An Introductory Pharmacy Practice Experience Emphasizing Student-Administered Vaccinations

American Journal of Pharmaceutical Education, 2007 by Turner, Christopher J, Ellis, Sam, Giles, Joel, Altiere, Ralph, Et al

Objective. To introduce a requirement for second-professional year (P2) and third-professional year (P3) students to administer vaccinations to adults in community pharmacy-based immunization clinics.

Design. Second-professional year students were trained to administer influenza, pneumococcal, and other vaccinations to adults following the American Pharmacists Association's standards. All P2 students in fall 2004 and all P2 and P3 students in fall 2005 were assigned to 2 community pharmacy-based immunization clinics in the metropolitan Denver area under the supervision of immunization-certified staff pharmacists. An evaluation of the experience was conducted using retrospective preceptor and student-based survey data.

Assessment. In 2004 and 2005, the students administered approximately 5,000 (30-50 immunizations per student) and 15,000 (60-70 per student) immunizations, respectively. Students and preceptors agreed that the requirement to administer vaccinations was an appropriate activity for students and that it increased the students' self-confidence. When asked to rate the value of the students' work administering adult immunizations in the fall 2004 semester, the mean score given by the P2 students' immunization-certified preceptors was 9.2 on a 10-point Likert scale (1 = no value and 10 = great value).

Conclusion. Consistent with accreditation standards for students to have direct patient care responsibilities in introductory pharmacy practice experience courses, a requirement for P2 and P3 students to administer vaccines to adult patients in community pharmacies was successfully introduced.

Keywords: immunization, vaccination, pharmacy student, introductory pharmacy practice experience, accreditation standards

INTRODUCTION

The University of Colorado at Denver and Health Sciences Center School of Pharmacy (UCDHSC-SOP) implemented its first professional doctor of pharmacy degree program in 1999. In line with Accreditation Council for Pharmacy Education (ACPE) accreditation standards and guidelines1, 6 introductory pharmacy practice experience (IPPE) courses designed to give each student increasing patient care responsibilities in preparation for advanced pharmacy practice (APPE) training were included in the new curriculum and descriptions of those courses have been published.2-5 Introductory experiential courses are many students' first exposure to pharmacy practice and, accordingly, it is crucial that IPPEs incorporate changes in the profession and reflect contemporary pharmacy practice. In 2003, the first community pharmacistadministered adult immunization clinics were offered in Colorado and, as a consequence, the UCDHSC-SOP chose to incorporate adult immunization experiences as part of its IPPE program. This paper describes the incorporation and evaluation of required adult immunization experiences as part of the school's third, fourth, and fifth IPPE courses which emphasize health-promotion and disease- prevention activities in community pharmacy practice and are offered sequentially in the fall and spring semesters of the P2 year and in the fall semester of the P3 year of the PharmD program.5

DESIGN

Students are trained to administer influenza, pneumococcal, and other vaccines to adults through the American Pharmacists Association's (APhA) Pharmacy-Based Immunization Delivery: A National Certificate Program for Pharmacists. They complete the program's self-study component during the summer prior to the start of the P2 year and the didactic and skills components are taught by the school's full-time faculty members assisted by immunization- certified adjunct faculty members in four 3-hour classes at the start of the fall IPPE course. Students returning to the school for the P3 year repeat the clinical skills component of the APhA course to hone their clinical immunization skills.

The school works with all chain and independent community pharmacies willing to supervise P2 and P3 students in pharmacist-administered adult immunization clinics in the metropolitan Denver area. All P2 and P3 students attend 2 clinics between the first of October and early December and participate for 90 minutes at each clinic under the supervision of an immunization-certified pharmacist. Multiple students (consistent with Colorado State Board of Pharmacy regulations) were assigned to each clinic. No pharmacy in the metropolitan Denver area schedules immunization clinics in the spring semester, but walk-in immunization services are offered year-round and, if the opportunity arises, students are expected to administer adult vaccinations as part of the community pharmacy-based component of the P2 spring IPPE course.5

An evaluation of the student-administered vaccination experience was conducted based on retrospective student (classes of 2007 and 2008) and preceptor survey data. Students in the UCDHSC-SOPprogram are required to complete a course evaluation survey using Blackboard at the completion of all IPPE courses and items about immunization were included in the surveys completed by P2 students at the end of the fall 2004, fall 2005, and spring 2005 semesters, and by P3 students at the end of the fall 2005 semester. At the end of the fall semester of their second-professional year, all students in the 2007 and 2008 classes were asked to self-assess their level of con- fidence in their immunization skills immediately prior to immunizing their first patient in their first clinic and their last patient in their second clinic on a 10-point scale (1 = minimal self-confidence and 10 = maximum self-confi- dence). Using the same scale, students in the 2007 class were asked at the end of the fall semester of their thirdprofessional year to self-assess their level of self-confi- dence in their immunization skills immediately prior to immunizing their first patient in their first P2 clinic, their first patient in their first P3 clinic, and their last patient in their second P3 clinic. In addition, using a 5-point Likert scale (strongly agree, agree, neutral, disagree, strongly disagree), the 2 classes were surveyed at the end of the fall semester of their second-professional year for opinions on the appropriateness of training P2 students to administer adult immunizations and on the appropriateness of requiring P2 students to administer adult immunizations. The same scale was used to survey students in the 2007 class at the end of the fall semester of their thirdprofessional year for opinions on the appropriateness of requiring P3 students to administer adult immunizations. Each P2 student at the completion of his/her fall and spring IPPE courses (third and fourth IPPE courses) and each P3 student at the completion of his/her fall IPPE course (fifth IPPE course) was asked to estimate the number of patients he/she immunized during the semester using the following scale: 0, 1-10, 11-20, 21-30, 31-40, 41-50, 51-60, 61-70, 71-80, 81-90, 91-100 and > 100.

All community pharmacy preceptors participating in the fall 2005 IPPE course for P2 students were asked to participate in a retrospective survey of the 6-course IPPE program. The School's interest was to determine preceptors' thoughts and opinions established since 1999 (when the IPPE program began) for curriculum review and planning purposes. The one-time request was made by the school's director of experiential programs as part of the normal yearly summer-time recruitment of IPPE preceptors and the preceptors were informed the survey instrument, which included items related to the immunization experience, would be administered by his/her P2 student at the start of the upcoming fall semester. The preceptors were told that their students would record their responses and transcribe them via the Blackboard software computer program to provide the school with collated anonymous data. The students, who were already familiar with the Blackboard program from their P1 year, collected and transcribed the data to avoid the necessity of training the preceptors to use Blackboard. The survey questions were administered at the start of the semester to avoid confusion (ie, to make sure each preceptor knew the survey did not relate to their new student's performance).