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‘Rooms full of toothpaste and toilet paper’ no place for jab: AMA

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The safety of patients could be put at risk under a trial to allow pharmacists in Queensland to administer flu vaccinations, the AMA has warned.

The AMA has written to Queensland’s Chief Health Officer Dr Jeanette Young urging her to withdraw Department of Health approval for a Pharmacy Guild of Australia pilot study under which pharmacists will be allowed to provide influenza vaccinations to people not covered by the National Immunisation Program.

AMA President Dr Steve Hambleton said doctors were extremely worried about the trial because of the potential for serious harm, particularly in instances where patients suffer an adverse reaction to the vaccine.

Dr Hambleton said practitioners who performed vaccinations needed to have specific training, including assessing the safety of the vaccine for each patient and recognising and responding to adverse reactions – knowledge and skills that pharmacists did not have.

“Pharmacies have no proven record that they are safe or appropriate locations for such a private and potentially risky clinical procedure as vaccination,” the AMA President said. “It is not in the interests of patient safety for pharmacists to participate in this irresponsible trial. It could even be dangerous.”

Dr Hambleton said that not only were there concerns about the safety of pharmacist-administered vaccinations, there were a multitude of issues regarding patient privacy, professional indemnity insurance, the appropriateness of facilities, fragmentation of care and the integrity of medical records that meant allowing pharmacists to provide vaccinations was a bad idea.

“Immunisation is a clinical service; it should be done in the clinical setting. It shouldn’t be done in a room full of toothpaste and toilet paper,” the AMA President said on ABC radio. “The AMA believes that general practice is the appropriate location for vaccination, with the procedure conducted by a highly-trained and accredited GP, or by an appropriately trained and qualified practice nurse under the supervision of a GP.”

But the trial has the backing of Queensland Premier Campbell Newman, who said experience overseas suggested it was an idea worth pursuing.

“If you go to New Zealand, to Canterbury for example, the Canterbury health system at Christchurch, you will see far greater involvement by pharmacists,” Mr Newman told the ABC. “Down in New Zealand they have made the call; they’ve said we’ve got some very highly trained people in pharmacies; they’re all university graduates, you know, qualified pharmacists, and they were being used as glorified shop keepers.”

President of the Queensland branch of the Pharmaceutical Society of Australia, Associate Professor Lisa Nissen, talked down the risks of pharmacist-administered vaccinations, arguing her members would be well equipped to handle any adverse reaction from patients to vaccines. 

“You don’t need a medical degree to give an injection or to manage anaphylaxis; you need to understand what the appropriate management is, and pharmacists will have appropriate first aid training, CPR training and management in giving adrenalin and managing that anaphylaxis. So as health professionals, pharmacists will be able to manage that situation,” Associate Professor Nissen said.

But Dr Hambleton said it was not clear what the purpose of giving pharmacists vaccination authority was, while the risks in terms of patient safety, continuity of care, integrity of medical records, privacy and medical indemnity were all too apparent.

“What’s the problem we’re trying to solve? You know, our immunisation rates in Queensland are quite high; we are successfully giving people access into their GPs,” he said.

“An online training course, coupled with a one-day course, is not going to equip someone with the ability to diagnose and manage anaphylaxis confidently.

“There’s going to be fragmentation of care and fragmentation of the clinical record. There’s no requirement to automatically notify the family doctor; in fact, there’s no requirement to seek information from the family doctor prior to immunisation.

“How do we prevent duplication of vaccination if there is not an established routine to either seek information from the patient’s usual doctor, or to inform the usual doctor?”

Dr Hambleton said administering vaccinations outside general practice should be subject to the same proficiency and quality requirements as those provided within general practice.

“The Queensland trial does not meet these requirements, and must cease immediately,” he said.

Adrian Rollins