Travel vaccination expert Alex Leung gives the need-to-know clinical advice for offering travel vaccines in your pharmacy
There are many reasons why people choose to travel. Whether visiting family abroad, expanding cultural horizons or choosing to work overseas, it’s never been easier to hop on a plane to a far-flung destination.
With the rise in travel, there has arguably never been a better time for community pharmacists to set up a travel clinic (for more detail on this, see here) so that they can profit from this trend.
Not only does community pharmacy offer patients the convenience of being able to receive their vaccinations in their local area, but pharmacists’ clinical knowledge means that your business can become a one-stop-shop for all the advice patients need before they embark on their travels.
Pharmacists must be trained before they administer travel vaccines. Different training providers will cater for different patient group directions (PGDs). PGDs define the specifics of a particular treatment, including how the treatment should be tailored to different patients.
When administering any vaccinations, pharmacists should always refer to their individual PGDs and the specific training they have received in providing the travel vaccination service.
Training will show pharmacists how to provide certain vaccines, including different injecting techniques, which in the case of basic travel vaccinations should include subcutaneous and intramuscular injections.
This article will give a basic overview of some simple clinical points to consider when administering travel vaccinations.
1 Know the risks and be prepared
As with many clinical services, vaccinations carry risks.
One such risk is that the patient could suffer from anaphylaxis upon being vaccinated.
In the case of anaphylaxis, pharmacists should keep at least three doses of adrenaline in their pharmacy at all times, which should be given to counter anaphylactic symptoms.
Pharmacists may give one dose of adrenaline at five-minute intervals, with the dose dependent on the age of the patient under 2016 guidelines from the Resuscitation Council. CPR should be administered if their breathing stops entirely.
Some patients may experience faintness after receiving an injection. Warning signs that a patient may faint include rapidly becoming pale, and verbal signs, such as the patient saying they are feeling faint.
Patients feeling faint should be asked if they would like to sit down and should be offered a glass of water.
Sugar can also be offered and placed under the tongue if the pharmacist suspects that the faintness is being caused by anxiety.
If your patient does faint, it is important to support their head to prevent head injuries. Patients who have fainted should be laid flat on the floor and their legs raised as high as possible.
2 Make sure you’re familiar with your service’s PGDs
As stated previously, different training providers will have different PGDs that pharmacists should adhere to when providing their travel vaccination service.
It is important that pharmacists familiarise themselves with the small print of the PGD issued by their training provider. Pharmacists should know the inclusions and exclusions.
Contraindications and cautions are separate. Contraindications mean that the service should not be offered to certain patients (for example, live vaccines in children and pregnant women). Cautions mean that the pharmacist should exercise their clinical judgment before offering the vaccination.
Some paediatric vaccinations vary in the ages they are suitable for, so pharmacists should familiarise themselves with the brand they are using and administer accordingly.
For example, for hepatitis A, the paediatric vaccine brand Harvix Junior is indicated for ages one to 15, but the brand Vaqta Paediatric is indicated for ages one to 17. Giving a Harvix Junior vaccine to a 16-year-old, for example, would be considered a clinical error. Thus, pharmacists need to be very careful when reading the age indication on each brand.
Often, there are no black-and-white answers. Pharmacists should weigh up the potential risks associated with offering vaccinations to certain patients and the risks of not vaccinating that patient – for instance, how dangerous it would be for the patient not to receive a typhoid vaccine if they were travelling to an area whether the incidence of typhoid was high.
It is important that the pharmacist carefully considers the course of action they take when administering vaccinations, so that they can justify their actions in the unlikely case that something goes wrong.
3 Ensure the service’s risk assessment is watertight
Patients should fill in a comprehensive risk assessment form, which should be scrutinised by the pharmacist before they give the vaccine. You should be given this risk assessment form by your training provider.
When shopping around for training providers, a good indication of their quality is how detailed and robust the risk assessment form is.
The risk assessment form, once completed by the patient, should give the pharmacist almost all of the information they need to determine whether it is clinically appropriate to vaccinate.
As the pharmacist’s time is precious, you could consider training your counter assistant to help patients complete their risk assessment form and especially to check that the entire form has been completed, with details including destinations, departure date, duration of trip, intended activities and vaccination history.
Counter assistants are not performing the clinical check and should not give clinical advice, but only make sure the form has been completed to give to the pharmacist.
Patients should spend roughly 15 minutes completing the form, if they are being completely accurate and honest in their answers.
Once the form has been completed, the pharmacist should have a discussion with the patient about whether vaccines should be given. This is a good opportunity to offer patients further clinical advice that may be pertinent to their travels.
For example, given the high incidence of travel diarrhoea, pharmacists should advise patients that products such as loperamide should only be taken 24 to 48 hours after onset so that the body can rid itself of toxins.
4 Be clear with the patient
You may find that many patients using your travel clinic believe they will be completely protected from the infections and diseases they have received a vaccination against. However, it is important to be clear with them that no vaccination is 100% effective.
You may sometimes find that patients have not given themselves enough time to finish a course of vaccinations before they leave for their travels.
In such cases, you should be clear that they will not be as protected from certain diseases and infections as they would be if they had allowed enough time to finish the course of vaccines. However, an incomplete course will still provide some protection, and is better than receiving no vaccination at all.
5 If unsure, delay vaccination
As stated previously, giving vaccines is not always black and white and pharmacists should always exercise their clinical judgment.
However, if at any point you are at all unsure about offering vaccinations to certain patients at any point, it is advisable
to ask the patient to return to the pharmacy at a later date to receive their vaccinations.
This will give you time to research whether vaccinations are suitable for this patient so that you can make a well-informed decision.
In certain situations where vaccinations are contraindicated but you feel it would be advisable for the patient to be vaccinated, you could consider contacting your training provider.
In certain situations, providers can give additional inclusion, based on a named patient basis, if they are clinically appropriate.
Community pharmacies are an excellent location to provide travel vaccinations. To ensure that they are offering the best and safest service possible, pharmacists should carefully shop around for training providers, comparing factors such as PGDs and risk assessment forms. This will allow them to be as confident as possible when offering the service.