FAQ: Providing Influenza Vaccines in a Community Pharmacy

Yes, but RNs must reflect on a number of questions before proceeding.

RNs must consider whether they are educated, authorized, and competent to perform and are able to manage the outcomes of providing vaccinations, whether legislation permits or prohibits this competency, and whether there is employer authorization (e.g., direct authorized prescriber order, medical directive, employer policy, etc.). Provision of the Flu vaccine can be incorporated into the scope of practice of an RN in NL.

RNs must have the individual competence to provide vaccinations, including Flu vaccines (i.e., have the necessary, skills, and clinical judgment to administer flu vaccines) and be competent to manage the outcomes of care. RNs are expected to seek appropriate education to add the administration of vaccines (e.g., Flu vaccines) to their scope of practice.

The provincial government provides a self-directed learning module on vaccinations:
https://www.gov.nl.ca/hcs/files/publichealth-cdc-pdf-self-directed-learning-module-immunizations.pdf

According to the Provincial Immunization Policy:

• RNs within acute care and long-term care require an authorized prescriber direct order to administer vaccinations.
• Within community health (including personal care homes), RNs are authorized to immunize under a medical directive directed by the NL Immunization policy: https://www.gov.nl.ca/hcs/publichealth/cdc/health-pro-info/#immunization
• In occupational health settings, a medical directive by the Regional Medical Officer is required to authorize RNs to provide immunizations.

Each year in NL, the Chief Medical Offer of Health provides a medical directive for RNs to provide flu vaccinations within the RHAs.

When an RN is practising in an employer/organization setting outside of an RHA, RNs must follow the provincial drug schedules. For RNs practising in a community pharmacy, the RN does not require an order. The Influenza vaccine falls under Schedule II and does not require an order from an authorized prescriber (i.e., Pharmacist); however, the RN must be knowledgeable of the vaccine and its product monograph before administering the vaccine and be knowledgeable of how to manage the outcomes of providing that vaccine to the client in this particular practice setting.

It is also imperative that the RN have employer policies that clearly outlines the RN’s and Pharmacist(s)’ responsibilities, e.g., who completes the client assessment, vaccines dosages, how to manage the outcomes of care, anaphylaxis, etc. These policies can be collaborative in nature and address the roles of the collaborative team (e.g., pharmacist, RN, LPN) in the provision of Flu vaccines in a pharmacy setting.

RNs must determine what is best practice to manage the outcomes of administering a Flu vaccine (e.g., the client has an adverse reaction, experience side effects, etc.) In the pharmacy setting, pharmacists are not permitted to prescribe epinephrine other than in pre-filled syringes intended for emergency administration by injection in the event or anaphylactic reactions to allergens.

See NAPRA drug schedules: https://napra.ca/national-drug-schedules

EpiPen and EpiPen Jr are Schedule II drugs and do not require a direct order from an authorized prescriber. RNs must ensure that the appropriate medication(s) are available to manage the outcomes of care.

RNs are expected to document the nursing care they provide. RNs are expected to document administration of the Flu vaccine according to the appropriate provincial legislative requirements (e.g., the provincial electronic medical record (EMR)). It is best practice to check the client’s current medication profile in the Pharmacy Network via the Healthe NL viewer from the NLCHI prior to administering the Flu vaccine. RNs must also follow employer policies for documentation.

RNs are expected to update MyCRNNL within 30 days of adding a new employment setting.

RNs are expected to engage in continuing education to maintain individual competence and to ensure that they incorporate evidence-informed best practices into their nursing practice.
November 2, 2021.