New Business: Providing injection services

I attended an educational session on the provision of injection services where the speaker began his presentation by asking how many pharmacists would like to do five extra prescriptions a day. Of course, just about all pharmacists raised their hands! Then he proceeded to explain that this was what could occur if we made the decision to provide injection services in our pharmacies.Until that time, I had thought of injection services as an event that was held in our pharmacy from time to time. (We had been doing this in collaboration with nursing services for over 10 years.) But once the penny dropped, I realized that an injection service could be another form of our regular prescription services.At another CE session this spring, a pharmacist described the pros and cons of providing injections by appointment, versus on a walk-in basis. The disadvantages included the risk of clients being upset when the pharmacist, who was also filling regular prescriptions, was unable to provide the injection precisely at the previously set appointment time.So, largely due to having been influenced by these ideas, I decided to offer influenza immunization services between the hours of 9 a.m. and 5 p.m. on all weekdays that an injecting pharmacist was on duty, which was four to five days a week. In promoting the service, I encouraged clients to come early in the morning if they wished to enjoy the least possible wait time (which was essentially no wait at all…). If they arrived later in the day, their request was put in line with any other prescriptions being done for waiting clients.In other words, they would be waiting for the same amount of time as any prescription client (with, of course, 15 minutes of additional wait time afterwards, for safety reasons). Often, we would receive an enquiry about the injections during a quiet period, with the client expecting that they would need to return at another time to receive the injection. They would be both surprised and pleased to discover that we could fulfill their request right away!Steps to setting upHere’s what was involved in setting up an injection service. In N.B., we were required to complete an accredited certification course in providing injections. In provinces where injecting is part of our new scope of practice (N.B., Alberta, B.C.) the training is relatively easy to access. The course involves an online portion that requires eight to 12 hours to complete, followed by a live one-day practical training with a didactic portion that reinforces the online learning and provides opportunity for discussion, questions and sharing of experiences and concerns. The pharmacist must successfully demonstrate their skills by giving two saline injections: an intramuscular injection into the deltoid muscle and a subcutaneous injection into the posterior aspect of the upper arm. First Aid/CPR certification must be maintained as long as the pharmacist will be injecting. In New Brunswick, the injection certification must be renewed every three years. Evidence of successful completion of all of these activities must be forwarded to the pharmacy regulatory body and a certificate received before injection activities may begin.There is also a requirement to have reference materials available when providing injection services. Unfortunately, this is not provided as part of the course (although, there has been discussion of doing this in the future). I complied with this requirement by printing off reference materials as I did the course and compiling them into a binder, where information can be added as new developments occur and as our service expands. The reference binder helps to ensure consistency in the service provided by various pharmacists, and helps pharmacists and supporting staff quickly find answers to various queries.Pros and cons?Well, I have to say it has really been exciting as a pharmacist to meet, and succeed at, the challenge of trying something new. It has definitely increased my job satisfaction to be contributing to improving the health of our clientele. As well, I am certain the service has drawn in many new clients, and given me a unique opportunity to chat with them and demonstrate my skills. Our regular prescription volume appears to have increased at the same time, although I did not gather definitive data.Clients, without exception, have expressed sincere appreciation for the service, citing convenience as a major factor that they appreciated. Initially a few did voice concerns regarding my qualifications to perform the service, but I was readily able to describe the training I received and this instilled confidence in my ability. Of course, as time passed, I was also able to tell them how many injections I had already given… one gentleman seemed concerned that he might be my first client but I readily assured him that I had given over 50 injections already.However, I did take the precaution of doing my very first injection at the store on my husband, just to test out my setup! I somehow managed to put the bandage onto a naturally occurring red dot on his skin, though, instead of the puncture site, so joked with clients that getting the bandage on the correct site was the most difficult part of the procedure! That, and the paperwork (which usually takes more time than the actual injection itself), provided some lighter conversation topics.The most difficult clients tended to be children who had unfortunately already developed a fear of needles. They would require additional time to calm them down and try to find a distraction technique that would work. In N.B., we are permitted to inject children over the age of five years and, while many were not any problem, I did have a few tears to cope with. It helped to inject the least worried child first rather than, as some parents would request, getting the worst over with first.A stressful response from the fearful child would usually cause increased worry on the part of the second child, creating increased difficulty. If I could manage it, I would have the child (or adult, for that matter…) relax, avoid tensing the arm muscle, look away and, perhaps take a deep breath as a distraction. I also put up an interesting poster to try to capture their attention and a few times, pulled out my iPad and asked the child to use the Etch-a-Sketch app to draw me a picture that I emailed to them later! I had several parents thank me for taking the time to make their child’s immunization as pleasant as possible.From the business point of view, we were able to connect with many new clients. Although we only advertised our service using posters around the store (our store is located inside a Co-op grocery store), we provided approximately 250 influenza injections in October and November. As I write this article in mid-December, we continue to give one or two injections a day several days a week to clients who are pleased to discover that they are not too late to be immunized. We are currently planning an advertising program to inform the public of other medications that we can administer by injection throughout the year.Overall, I found that the addition of injection services has been a very positive experience, and a valuable expansion of my role as a pharmacist. I am certain that pharmacist injection services will ease the burden in other areas of the healthcare system and improve access to clients.Jeannie Collins Beaudin is a New Brunswick pharmacist who recently sold her successful compounding pharmacy business.

New Business: Providing injection services

Register for free access or login.

Related Topics