Pharmacists Push to Provide Immunizations

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New York State Nurses Association

REPORT: December 2002

Pharmacists Push to Provide Immunizations

A bill that would allow pharmacists to administer adult immunizations will again be introduced during the upcoming legislative session, and there is evidence that the pharmacists' lobby is mounting an aggressive campaign to get it passed.

The bill is modeled after the 1999 law, which allows registered nurses to provide immunizations under non-patient-specific protocols. With the proposed change, licensed pharmacists would be allowed to immunize adults for influenza and pneumococcal disease, plus administer anaphylactic treatment.

NYSNA is opposing this change for several reasons:

#1 It compromises patient safety. As many healthcare employers learned in the 1990s, there is no substitute for a Registered Nurse. As part of the "checks and balances" in the healthcare system, pharmacists know about drug treatments and are trained to check prescriptions for proper dosage and possible interactions. Nurses, on the other hand, are responsible for administering medications and are trained to assess patients for contraindications and adverse reactions.

#2 It will not improve immunization rates. Pharmacists argue that adult immunization rates would improve if they could give flu shots. In fact, data from the Centers for Medicare Services indicate no differences in immunization rates between states that allow pharmacists to give flu shots and states that don't.

The pharmacists' lobby is using data from 1999 to illustrate a low immunization rate for New York. These data were collected before a state law went into effect allowing registered nurses to administer immunizations under general orders. This has made it easier for RNs to set up and operate immunization clinics, many of them in pharmacies.

In recent years, New York's immunization rate has improved significantly. According to a study published in a May 2002 issue of the Journal of the American Medical Association, influenza vaccination rates in New York for adults aged 65 and older, which had been 48.5% in 1991, increased to 68.1% in 2001. Pneumococcal vaccination rates increased from 21.0% to 50.1%.

#3 There are plenty of nurses to provide immunizations. While there is a shortage of acute-care nurses, there are enough nurses to provide adult immunizations. Registered nurses participated in more than 250 flu vaccination clinics across the state in the past month, according to a listing by the New York State Office for the Aging.

#4 Pharmacies are not set up as clinics. Is it best practice for a person to stop by for a flu shot while picking up contact lens solution? Nurses know that, for any healthcare procedure, patient history needs to be discussed in a confidential setting and patients need to remain on site in case of an adverse reaction.

NYSNA will again oppose this measure in the State Legislature. At the same time, the association is working with other provider groups to improve immunization rates further by removing barriers that prevent access to this service. Some of the barriers include vaccine shortages (none have been identified this year), cultural issues, better education of the public about the value of immunization, and appropriate reimbursement to providers.

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