Frequently Asked Questions for Pharmacists on Vaccinations
Q: Where can I find more information about using the NC Vaccination / Immunization Registry?
A: The NC Association of Pharmacists has made available a North Carolina Immunization Registry Pharmacy User Webinar that immunizing pharmacists will find highly instructive. It may be accessed here: http://www.ncpharmacists.org/content.asp?contentid=147.
Q: Are pharmacists required to report influenza vaccine administration to the North Carolina Immunization Registry?
A: No. NCGS 90-85.15B(d)(3) (part of the pharmacist vaccine administration statute passed in 2013) previously stated that “except for influenza vaccines administered under G.S. 90-85.15B(b)(6)”, an immunizing pharmacists must “access the North Carolina Immunization Registry prior to administering the vaccine . . . and record any vaccine . . . administered to the patient in the registry within 72 hours after the administration.” The clear intent of the statute, therefore, was that influenza vaccine administrations not be reported to the Registry. Confusion rose because the referenced paragraph – G.S. 90-85.15B(b)(6) – does not exist. Rather, influenza vaccine administration is discussed in G.S. 90-85.15B(c). The mismatched cross-reference has now been corrected by the General Assembly, and the statute is now clear that influenza vaccines administered under G.S. 90-85.15B(c) do not have to be reported to the Registry.
** JULY 1, 2014 UPDATE ** GENERAL ASSEMBLY GRANTS PHARMACISTS BROADER VACCINATION AUTHORITY. On July 3, 2013 the Governor signed S.L. 2013-246, An Act to Protect the Public’s Health by Increasing Access to Immunizations and Vaccines through the Expanded Role of Immunizing Pharmacists. The text of the statute may be found here, and pharmacists are strongly encouraged to read the new statute: http://www.ncleg.net/Sessions/2013/Bills/House/PDF/H832v6.pdf Pharmacists are, understandably, asking a number of questions about implementation. The following are the most common ones:
1. When does the law take effect? The law’s effective date is October 1, 2013. Pharmacists may begin exercising this broader authority after October 1 provided that all requirements of the statute and rule are met. Protocols must be updated – including incorporation of the mandatory minimum questionnaires (see #5 below). Immunization registry training must be completed and access activated (see #4 below). Information must be available to provide to patients who do not indicate a primary care provider (see #8 below).
2. What does the law allow? “Immunizing pharmacists” who meet the requirements in the statute may administer any CDC-recommended vaccination to any patient at least 18 years of age pursuant to a specific prescription order. Immunizing pharmacists may administer pneumococcal, zoster, hepatitis B, meningococcal, tetanus, tentanus-diptheria, and TDAP vaccines to patients at least 18 years of age pursuant to written protocols as defined in existing vaccination rules (found at 21 NCAC 46.2507). Pharmacists may continue to administer the influenza vaccine to patients age 14 and over as specified in current rules.
3. What notifications will be required? The immunizing pharmacist must notify the patient’s identified primary care provider within 72 hours of administering any vaccine. If the patient does not identify a primary care provider, the pharmacist will be required to “direct the patient to information describing the benefits to a patient of having a primary care provider,” which information may be prepared by any of the North Carolina Medical Board, North Carolina Academy of Family Physicians, North Carolina Medical Society, or Community Care of North Carolina. As these organizations develop these materials, Board staff will endeavor to provide links to them. Except for flu vaccines, a pharmacists must, within 72 hours, report administration of any vaccine to the North Carolina Immunization Registry, if “operable.”
4. How do I get access to the North Carolina Immunization Registry? Various stakeholders are working with Immunization Branch officials on training and access issues. Registry access training has begun. Roll-out is gradual. Some pharmacists have completed training and have obtained access to the registry. Others have not. Provided that a pharmacist has met all of the other requirements of the new statute, he/she may begin exercising the new immunization authority upon obtaining access to the registry. The North Carolina Association of Pharmacists has made available a North Carolina Immunization Registry Pharmacy User Webinar that immunizing pharmacists will find highly instructive. It may be accessed here: http://www.ncpharmacists.org/content.asp?contentid=147.
5. I’m already an immunizing pharmacist. Should I begin revising my supervising physician protocols? Board staff recommends that immunizing pharmacists discuss the expanded authority with their supervising physicians and preparing appropriate changes to protocols. Those agreements must specifically include the “minimum standard screening questionnaire and safety procedures” for protocol-administered vaccines (i.e., non-prescription based vaccines). That questionnaire, which was agreed upon by the North Carolina Academy of Family Physicians, North Carolina Medical Society, North Carolina Pediatric Society, North Carolina Association of Community Pharmacists, North Carolina Association of Pharmacists, and North Carolina Retail Merchants Association is found here: http://www.ncbop.org/PDF/ImmunizingPharmacistsMinScreeningQuestionnaire091313.pdf. The Pharmacy, Nursing, and Medicals has received and accepted the questionnaire. If immunizing pharmacists have updated their supervising physician agreements in accordance with the new law, they may begin administering prescription-based CDC-recommended vaccines to adult patients or the specifically listed protocol-based vaccines to adults (or patients 14 and up for flu) when access to the immunization registry becomes available (see question # 4 above).
6. How do I register with the Board of Pharmacy and Board of Medicine as an immunizing pharmacist? North Carolina pharmacists who provide immunizations are already documented in the Board of Pharmacy database. Pharmacists will continue to confirm immunizing pharmacists status each year as part of the license renewal process. Pharmacists do not need to separately notify the Medical Board of their immunizing status. The Board of Pharmacy will, upon request, provide the Medical Board with any information it may need.
7. Where may I obtain “information describing the benefits to a patient of having a primary care physician” that the statute directs me to provide to a patient who “does not identify a primary care provider”? The statute says that, when administering a protocol-based immunization to a patient who does not identify a primary care provider, the immunizing pharmacist shall “direct the patient to information describing the benefits to a patient of having a primary care physician prepared by any of the following: North Carolina Medical Board, North Carolina Academy of Family Physicians, North Carolina Medical Society, or Community Care of North Carolina.” The North Carolina Academy of Family physicians has prepared an information sheet, which may be downloaded here: http://www.ncbop.org/PDF/WhatIsAPrimaryCarePhysician.pdf. Board staff will post any like materials prepared by the Medical Board, Medical Society, or CCNC.
Please continue to monitor this website for further updates on this important issue.
WEDNESDAY, JUNE 29, 2011
Governor Perdue Signs S609, Which Authorizes Pharmacists to Administer Flu Vaccine to Patients 14 and Older. Yesterday, Governor Perdue signed into law S609, which provides in part: “A pharmacist licensed under Article 4A of Chapter 90 who may administer vaccines under 21 NCAC 46 .2507 and 21 NCAC 32U .0101 shall be granted the authority to administer influenza vaccine to patients aged 14 years and older pursuant to 21 NCAC 46 .2507 and 21 NCAC 32U .0101.” This provision was effective immediately upon Governor Perdue’s signature. Accordingly, pharmacists presently authorized to administer vaccines under existing Board rules may begin administering flu vaccine to patients 14 and older.
Q: May pharmacists administer the zoster vaccine?
A: Yes. Effective February 1, 2008, pharmacists may administer the zoster vaccine to their patients in accordance with amended Rule .2507.
Q: May a properly trained pharmacy student administer vaccinations?
A. An appropriately trained pharmacy student may administer vaccines so long as, and only if, that student is doing so under the direct supervision of a certified pharmacist vaccinator.
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