COVID-19 vaccination: risk assessment and mitigation

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Be aware and prepare for expansion of immunization services, PDL warns

In its latest practice alert, PDL offered advice on ivermectin and COVID-19 vaccination.

Pharmacist immunization services continue to expand and PDL urges all pharmacists to consider risk assessment and risk mitigation strategies necessary to prevent errors or incidents.

Below are some of the most common risk areas identified by professional PDL agents.

Check the patient’s age The inclusion of Moderna’s Spikevax vaccine as part of the community pharmacy requires even more vigilance to ensure that the minimum age limit is respected. PDL advises pharmacists to consider the following:

  • Realizing that TGA approval for Moderna Spikevax is 12 years old and Vaxzevria from AstraZeneca is 18 years old.
  • State or territory regulations may impose a higher minimum age, so please check your jurisdiction’s requirements.
  • Some consent and reservation forms may ask for a patient’s date of birth, but not search for or translate this data into age in years. Confirm the age in years to avoid errors.
  • Use a reminder in the vaccination area or next to the computer reservation system to confirm the patient’s current date and date of birth to ensure minimum ages. For example, on September 16, 2021, a patient aged 12 or over would have a date of birth on or before September 16, 2009 and 18 and over would be on or before September 16, 2003.
  • PDL stresses the importance of checking the Australian Immunization Registry (AIR) before each vaccination.

Check the brand

Many patients show up for the second dose of a COVID-19 vaccine. The patient’s expectations as to which brand to administer should be confirmed using open-ended questions.

  • For example, a question such as “Can you please confirm the vaccine you plan to receive today?” “
  • Don’t use closed-ended questions like “So you’re here for a Vaxzevria today, aren’t you?” Or “So you received your first COVID-19 vaccine without any problems?” “

Check the interval

  • Since the three vaccines currently available have a range of administration intervals depending on the vaccine and the state of the epidemic, there is a risk of confusion between the patient and the pharmacist.
  • Examine the AIR before each vaccination and ensure that any second dose is within the approval interval for the brand and setting. Review previous PDL vaccination alerts by visiting the website.

Separate and differentiate immunization services

  • Separate Spikevax and Vaxzevria with respect to storage, preparation, labeling, reservations and administration to the extent possible.
  • Color coding vaccines in all handling areas can minimize the risk of an incident.
  • Be aware of the different considerations for expiration of vaccines.

Ivermectin

The recent increase in the prescription of ivermectin has prompted the TGA to apply new restrictions on the prescription of ivermectin.

PDL reminds all pharmacists to always assess each prescription on an individual basis and to ensure that there is sufficient information to support the delivery of a drug in a way not stated on the label.

Please note that according to the new TGA guidelines, general practitioners can only prescribe ivermectin for the indicated conditions of the treatment of scabies and certain parasitic conditions.

Some specialists (listed below) may prescribe for unapproved indications if they deem it appropriate.

  • Infectious disease specialists
  • Dermatologists
  • Gastroenterologists
  • Hepatologists (specialists in liver disease)

For immediate advice and assistance in the event of an incident, members can call PDL on 1300 854 838 to speak to one of its professional agents. PDL is here to support its member pharmacists 24 hours a day, 7 days a week, across Australia.


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