Training Pharmacists and Technicians on Vaccine Policy

A discussion on how to effectively train pharmacists and technicians on immunization coverage, administration and follow-up.

Troy Trygstad, PharmD, MBA, PhD: Give me an example of training a staff person: What does that look like? They’re new, a pharmacy technician joins your group: What is their immunization curriculum in your mind?

Tana Kaefer, PharmD: It’s different for pharmacists and technicians obviously. For technicians, letting them know that our screening forms are created in a way that makes it easy for them to just glance at and say, “Oh, because you answered ‘yes’ to this question, you might also be a candidate for the pneumococcal vaccine. Would you like to talk to the pharmacist about that?” Or: “I can see because you answered this question, you actually need a Tdap [tetanus-diphtheria-pertussis] vaccine. Is that something you want to talk to the pharmacist about?”

So empowering them to looking at those forms and making it such that they’re not making a clinical decision, but they’re passing that information along. When it gets to me I know I need to look at this a little closer—this is not just a flu shot, I need to figure out what other things they may need. So making it easy for them to identify that.

Troy Trygstad, PharmD, MBA, PhD: Are you keeping track of which staff are producing the most vaccinations?

Tana Kaefer, PharmD: That’s interesting. We have in the past, but we’re not currently doing it. We have done that with Tdap vaccinations when the recommendation changed for pregnant women. We had a whole study on that. And then when Zostavax first came out we did that. So it really depends, but certainly we do set goals for our staff to enjoy and have fun, and really meet our goals. And then, of course it makes it beneficial for them as well.

Troy Trygstad, PharmD, MBA, PhD: Dorothy, I suspect you track which of your pharmacists are administering which vaccines. As a person responsible for immunizations across the Walgreens’ enterprise, what’s the most important training tool you have at your disposal, particularly for non-flu vaccinations?

Dorothy Loy, PharmD, MBA: I think the most important tool is actually our people, and this brings me back to getting their buy-in. We want to make sure they feel empowered to be the vaccination ambassadors. If they have the time, they should talk to their patients about all of their needs, not just the refill that they might be there for; that’s the most important piece of training. There’s lots of tips and tricks that we can give out technicians and our pharmacists, but it really comes down to them being confident in the fact that they can give this recommendation. It’s important, as part of the patient’s healthcare, not to just rush through the process, but to really take the time to form that relationship. There’s a lot to gain from a positive relationship with our patients. They really trust our pharmacists to give them the appropriate recommendations. They want to come back for any question they may have, whether it’s a medical or even personal question. So we need to create these relationships. And I think this goes back to empowering our practitioners to feel confident to provide that recommendation.

Troy Trygstad, PharmD, MBA, PhD: Do you feel like once they get past that barrier, that they actually have more professional fulfillment? I mean, do you see concrete examples of that?

Dorothy Loy, PharmD, MBA: Definitely. I would say we’ve seen an increase in tenure with the pharmacists that take a bigger step in healthcare services—immunization being one of them. But if they’re having a bigger part in the patient’s overall health, they are much more satisfied and willing to stay and take part in seeing the patient through.

Michael Popovich: There’s a number of other opportunities for pharmacists to engage with the folks who visit the store. Obviously, if you come in for your flu shots, you can have conversations about what else you need. But being more proactive so that, when you implement a prescription alignment MGM [Medication Therapy Management] program, you’re engaging your customers and telling them: “Oh, by the way, when you come in we can provide this immunization because you’re due,” and you have the data to back it up.

And then certainly we have outreach programs that the pharmacies hold about series completion. Often you’ll come in and have the conversation about the flu, and the individual will say, “I’ll go to my physician to get that second dose,” and the pharmacist, through a proactive outreach, will ping the individual and monitor whether they got that second dose. Sooner or later, they will, more than likely, come in and receive that second dose. It builds a stronger bond: you have communication, and the individual would say, “This guy or lady is really looking out for me, I really appreciate that.” This continuous outreach is kind of a big deal. Data and capacity training really does help drive opportunity into this area.

Troy Trygstad, PharmD, MBA, PhD: Between both of your answers, it seems to me that the practice of pharmacies in terms of vaccination is it’s about more than just administration. Getting the vaccinations leads to other avenues, as far as professional satisfaction—MTM builds on vaccinations, and vice versa. So it becomes one of those pillars of progressive pharmacy practice.

Tana, give us your best story of interacting with a patient where they were surprised to find that you offered immunizations.

Tana Kaefer, PharmD: Okay, I can certainly do that. This happens when I go out to employer groups—everyone calls me a nurse. So we’re talking about the working cohorts. Usually, they don’t come into the pharmacies. They don’t utilize those services. They’re always calling me a nurse, and they’re very surprised that we offer immunizations and that our screening process is such that they identify things that they have not been immunized against and are at risk for.

Troy Trygstad, PharmD, MBA, PhD: Dorothy?

Dorothy Loy, PharmD, MBA: I would say that the biggest surprise is usually around travel vaccinations. Just knowing that pharmacists can provide that advice, and that they know which vaccines a patient may need for their travel, I think that usually comes as a surprise when the pharmacists have that knowledge. When that happens it becomes word-of-mouth. That patient tells their friend, and tells their friend, and that’s how we form a community of knowledge for our pharmacists being the expert when it comes to travel vaccines.

Troy Trygstad, PharmD, MBA, PhD: Tana, what’s the single most important thing you’ve ever done to raise awareness for vaccines?

Tana Kaefer, PharmD: Educate my staff.

Troy Trygstad, PharmD, MBA, PhD: So your staff is the extension of you, so to speak.

Tana Kaefer, PharmD: Absolutely. I stay up-to-date with all of this. If they don’t understand, how are they going to make those interventions when I’m not there?

Troy Trygstad, PharmD, MBA, PhD: So you’re the champion—you extend that champion’s aura around all of your staff, and it’s a forced multiplier—you’re really relying on them.

Tana Kaefer, PharmD: Absolutely, and do training with our staff.

Troy Trygstad, PharmD, MBA, PhD: On a word-of-mouth, patient-to-patient example.

Tana Kaefer, PharmD: Right.

Troy Trygstad, PharmD, MBA, PhD: Ever anything in a newspaper advertisement or radio commercial?

Tana Kaefer, PharmD: That we do?

Troy Trygstad, PharmD, MBA, PhD: Yes.

Tana Kaefer, PharmD: Oh, absolutely.

Troy Trygstad, PharmD, MBA, PhD: What does that look like?

Tana Kaefer, PharmD: As Dorothy said, we push the information out to your patients. We do a blog post around relative information around, say, the MTM program and the measles outbreak which is very relevant. So we publish a blog post on our website to alert patients about this. We give them information and meet them where they are. If they’re a younger cohort, the text messages are ways to engage them. Also, yes, radio advertisements have been very beneficial for us. Certainly around flu season we do that, but then, if we have some particular initiative going on like Tdap, that was something we advertised as well.