - Vaccine Hesitancy and Motivational Interviewing

At the completion of this activity, participants will be able to:

  • Describe vaccine hesitancy
  • Discuss the role of social determinants of health in vaccine hesitancy
  • List steps of the transtheoretical model of health behavior change
  • Describe key principles of motivational interviewing
  • Explain how to apply motivational interviewing skills and strategies

Module - Pharmacy Workflow for Immunization Services

At the completion of this activity, participants will be able to:

  • Explain how the pharmacy practice setting affects workflow models for immunization services
  • List factors that affect scheduling for vaccine services
  • Describe roles for support staff in the delivery of pharmacy-based immunization services

Module - Mass Vaccination Clinics

At the completion of this activity, participants will be able to:

  • List situations in which a mass vaccination clinic would be appropriate
  • Describe considerations for planning a mass vaccination clinic
  • Identify best practices for a mass vaccination clinic

Module - Marketing an Immunization Program

At the completion of this activity, participants will be able to:

  • Describe print and nonprint strategies that can be used to market vaccination services
  • List examples of free print and nonprint materials that can be used to market vaccination services
  • Explain how pharmacists can develop relationships in their community that support their vaccination services

Module - Working with Pharmacy Technicians

At the completion of this activity, participants will be able to:

  • Explain roles for pharmacy technicians in supporting pharmacy-based immunization services
  • Identify immunization-related roles that should be performed by only pharmacists
  • List activities that pharmacy technicians can perform to streamline the workflow for vaccination and pharmacy operations

Module - Volunteer Opportunities and International Vaccine Programs

At the completion of this activity, participants will be able to:

  • Discuss volunteer roles for pharmacists in public health immunization programs
  • Describe opportunities for pharmacists to become involved with international vaccination programs and global public health promotion
  • Describe liability and scope-of-practice considerations for volunteering pharmacists

Live Seminar Learning Objectives

 

The second component of the APhA’s Pharmacy-Based Immunization Delivery certificate training program is an active learning seminar focusing on pharmacy practice implementation. The live training seminar is based on the experience of practitioners involved in immunization advocacy and administration. The training seminar reinforces and expands on the self-study program and addresses areas such as immunization needs, legal and regulatory issues, and injection-technique training. Participants will be expected to practice giving intramuscular and subcutaneous injections.

At the completion of this activity, participants will be able to:

  • Describe strategies for increasing immunization rates, including physician collaborations, community level activities, and immunization coalition activities
  • Describe pharmacy operations and a process for administering vaccines in various pharmacy practice settings
  • Evaluate patient histories and make patient-specific recommendations based on the appropriate immunization schedule
  • Demonstrate effective strategies for communicating with patients who have concerns about vaccines
  • Describe current evidence regarding vaccine safety
  • Recognize the signs and symptoms of adverse reactions that can occur after vaccination
  • Describe procedures for management of patients with adverse reactions to vaccination that constitute an emergency
  • List the steps for administering currently available intranasal and intradermal vaccines
  • Demonstrate appropriate intramuscular and subcutaneous injection techniques for adult immunization

All participants are strongly encouraged to obtain CPR or BCLS certification. However, certification is not a prerequisite of the program. A Certificate of Achievement is awarded to participants who successfully complete all program requirements. The Certificate of Achievement is invalid, however, without written proof of current CPR or BCLS certification.

Accreditation Information

The American Pharmacists Association is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. APhA's Pharmacy-Based Immunization Delivery certificate training program is approved for a total of 20.0 contact hours of continuing pharmacy education (CPE) credit (2.0 CEUs). The ACPE Universal Activity Numbers (UAN) for this activity are listed below.

Successful completion of the self-study component involves passing the self-study assessment with a grade of 70% or higher and will result in 12 contact hours of CPE credit (1.2 CEUs). ACPE UAN: 0202-0000-22-009-H06-P / 0202-9999-22-009-H06-P

Successful completion of the live seminar component involves attending the full live seminar, successfully completing the injection technique assessment, and completing the online assessment and evaluation. Successful completion of this component will result in 8 contact hours of CPE credit (0.8 CEU). ACPE UAN: 0202-0000-20-180-L06-P / 0202-9999-20-180-L06-P

To obtain 20.0 contact hours of CPE credit (2.0 CEUs) for APhA's APhA's Pharmacy-Based Immunization Delivery certificate training program, the learner must complete all components listed above, and CLAIM credit for each component. Participants will need to have a valid APhA (pharmacist.com) username and password, as well as a CPE Monitor account to claim credit. After credit has been claimed, please visit CPE monitor for your transcript. The Certificate of Achievement will be available online upon successful completion of the necessary activity requirements on the participant’s My Training page.

Release Date: March 30, 2020

Expiration Date: March 20, 2023 - PLEASE NOTE: NO Home Study credit granted after this date; Live Credit can only be granted within 60 days from the day of the seminar attended.

 

Development

 

 APhA's Pharmacy-Based Immunization Delivery was developed by the American Pharmacists Association. Copyright © 2022 by the American Pharmacists Association.

 

Acknowledgements and Disclosures

Advisory Board

Lauren B. Angelo, Pharm.D, MBA (Co-chair)

Associate Dean, Academic Affairs
Associate Professor, Pharmacy Practice

Rosalind Franklin University of Medicine and Science
North Chicago, Illinois

 

Adam C. Welch, Pharm.D, MBA, FAPhA (Co-chair)

Associate Professor

Bill Gatton College of Pharmacy
East Tennessee State University
Johnson City, Tennessee

 

Jeff Goad, Pharm.D., MPH, FAPhA, FCPhA, FCSHP

Professor and Associate Dean of Academic Affairs

Chapman University School of Pharmacy
Irvine, California

Jean-Venable “Kelly” R. Goode, PharmD, BCPS, FAPhA, FCCP

Professor and Director, Community-Based Pharmacy Residency Program

Virginia Commonwealth University
Richmond, Virginia

Vincent A. Hartzell, Pharm.D.

President

Hartzell's Pharmacy
Catasauqua, Pennsylvania

Carrie Foust Koenigsfeld, Pharm.D, FAPhA

Professor of Clinical Sciences

Drake University, College of Pharmacy and Health Sciences
Des Moines, Iowa

 
 

APhA Staff Members

The following APhA staff members contributed to the development of this program:

Mitchel C. Rothholz, RPh, MBA

Executive Director, APhA Foundation

Daniel Zlott, PharmD, BCOP

Senior Vice President, Education & Business Development

Kelly French, MPH

Senior Director, Education

Bronhed Shaw

Associate Director, Advanced Training

Misty Knack

Associate Director, Advanced Training

 

The original publication was prepared by Judy Crespi Lofton, MS, of JCL Communications, on behalf of APhA.

 

Disclosures

Lauren B. Angelo, Pharm.D, MBA,

has served as a speaker for Seqirus, Inc. and a consultant for MDBriefCase Group, Inc. and Moderna.

Jeffrey A. Goad, PharmD, MPH, FCPhA, FCSHP

has served as a speaker for Merck and on advisory boards for Valneva, Emergent Biosolutions, Takeda, and Seqirus.

Carrie Foust Koenigsfeld, PharmD, FAPhA,

has served as a speaker for Merck Vaccines and Pfizer.

Mitchel C. Rothholz, RPh, MBA,

declares that his spouse is an employee of Merck and that he has served on advisory boards for Merck and Pfizer.

 
 
 

All other individuals involved in the development of this material declare no conflicts of interest, real or apparent, and no financial interests in any company, product, or service mentioned in this program, including grants, employment, gifts, stock holdings, and honoraria. APhA’s editorial staff declare no conflicts of interest or financial interests in any product or service mentioned in this activity, including grants, employment, gifts, stock holdings, and honoraria. For a complete list of APhA staff disclosures, please visit the APhA website at aphanet.pharmacist.com/apha-disclosures.

Conflicts of interest have been resolved through content review by Helen Sairany, PharmD, BCACP, Associate Director of Content Development at the American Pharmacists Association.

The material presented here does not necessarily reflect the views of the American Pharmacists Association. Every attempt has been made to ensure the accuracy of the information contained herein at the time of writing; however, owing to the nature of pharmacy practice, standards and recommendations change regularly. Pharmacists are advised to verify all information and data before treating patients or employing the practices described in this educational activity.

 

System Requirements

 

Computer and Internet access are required to complete this activity. Please visit our website to view the Technology System Requirements in order to have a positive learning experience
 

 

Additional Resources

 

If you are looking for some additional resources, try visiting our Pharmacist Immunization Center.