Techs’ Role in Immunization Administration Expands

As the role of the pharmacists progresses from dispensing tasks to increasingly clinical services, the function of the pharmacy technician is changing as well. In many states, techs have been stepping into clinical roles previously performed by pharmacists. One recent change is the physical administration of an immunization. In 2017, a new administrative law made Idaho the first state to allow techs to administer immunizations in the United States. Rhode Island and Utah soon followed. Additionally, within the federal system, techs are not bound by a state’s scope of practice rules, so federal techs in many states have also begun administering immunizations.

Questions exist about which states will be next to follow suit. Eid and colleagues conducted a protocol-driven review of state-specific regulations and statues related to tech administration of immunizations.¹ As of late 2019, only Rhode Island had language specifically allowing techs to immunize, and 9 states (Idaho, Kentucky, Michigan, Minnesota, Nebraska, New Mexico, Tennessee, Utah, and Washington) do not expressly allow or prohibit tech immunization administration. Interestingly, in 2 of these states, Idaho and Utah, techs are already administering immunizations. Discussions, waivers, and adjustments to ancillary utilization plans are ongoing in several of the remaining 7 states. Of the additional remaining states, 21 were found to be directly prohibitive, and 20 are indirectly prohibitive.¹

Washington State University (WSU) faculty members created the Pharmacy Technician Immunization Training Program in 2016.² This 6-hour accredited program comprises a 2-hour self-study with multiple choice exam and a 4-hour live training with a skills assessment. The faculty members created the program to prepare for the administrative rule change in Idaho and have trained more than 550 techs nationwide. In 2020, WSU is partnering with the American Pharmacists Association (APhA) to increase availability to a national tech audience.³ The APhA has been considered the gold standard for pharmacist immunization training in the United States for decades.

After training to administer immunizations and ensuring that state requirements have been met, techs can perform the clinical portions of immunization administration. These aspects—such as answering medical questions, counseling the patient, ensuring the vaccine is appropriate for the patient, reviewing the immunization screening questions, and verifying the prescription—are all still the responsibility of the pharmacist. Although this is a relatively new role for techs, it has so far been well received in pharmacies.

According to Bertsch and colleagues, community pharmacists supervising immunization techs felt that this advanced role created a positive change in morale and led to an increase in the number of immunizations administered by the pharmacy team.⁴

A 2019 study described how 7 newly trained immunization techs administered more than 4800 vaccinations in 1 year.⁵ Patients vaccinated by techs in this study ranged in age from 2 months to 85 years, and techs administered a spectrum of immunizations, including protection against diphtheria, hepatitis A and B, Haemophilus influenzae, human papillomavirus, polio, measles, meningococcal diseases, mumps, pneumonia, rotavirus, rubella, seasonal influenza, tetanus, and varicella.⁵

Ongoing discussions about whether to allow techs to immunize have raised interesting questions. Doucette and Schommer assessed the willingness of techs in a community setting to perform new tasks, including immunization.⁶ Techs were surveyed about their willingness to perform 12 recently emerging tasks. The 2 tasks respondents ranked as “low willingness” were administering an immunization and collecting a finger-stick blood sample. However, appropriate training and support of fellow pharmacy staff members were listed as variables that could support techs’ willingness to take on these new tasks.⁶ Historically, many techs have had little to no training on immunizations, so their hesitancy to perform this task without training is understandable. Additionally, in states that allow techs to immunize, a supervising pharmacist must still delegate this task to the tech. As pharmacists gain increased comfort with techs’ immunization administration and an understanding of its potential for success, techs’ interest in and willingness to perform this task may increase.

Kimberly C. McKeirnan, PharmD, BCACP, is a clinical assistant professor in the Department of Pharmacotherapy at the Washington State University College of Pharmacy and Pharmaceutical Sciences in Spokane.

REFERENCES

• Eid D, Osborne J, Borowicz B. Moving the needle: a 50-state and District of Columbia landscape review of laws regarding pharmacy technician vaccine administration. Pharmacy (Basel). 2019;7(4). doi: 10.3390/pharmacy7040168.
• McKeirnan KC, Frazier KR, Nguyen M, MacLean LG. Training pharmacy technicians to administer immunizations. J Am Pharm Assoc (2003). 2018;58(2):174-178.e1. doi: 10.1016/j.japh.2018.01.003.
• Pharmacy-based immunization administration by pharmacy technicians. American Pharmacists Association website. pharmacist.com/pharmacy-based-immunization-administration-pharmacy-technicians-1. Accessed February 21, 2020.
• Bertsch TG, McKeirnan KC, Frazier K, VanVoorhis L, Shin S, Le K. Supervising pharmacists’ opinions about pharmacy technicians as immunizers. J Am Pharm Assoc (2003). 2019;59(4):527-532. doi: 10.1016/j.japh.2019.03.008.
• McKeirnan K, Sarchet G. Implementing immunizing pharmacy technicians in a federal healthcare facility. Pharmacy (Basel). 2019;7(4):152. doi: 10.3390/pharmacy7040152.
• Doucette WR, Schommer JC. Pharmacy technicians’ willingness to perform emerging tasks in community practice. Pharmacy. 2018;6(4). doi: 10.3390/pharmacy6040113.