Implementing a Pharmacy Training Program of Immunizations and Injections in Manitoba Immunizations and Injections Program Group (Christopher Louizos 1 , Kim McIntosh 2 , Lavern Vercaigne 1 , Casey Sayre 1 , Shawn Bugden 1 , Harris Iacovides 1 , Kelly Brink 1 , Dinah Santos 1 , Susan Lessard-Friesen 2 , Nicole Nakatsu 4 , Michelle Glass 5 ), Theresa Bowser 3 , Grace Frankel 1 , Sheila Ng 1 , Melissa Gobin 1 , Neal Davies 1 1 University of Manitoba, Faculty of Pharmacy, 2 Manitoba Pharmaceutical Association (MPhA), 3 University of Manitoba, Faculty of Nursing 4 Canadian Society of Hospital Pharmacists, 5 Manitoba Society of Pharmacists, Winnipeg, Manitoba, Canada Methods Introduction Results Conclusions Pharmacists in Manitoba do not yet have the legal authority to administer immunizations and injections. The new Pharmaceutical Act (Bill 41) in Manitoba which will allow Pharmacists an expanded scope of practice has undergone the following process: Objective An Immunizations and Injections Program Group (IIPG) was established with the task of developing a certificate program for students and practitioners to embrace the expanding scope of Pharmacy practice in Manitoba. The IIPG was comprised of interested stakeholders focused on the development of a certificate program. The IIPG included representation from the University of Manitoba, Faculty of Pharmacy, Manitoba Pharmaceutical Association (MPhA), Manitoba Society of Pharmacists, Canadian Society of Pharmacists, and Manitoba Health. The IIPG completed an environmental scan of existing Immunizations and Injections programs available in Canada. The IIPG also consulted with associated Health Faculties at the University of Manitoba to determine what is currently taught in the curriculum in regards to immunizations and injections. Based on this information an appropriate online program was selected which would initially be the only program accepted in Manitoba. An ad-hoc committee was then created comprised of members from the University of Manitoba, Faculty of Pharmacy and the MPhA who collaborated with the Faculty of Nursing to create a detailed practical workshop which trained and evaluated participants. The ad-hoc committee also worked with the MPhA to create specific content regarding the legal obligation and best practices for Manitoba Pharmacists to administer immunizations and injections. The IIPG developed an Immunizations and Injections certificate program comprised of two distinct parts; Pre-requisites include standard or emergency first aid and CPR level C. The IIPG decided that it is essential that participants are up-to-date and trained in the management of medical emergencies which may arise during the immunization and injection process. Licensed practitioners have the option of standard or emergency first aid, however University of Manitoba, Faculty of Pharmacy students must complete the standard first aid CPR-HCP program. Participants must also complete the selected online Immunization Competencies Education Program (CCCEP # 1066-2010-092-I-P), which was developed by Advancing Practice (Fig. 1). This program was selected by the IIPG for its thorough content, user friendly interface, French language option, and 24 hour availability. The ad-hoc committee created a Manitoba specific module (CCCEP #1193-2012-577-B-P) to ensure participants have access to regional specific content (Fig. 2). Each module is comprised of specific learning objectives, pre-test, module specific content (written and audio/visual), learning summary, post-test, discussion forum, course evaluation, and references. In order to successfully complete a module, each participant is required to complete a post-test, submit a post on an open discussion forum, and complete a course evaluation. The post-test must be passed with a grade of 70% or greater. Failure to complete the post-test with 70% or greater in two attempts will result in failure of the online portion and the inability to complete the certificate program. The University of Manitoba, Faculty of Pharmacy 3 rd year students must also complete two in-class quizzes to ensure competency. The in-class quizzes must be passed with a grade of 60% or greater to receive standing. Results Continued The Immunizations and Injections Workshop consists of two parts, a didactic overview and a practical lab portion, where students practice and are assessed on their administration of intradermal, subcutaneous, and intramuscular injections. The agenda (Table 1) describes the flow of the Immunizations and Injections workshop. The participants practice their skills using a Limbs and Things® injection trainer. This trainer was selected because of its ability to demonstrate all three of the injection types (Fig. 3). Each individual participant is given a practice kit (Fig. 4) comprised of the following equipment; Practi- Ampules™ (2 mL of sterile water), BD 3 mL syringe Luer-Lok™, BD Eclipse™ Needle 25G x 1", BD Integra™ Syringe with Retracting BD PrecisionGlide™ Needle 3 mL 21G x 1”, and a VanishPoint® Tuberculin syringe 1 mL 27 G x 1/2". Additional expendable supplies such as gloves, cotton balls, and saline for injection are provided to the participants. Participants are then evaluated on their technique of the Pre-injection phase, Injection Phase (intradermal, subcutaneous, and intramuscular injections), and Post Injection Phase by administering injections on other participants while supervised by a trained Evaluator. The Immunizations and Injections certificate program was optional to all interested practicing Pharmacists and 4 th year Pharmacy students however, mandatory to all 3 rd year Pharmacy students. The program has had 6 full sessions since its inception in August 2012 and has certified 104 Pharmacy students and 158 practicing Pharmacists (Table 2). Time Activity Comments 8:00 – 8:30 Program Registration 8:30 – 10:00 Pharmacy Didactic Portion Introductions Workshop Overview Regulations Informed Consent Patient Assessment Vaccination Myths Preparing Medications Summary Post injection monitoring Anaphylaxis/Adverse Events Needle stick injuries Documentation 10:00 – 10:15 Nursing Didactic Portion The “5 rights” Landmarking 10:15 – 10:30 Break / Move to Lab 10:30 – 11:30 Nursing Lab Portion Part 1 A. Routine Practices review B. Sharps Review C. Reconstitution D. Withdraw Med for Injection E. 5 Rights and patient assessment 11:30 – 12:30 Lunch 12:30 – 1:30 Nursing Lab Portion Part 2 F. Subcutaneous Injections G. Intradermal Injections 1:30 – 1:45 Break 1:45 – 2:30 Nursing Lab Portion Part 3 H. Intramuscular Injections 2:30 – 4:30 Practice/Assessment The IIPG has successfully implemented a model for an Immunizations and Injections certificate program that is embedded into the Pharmacy program curriculum and for use by practicing Pharmacists. All feedback from practitioners and students regarding the Immunizations and Injections certificate program has been overwhelmingly positive. Students with Immunizations and Injections Certification 104 Practitioners with Immunizations and Injections Certification 158 Eligible 3 rd and 4 th Year Students 107 Eligible Practitioners 1395 Percentage 97.2% Percentage 11.3% Figure 1 Figure 2 Figure 3 Figure 4 Table 1 Table 2 December 7 th , 2006 • The Pharmaceutical Act in Manitoba was passed and received Royal Assent. In order for proclamation to occur regulations, bylaws and a Code of Ethics are to be prepared and approved by the membership and government. March 2008 • The membership voted on the original Bill 41 Regulations Policy Document which did not receive majority support. November 9 th , 2010 • The membership completed a second vote on an updated Bill 41 Regulations Policy Document which received support and was approved. November 17 th , 2010 • The approved updated Bill 41 Regulations Policy Document was forwarded to the Minister of Health. April 21 st , 2012 • The membership voted on a new Code of Ethics which was unanimous and approved. February 20 th , 2013 • Special General Meeting was held for the membership to review an updated first draft of the regulations (Parts 1 to 11). Present • The remaining parts of the regulations are still under review by government and once the re-drafting process is complete, the membership will again be called to review and approve the regulations to the new Act in its entirety.