The document provides an overview of Saskatchewan's 2015-2016 seasonal influenza immunization program and administering drugs by injection. Key points include: - Over 55,000 flu shots were administered by 906 trained pharmacists in 72% of Saskatchewan pharmacies. - Feedback from the program will inform improvements for next season, including ensuring adequate vaccine distribution and clarifying documentation requirements. - Legislation allowing pharmacists to administer other injections besides flu shots has been passed, and training and certification processes are in place. - Stakeholders will continue working together on issues like eligible vaccines, age restrictions, and reporting protocols.

1. 2015-2016 Seasonal Influenza Immunization Program Review
&
Administering Drug By Injection and Other Routes
April 30, 2016
Ray Joubert, SCPP
Myla Wollbaum, PAS

2. Overview of Session
• Review Influenza Immunization Program (IIP) uptake and
stats
• Beyond Flu Shots: Bill 151 Administering Drugs by Injection
and Other Routes
– Training update
– Legislation Update
– Certification/recertification
• PAS Survey Results
• Next Steps

3. Roles Associated with IIP
• SCPP
– Creates legislation, sets training parameters and certification requirements
• CPDP
– Creates training certification based on SCPP requirements
• Population Health
– Oversees provincial Seasonal Influenza Program
– Orders and pays for vaccine
– Chooses type of vaccine to be distributed to pharmacy
• Drug Plan and Extended Benefits Branch
– Creates Influenza Immunization Program policy
– Pays for the administration of flu vaccine
– Works with POP Health and distributors for vaccine distribution
– Creates Pharmacist Handbook
– Woks with PAS for remuneration and pharmacist communication
• PAS
– Negotiates fee for administration of flu vaccine, provides feedback for policy and
protocols of the IIP
– Creates support material, pharmacist education
– Public education and promotion

4. 2015-2016 Influenza Immunization
Program (IIP)
• October 19, 2015 to April 29th, 2016

5. PAS Pharmacist Support for IIP
• Numerous support material on PAS website
– Cold chain, emergency protocol, supply checklists, adverse reaction
reporting, documentation forms
– All Drug Plan policy documents
• Telehealth, webinar

6. Public Education Strategy Update
• Participating pharmacies were shipped print material including pharmacist badges,
tent cards, posters, and bag stuffers at no charge from PAS.
• Additional materials including stickers, floor decals, shelf talkers and poster stands
were available for purchase.
• Kicked off the official campaign on Oct 26th which included:
– Billboards, bus boards, advertisements in weekly newspapers and seniors
publications
– Several TV and radio interviews
– A public service announcement commercial (that ran on CTV, Global, and CBC)
A media event where Minister of Health, Dustin Duncan was immunized by a
pharmacist within a local pharmacy.
• Ran a survey in conjunction with CPhA on professional services through Abacus to
provide benchmark of the public’s awareness and opinion of pharmacists being
able to provide flu shots

7. Influenza Immunization Program (IIP)
• Because of additional outbreaks appearing late in the
season across the province and country, Population
Health (the purchasers of vaccination product to the
program) extended the official length of the flu
season to April 29th (from March 31).
• As a result, the Drug Plan remuneration for
administering the flu injection was extended as well.

8. Statistics
• 906 pharmacists are Saskatchewan are trained to
give flu shots
• 72%, or 262 of the 362 pharmacies in Saskatchewan
participated in the IIP

9. Statistics
• 55,654 flu injections given
– 62,500 anticipated
– 21% of total shots of the entire program were given by
community pharmacists
– 25% of all shots given were in 1st week
• Most shots given in a pharmacy = 1237

10. PHARMACIST INFLUENZA IMMUNIZATION
STATISTICS BY HEALTH REGION AS OF APRIL 2, 2016
RHA
Age (at immunization)
Total Immunized,
by Pharmacists9 to
11 years
12 to 17
years
18 to 64 years
65 years and
older
Athabasca Health Authority 0 0 0 0 0
Cypress RHA 21 59 1,086 625 1,791
Five Hills RHA 37 90 1,780 1,613 3,520
Heartland RHA 20 84 997 548 1,649
Kelsey Trail RHA 4 36 600 530 1,170
Keewatin Yatthé RHA 0 0 18 5 23
Mamawetan Churchill River RHA 7 10 177 47 241
Prairie North RHA 17 41 683 389 1,130
Prince Albert Parkland RHA 69 128 1,721 866 2,784
Regina Qu'Appelle RHA 236 563 9,925 7,261 17,985
Saskatoon RHA 320 759 11,466 7,759 20,304
Sun Country RHA 31 99 1,715 859 2,704
Sunrise RHA 35 85 1,317 922 2,359
Total Immunized, by age 797 1,954 31,485 21,424 55,660

11. IIP: What We Learned
Vaccine
– Distribution went relatively smoothly with some
minor issues of shortages at wholesalers for a very
brief period of time.
– The Drug Plan was able to work with POP Health in a
timely basis to replenish stock to a different type of
vaccine to make up for shortages.
– Shortages were mostly due to pharmacies
overstocking.
– The Drug Plan is currently working with distributors
and POP Health on next years flu program and
distribution plans.

12. IIP: What We learned
Documentation
– Pharmacists could use any documentation forms
as long as they included the requirements on the
Drug Plan policy and SCPP Bylaws.
– Some people used their own in-house developed
forms and others used CPDPs.
– PAS in conjunction with medSask, is close to
finalizing forms
• for flu vaccination, plus a clinical support Guide
• other drugs by injections

13. IIP: What We Learned
Limiting Policy
– Ability to administer publically funded FluMist
• This was, and will be a decision by Population Health,
as the purchasers of supply. PAS has a pending meeting
with all stakeholders where we will continue to
advocate for this to be a part of the program.
– Limiting Administration to Pharmacy
• Again, this will be discussed with POP Health and other
stakeholders in a pending joint meeting.

14. What We learned
PAS Survey
• There were 157 respondents.
• Approximately 80% of pharmacists felt comfortable or very comfortable
providing injections.
• Up to 74% of respondents used at least one type of education material
sent to them (posters, tent cards, buttons etc.)
• Additional training and education may be needed for Cold Chain break
protocol and reporting, Wastage procedure and reporting, Needle Stick
injuries and a reminder about Adverse Event reporting.
• Other areas where education may be required include: workflow ideas
and support, and education on “other injectables”.
• PAS will evaluate the best time to offer a webex in the future, based on
current information and on feedback from this session.

15. Training and Certification Update
• CPDP announced fall training sessions that can
accommodate up to almost 300 more spots
this September.
• These spots will also include newly graduated
students.
• PAS has extended the training grant until Sept
30, 2016, with the option to re-evaluate any
additional funding into the future.

16. Legislative Update

17. Legislative Update
1. Legislation (Act and bylaws) complete
2. Supplementary policies, standards and guidance mostly complete,
except vaccination reporting protocols to Panorama
3. Injection “Advanced Method’ initial certification, then re-certification
required for every license renewal, continues, but:
a. Minimum number of injections (1) waived for 2016-17 only
4. Future
a. Training PRN other routes (PAS?)
b. Issues to reconcile with Ministry of Health (Population Health
Branch)
i. Types of vaccines (FluMist or prefilled syringes)
ii. Age restrictions (fragments care)

18. Continued….
iii. Limiting administration to pharmacy (better access to the
underserved population (i.e. personal care homes))
iv. Flu-shot screening questions/forms (opportunity to discuss other
health needs)
v. Adverse event reporting (evidence to support problem with
reporting - training?)
vi. Cold chain breaks and reporting (training?)
vii. Wastage and reporting (training?)
viii. Revision of population health handbook in June – anything to
add?
ix. Clarify responsibility for immunization record keeping
(pharmacists access to panorama for data entry purposes?)
c. Above informed by PAS survey

19. Other Injectables & Fees
• Across country
– pharmacies in other provinces are charging a Fee that has been
determined and set by each individual pharmacy
– Fee of between $13 - $25 per injection.
• The fee may take into account but is not limited to:
– required supplies, human resource requirements (injection prep
time administration time) and general pharmacy economics.
• PAS will continue to seek public funding for these and other services
• Pharmacies may begin to charge for these additional injectable
medications within the framework of the policy from SCPP and at a fee
they determine.

20. Next Steps
• Continue to work together with SCPP, DPEBB, CPDP and
other stakeholders to ensure pharmacists needs are met
• PAS has been asked to review the Pharmacist Handbook
for the 2016-2017 Influenza Immunization Season.
• Continue support by way of education as a result of
feedback from PAS Survey and feedback today
• Recorded webinar in near future

21. Questions?