2015-2016 Seasonal Influenza Immunization Program Review&

Administering Drug By Injection and Other Routes

April 30, 2016Ray Joubert, SCPP

Myla Wollbaum, PAS

Overview of Session

• Review Influenza Immunization Program (IIP) uptake and stats

• Beyond Flu Shots: Bill 151 Administering Drugs by Injection and Other Routes– Training update– Legislation Update– Certification/recertification

• PAS Survey Results• Next Steps

Roles Associated with IIP• SCPP

– Creates legislation, sets training parameters and certification requirements• CPDP

– Creates training certification based on SCPP requirements• Population Health

– Oversees provincial Seasonal Influenza Program– Orders and pays for vaccine– Chooses type of vaccine to be distributed to pharmacy

• Drug Plan and Extended Benefits Branch– Creates Influenza Immunization Program policy– Pays for the administration of flu vaccine– Works with POP Health and distributors for vaccine distribution– Creates Pharmacist Handbook– Woks with PAS for remuneration and pharmacist communication

• PAS– Negotiates fee for administration of flu vaccine, provides feedback for policy and protocols

of the IIP– Creates support material, pharmacist education– Public education and promotion

2015-2016 Influenza Immunization Program (IIP)

• October 19, 2015 to April 29th, 2016

PAS Pharmacist Support for IIP

• Numerous support material on PAS website– Cold chain, emergency protocol, supply checklists, adverse reaction

reporting, documentation forms– All Drug Plan policy documents

• Telehealth, webinar

Public Education Strategy Update• Participating pharmacies were shipped print material including pharmacist badges, tent

cards, posters, and bag stuffers at no charge from PAS. • Additional materials including stickers, floor decals, shelf talkers and poster stands were

available for purchase.• Kicked off the official campaign on Oct 26th which included:

– Billboards, bus boards, advertisements in weekly newspapers and seniors publications– Several TV and radio interviews

– A public service announcement commercial (that ran on CTV, Global, and CBC) A media event where Minister of Health, Dustin Duncan was immunized by a pharmacist within a local pharmacy.

• Ran a survey in conjunction with CPhA on professional services through Abacus to provide benchmark of the public’s awareness and opinion of pharmacists being able to provide flu shots

Influenza Immunization Program (IIP)

• Because of additional outbreaks appearing late in the season across the province and country, Population Health (the purchasers of vaccination product to the program) extended the official length of the flu season to April 29th (from March 31).

• As a result, the Drug Plan remuneration for administering the flu injection was extended as well.

Statistics

• 906 pharmacists are Saskatchewan are trained to give flu shots

• 72%, or 262 of the 362 pharmacies in Saskatchewan participated in the IIP

Statistics

• 55,654 flu injections given– 62,500 anticipated– 21% of total shots of the entire program were given

by community pharmacists– 25% of all shots given were in 1st week

• Most shots given in a pharmacy = 1237

PHARMACIST INFLUENZA IMMUNIZATION STATISTICS BY HEALTH REGION AS OF APRIL 2, 2016

RHA

Age (at immunization)

Total Immunized,by Pharmacists 9 to

11 years 12 to 17

years 18 to 64 years 65 years and older

Athabasca Health Authority 0 0 0 0 0

Cypress RHA 21 59 1,086 625 1,791

Five Hills RHA 37 90 1,780 1,613 3,520

Heartland RHA 20 84 997 548 1,649

Kelsey Trail RHA 4 36 600 530 1,170

Keewatin Yatthé RHA 0 0 18 5 23

Mamawetan Churchill River RHA 7 10 177 47 241

Prairie North RHA 17 41 683 389 1,130

Prince Albert Parkland RHA 69 128 1,721 866 2,784

Regina Qu'Appelle RHA 236 563 9,925 7,261 17,985

Saskatoon RHA 320 759 11,466 7,759 20,304

Sun Country RHA 31 99 1,715 859 2,704

Sunrise RHA 35 85 1,317 922 2,359

Total Immunized, by age 797 1,954 31,485 21,424 55,660

IIP: What We Learned

Vaccine– Distribution went relatively smoothly with some minor

issues of shortages at wholesalers for a very brief period of time.

– The Drug Plan was able to work with POP Health in a timely basis to replenish stock to a different type of vaccine to make up for shortages.

– Shortages were mostly due to pharmacies overstocking.– The Drug Plan is currently working with distributors and

POP Health on next years flu program and distribution plans.

IIP: What We learned

Documentation– Pharmacists could use any documentation forms as

long as they included the requirements on the Drug Plan policy and SCPP Bylaws.

– Some people used their own in-house developed forms and others used CPDPs.

– PAS in conjunction with medSask, is close to finalizing forms • for flu vaccination, plus a clinical support Guide • other drugs by injections

IIP: What We Learned

Limiting Policy – Ability to administer publically funded FluMist• This was, and will be a decision by Population Health,

as the purchasers of supply. PAS has a pending meeting with all stakeholders where we will continue to advocate for this to be a part of the program.

– Limiting Administration to Pharmacy• Again, this will be discussed with POP Health and other

stakeholders in a pending joint meeting.

What We learned

PAS Survey• There were 157 respondents. • Approximately 80% of pharmacists felt comfortable or very comfortable providing

injections. • Up to 74% of respondents used at least one type of education material sent to them

(posters, tent cards, buttons etc.)

• Additional training and education may be needed for Cold Chain break protocol and reporting, Wastage procedure and reporting, Needle Stick injuries and a reminder about Adverse Event reporting.

• Other areas where education may be required include: workflow ideas and support, and education on “other injectables”.

• PAS will evaluate the best time to offer a webex in the future, based on current information and on feedback from this session.

Training and Certification Update

• CPDP announced fall training sessions that can accommodate up to almost 300 more spots this September.

• These spots will also include newly graduated students.

• PAS has extended the training grant until Sept 30, 2016, with the option to re-evaluate any additional funding into the future.

Legislative Update

Legislative Update

1. Legislation (Act and bylaws) complete2. Supplementary policies, standards and guidance mostly complete,

except vaccination reporting protocols to Panorama3. Injection “Advanced Method’ initial certification, then re-certification

required for every license renewal, continues, but:a. Minimum number of injections (1) waived for 2016-17 only

4. Futurea. Training PRN other routes (PAS?)b. Issues to reconcile with Ministry of Health (Population Health

Branch)i. Types of vaccines (FluMist or prefilled syringes)ii. Age restrictions (fragments care)

Continued….

iii. Limiting administration to pharmacy (better access to the underserved population (i.e. personal care homes))

iv. Flu-shot screening questions/forms (opportunity to discuss other health needs)

v. Adverse event reporting (evidence to support problem with reporting - training?)

vi. Cold chain breaks and reporting (training?)vii. Wastage and reporting (training?)viii. Revision of population health handbook in June – anything to

add?ix. Clarify responsibility for immunization record keeping

(pharmacists access to panorama for data entry purposes?)

c. Above informed by PAS survey

Other Injectables & Fees• Across country

– pharmacies in other provinces are charging a Fee that has been determined and set by each individual pharmacy

– Fee of between $13 - $25 per injection.

• The fee may take into account but is not limited to: – required supplies, human resource requirements (injection prep time

administration time) and general pharmacy economics.

• PAS will continue to seek public funding for these and other services

• Pharmacies may begin to charge for these additional injectable medications within the framework of the policy from SCPP and at a fee they determine.

Next Steps

• Continue to work together with SCPP, DPEBB, CPDP and other stakeholders to ensure pharmacists needs are met

• PAS has been asked to review the Pharmacist Handbook for the 2016-2017 Influenza Immunization Season.

• Continue support by way of education as a result of feedback from PAS Survey and feedback today

• Recorded webinar in near future

Questions?