Vaccinating pediatric patients requires preparation, planning

Abstract

In August, the U.S. Department of Health and Human Services (HHS) expanded pharmacists’ authority to immunize children ages 3 to 18 years with vaccines recommended by CDC's Advisory Committee on Immunization Practices (ACIP) and authorized or licensed by FDA—including the COVID-19 vaccine. HHS is counting on pharmacists to help boost access and administration of childhood vaccines at a time when individuals and communities need protection from vaccine-prev+entable diseases. Earlier this year, CDC reported that rates of childhood immunizations had declined sharply nationwide because of the pandemic. Pharmacists across the country are now able to immunize pediatric patients during the COVID-19 public health emergency. The authority applies to pharmacists in all states, regardless of regulations restricting pharmacists from administering specific vaccines or limiting the age groups they may immunize. Pharmacy interns and technicians who meet HHS requirements can administer childhood and COVID-19 vaccines as well. While some barriers exist—namely, the relatively few pharmacies enrolled in the Vaccines for Children (VFC) program—states and pharmacy associations are working through these roadblocks so that pharmacists, pharmacy interns, and pharmacy technicians can provide vaccinations to children. More than half of children in the United States are eligible to receive vaccinations through the VFC program, including children who are Medicaid eligible, uninsured, underinsured, American Indian, or Alaska Native. Under the VFC program, CDC purchases ACIP-recommended vaccines from manufacturers and distributes them to grantees, such as state health departments, which then partner with physicians’ offices or pharmacies that are registered VFC providers. Health care practitioners must be recognized by the VFC program to receive payment for vaccine administration. Rebecca Snead, RPh, executive vice president and CEO of the National Alliance of State Pharmacy Associations, said one of the obstacles for pharmacies providing childhood vaccinations is that fewer than 100 pharmacies in the United States are enrolled in the VFC program. For all providers participating in the VFC program, the main barrier is in the onerous enrollment process, which is essential to receiving payment for vaccine administration. In addition, according to Snead, many private insurers that cover the rest of the childhood population have not enrolled pharmacists as providers on the medical benefit where these vaccines are routinely reimbursed for other providers. “There is a time delay to get pharmacists enrolled in networks,” said Snead. Under the new authority, HHS requires pharmacists to notify a patient and their adult caregiver about the importance of the well-child visit with a pediatrician or other licensed primary care provider and to refer patients when appropriate. APhA worked with a coalition to develop three tools pharmacists can use to be compliant with the pediatric immunization patient/caregiver education requirements in the HHS authority. Pharmacists can give patients the three tools—a referral form, a well-child visit brochure, and a template letter (available at www.pharmacist.com/coronavirus/immunizations). Stephan Foster, PharmD, FAPhA, APhA liaison to ACIP, said many adolescent vaccines are not being given during this time—everything from the HPV to the meningococcal vaccine—and there would be many benefits to focusing on this age group, especially if some pharmacists are not comfortable vaccinating small children. Overall, for children ages 3 years and up through adolescence, the technique for vaccine administration is the same as for adults. Foster says needle size is important to remember. (See infographics from the Immunization Action Coalition.) Pharmacists need to be fast when giving a vaccine to a child, and a parent or caregiver can provide support by holding the child still. See the sidebar for more tips and advice. Pediatric vaccination tips from pharmacists▪Keep a bag of candy in the vaccination room, and offer it after the vaccine with the parent's permission. Stickers are an alternative.▪Make sure the child's parent or caregiver is in the room. Have them hold the child's hand, or have the child sit on their lap.▪Use kid-friendly adhesive bandages (e.g., those with a Frozen or “Pokemon” design).▪Prepare everything before entering the immunization room—nothing is scarier to a child than seeing a vaccine drawn into a syringe or a needle put into a syringe.▪Try distracting the patient by asking them what music they like listening to, for example.▪Use the Shot Blocker gadget. ▪Keep a bag of candy in the vaccination room, and offer it after the vaccine with the parent's permission. Stickers are an alternative.▪Make sure the child's parent or caregiver is in the room. Have them hold the child's hand, or have the child sit on their lap.▪Use kid-friendly adhesive bandages (e.g., those with a Frozen or “Pokemon” design).▪Prepare everything before entering the immunization room—nothing is scarier to a child than seeing a vaccine drawn into a syringe or a needle put into a syringe.▪Try distracting the patient by asking them what music they like listening to, for example.▪Use the Shot Blocker gadget.