Absolutely hate immunizations, please help! Long post sorry

[MARX22]

Hey guys,

sorry im gonna just let it all out

1-I have a phobia of needles but also am very worried about the actual ins and outs of immunizations in terms of knowing who is eligible for what vaccine and how often they can get it. Like tdap vs td, the meningitis shots, different flu shots fluad vs fluvirin, pregnancy etc...


2- For example, how do you know which pneumococcal vaccine to give if the tech at drop off just types and chooses or asks u which to choose? Without asking patients about risk factors, how would you even know which to give first--prevnar or pneumovax? My preceptor just always gave pneumovax and told the tech its always pneumovax when the tech asked what to choose lol.... but i know it depends on what condition the patient has, then you go by that to determine whether they get prevnar first or pneumovax



3- Depending on whichever is given first, you still need to separate prevnar and pneumovax by 1 yr but the two pneumovaxes by 5 yrs...so if a year passes since pcv 13 which was given a yr after pneumovax, you still have to wait five years since the first pneumovax to give it again even if itl be >1 yr after prevnar, right? The 1 yr gap is probably between the first dose of pneumovax and prevnar, not between the prevnar and second dose of pneumovax (only way it makes sense, i know im overthinking lol)



4- For the screening paper live vaccine questions, do u jus go by what they checked off on the screening sheet or do u also check their medication profile to see if they've been on prednisone >20 mg or equivalent for more than 2 weeks?



5-Also, how do you know what to do if the patient happens to mark something off as yes on the sheet?
Here's a link to the sheet they use at walgreens, questions 7-14 are for live vaccines. If they say yes to any of these questions then they should NOT receive the live vaccine, right? For MMR II, having thrombocytopenia is on the screening paper question 7 so I would think its a contraindication... but as per the package insert it seems to be a case where vaccinating with MMR II might worsen it, but it isn't a contraindication.... it says to evaluate risk vs benefit before administering.. so what do you do as a pharmacist?

https://www.walgreens.com/images/pdfs/IN-2225/WAG_VAR_Form_EDIT_10172013_v1.pdf

link to mmr II PI, page 4: https://www.merck.com/product/usa/pi_circulars/m/mmr_ii/mmr_ii_pi.pdf




5a) What's considered a high dose for methotrexate?



5b) What about question 12-Do you have a history of thymus disease (including myasthenia gravis), thymoma or prior thymectomy? (Yellow fever only)

For the yellow fever package insert it says "Thymic disorders associated with abnormal immune cell function (e.g. myasthenia gravis, thymoma) may be an independent risk factor for the development of yellow fever vaccine-associated viscerotropic disease, (see WARNINGS section)"....
so is it still considered a contraindication (CI) or just a warning even though its listed under the CI?

link to yellow fever PI: page 5 bottom is on thymic disorder
https://www.fda.gov/downloads/biologicsbloodvaccines/vaccines/approvedproducts/ucm142831.pdf





5c) For yellow fever PI page 6 bottom, it talks about the risk of Yellow fever vaccine-associated viscerotropic disease which can lead to multi organ failure/death and how its risk is higher if you immunize someone 60+.... at the end it says "The decision to vaccinate individuals 60 years of age and older needs to weigh the risks and benefits of vaccination and the risk for exposure to yellow fever virus."
As a community pharmacist, again, how are you supposed to weigh that risk v. benefit even if the patient says theyre going to an area that has high exposure to yellow fever virus? How do you cover yourself if the fact that theyre 60+ can increase their risk for viscerotropic disease and ultimately organ failure/death? Refuse to give it?




6) For question 11." Have you received a transfusion of blood or blood products or been given a medicine called immune (gamma) globulin in the past year?"
Do we just not administer live vaccines or is there a certain amount of time we should defer it by?




7) For the second page of the walgreens screening paper, section D number 3a, it asks to list any high risk conditions a patient may have. What are you supposed to even list if the patients already marked off what they do or dont have?

https://www.walgreens.com/images/pdfs/IN-2225/WAG_VAR_Form_EDIT_10172013_v1.pdf


THANK YOU SO MUCH!

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[johnpharm01]

You are right this is a long post. Trying to make heads or tails of who gets what vaccine when and what dose? It looks like you work for walgreens so good news check out intercom plus find the immunizations tab. This area will provide a lot of guidance. Next study the CDCs pink book. Also consider contacting your clinical coordinator for the area- the person who tries to get everyone to work for free at health fairs etc. In the end you have to satisfy state law, company policy and procedure, FDA approval i.e. age, and the CDC recommendations.

Some pointers rxs prescribed have different restrictions vs under protocol at least in my state, always ask the shingles vaccine candidates if they are experiencing an outbreak, use the right diluent with the right reconstituted vaccine, and don't forget the components in multiple component vaccines.

 

[Amphetamine Salts]

did you have to take some kind of immunization course after you became a licensed pharmacist and started working at walgreens? i took the apha immunization training but i'm not sure if that's enough to start giving vaccines. or if there is additional training that is required. if anyone knows please let me know, thanks

 

[zelman]

Hey guys,

sorry im gonna just let it all out

1-I have a phobia of needles but also am very worried about the actual ins and outs of immunizations in terms of knowing who is eligible for what vaccine and how often they can get it. Like tdap vs td, the meningitis shots, different flu shots fluad vs fluvirin, pregnancy etc...


2- For example, how do you know which pneumococcal vaccine to give if the tech at drop off just types and chooses or asks u which to choose? Without asking patients about risk factors, how would you even know which to give first--prevnar or pneumovax? My preceptor just always gave pneumovax and told the tech its always pneumovax when the tech asked what to choose lol.... but i know it depends on what condition the patient has, then you go by that to determine whether they get prevnar first or pneumovax



3- Depending on whichever is given first, you still need to separate prevnar and pneumovax by 1 yr but the two pneumovaxes by 5 yrs...so if a year passes since pcv 13 which was given a yr after pneumovax, you still have to wait five years since the first pneumovax to give it again even if itl be >1 yr after prevnar, right? The 1 yr gap is probably between the first dose of pneumovax and prevnar, not between the prevnar and second dose of pneumovax (only way it makes sense, i know im overthinking lol)



4- For the screening paper live vaccine questions, do u jus go by what they checked off on the screening sheet or do u also check their medication profile to see if they've been on prednisone >20 mg or equivalent for more than 2 weeks?



5-Also, how do you know what to do if the patient happens to mark something off as yes on the sheet?
Here's a link to the sheet they use at walgreens, questions 7-14 are for live vaccines. If they say yes to any of these questions then they should NOT receive the live vaccine, right? For MMR II, having thrombocytopenia is on the screening paper question 7 so I would think its a contraindication... but as per the package insert it seems to be a case where vaccinating with MMR II might worsen it, but it isn't a contraindication.... it says to evaluate risk vs benefit before administering.. so what do you do as a pharmacist?

https://www.walgreens.com/images/pdfs/IN-2225/WAG_VAR_Form_EDIT_10172013_v1.pdf

link to mmr II PI, page 4: https://www.merck.com/product/usa/pi_circulars/m/mmr_ii/mmr_ii_pi.pdf




5a) What's considered a high dose for methotrexate?



5b) What about question 12-Do you have a history of thymus disease (including myasthenia gravis), thymoma or prior thymectomy? (Yellow fever only)

For the yellow fever package insert it says "Thymic disorders associated with abnormal immune cell function (e.g. myasthenia gravis, thymoma) may be an independent risk factor for the development of yellow fever vaccine-associated viscerotropic disease, (see WARNINGS section)"....
so is it still considered a contraindication (CI) or just a warning even though its listed under the CI?

link to yellow fever PI: page 5 bottom is on thymic disorder
https://www.fda.gov/downloads/biologicsbloodvaccines/vaccines/approvedproducts/ucm142831.pdf





5c) For yellow fever PI page 6 bottom, it talks about the risk of Yellow fever vaccine-associated viscerotropic disease which can lead to multi organ failure/death and how its risk is higher if you immunize someone 60+.... at the end it says "The decision to vaccinate individuals 60 years of age and older needs to weigh the risks and benefits of vaccination and the risk for exposure to yellow fever virus."
As a community pharmacist, again, how are you supposed to weigh that risk v. benefit even if the patient says theyre going to an area that has high exposure to yellow fever virus? How do you cover yourself if the fact that theyre 60+ can increase their risk for viscerotropic disease and ultimately organ failure/death? Refuse to give it?




6) For question 11." Have you received a transfusion of blood or blood products or been given a medicine called immune (gamma) globulin in the past year?"
Do we just not administer live vaccines or is there a certain amount of time we should defer it by?




7) For the second page of the walgreens screening paper, section D number 3a, it asks to list any high risk conditions a patient may have. What are you supposed to even list if the patients already marked off what they do or dont have?

https://www.walgreens.com/images/pdfs/IN-2225/WAG_VAR_Form_EDIT_10172013_v1.pdf


THANK YOU SO MUCH!

You need to get certified to immunize. That process should resolve 90% of this.

 

[Unchained]

We should've never been granted the "right" to immunize. It just doesn't fit into the retail model. This is more evidence. Not saying your are one of them but there are many pharmacists I know who have no business immunizing patients. Anyhow don't worry too much the patient signs a waiver removing you from any liability. It's just like the one you sign when you jump out of an airplane.

 

[FlavyFlav]

So, I'm in Florida which means I'm only licensed to vaccinate 18 and up, I don't know if you are able to go under that but I won't be able to speak well to ages under 18.

1-I have a phobia of needles but also am very worried about the actual ins and outs of immunizations in terms of knowing who is eligible for what vaccine and how often they can get it. Like tdap vs td, the meningitis shots, different flu shots fluad vs fluvirin, pregnancy etc...

Your phobias and worries require practice and repetition to get over. You should always keep a healthy awareness of needles as this will prevent needlestick injuries. I don't know what chain you work for, but we have safety needles at walgreens that retract when you press a button. You should start by developing a habit that covers all steps of the immunization process, if you have another pharmacist that is practiced in this, ask them to show you their technique and develop yours off of that. Knowing which shots to give is also a matter of reading the material and... practice. You won't know what to do until you actually dive in and figure it out. Some quick ones based off what you listed, I only give tdap as I've never run into a patient that couldn't have the pertussis shot, and everyone should be covered for whooping cough. Meningitis is normally college-aged kids, but I think I've only done like one of those, so I won't say much more.

Fluad and Fluzone are for 65+. Fluad is a normal trivalent flu shot that includes an adjuvant and fluzone is a quadruple concentrated dose. Both are designed to increase effectiveness in elderly population. It doesn't matter which one you pick. Fluvirin is the basic shot, trivalent, most of your population will receive this. Fluarix is the quadrivalent shot (4 strains), we give this to people who ask for it or we run out of Fluvirin. Some elderly will sometimes want the quad shot over the high dose. There is no more flumist (the nasal spray) that I know of as it wasn't effective. Pregnant women still get a flu shot, just make sure it's preservative free (all of our shots these days are single dose which means preservative free, just avoid the multi-dose vial for pregnant women).

2- For example, how do you know which pneumococcal vaccine to give if the tech at drop off just types and chooses or asks u which to choose? Without asking patients about risk factors, how would you even know which to give first--prevnar or pneumovax? My preceptor just always gave pneumovax and told the tech its always pneumovax when the tech asked what to choose lol.... but i know it depends on what condition the patient has, then you go by that to determine whether they get prevnar first or pneumovax

Prevnar 13 and Pneumovax 23 are both indicated for anyone 65 and up. Pneumovax can be given below 65 with certain medical conditions (asthma, copd, asplenia, many more). When a normal, healthy patient reaches 65, they will receive a dose of Prevnar. As little as a month later they can receive a dose of Pneumovax (Medicare will only pay for it after a year wait though). And this is it. They don't receive another shot of either one. The 5 year wait is if they receive a dose of Pneumovax before they reach 65, then they get another dose in 5 years or when they reach 65 (but give Prevnar first), whichever comes last. That is the course you follow for every patient for pneumonia shots, easy to remember.

3- Depending on whichever is given first, you still need to separate prevnar and pneumovax by 1 yr but the two pneumovaxes by 5 yrs...so if a year passes since pcv 13 which was given a yr after pneumovax, you still have to wait five years since the first pneumovax to give it again even if itl be >1 yr after prevnar, right? The 1 yr gap is probably between the first dose of pneumovax and prevnar, not between the prevnar and second dose of pneumovax (only way it makes sense, i know im overthinking lol)

Answered above

4- For the screening paper live vaccine questions, do u jus go by what they checked off on the screening sheet or do u also check their medication profile to see if they've been on prednisone >20 mg or equivalent for more than 2 weeks?

You can check their profile, but most people aren't receiving huge doses of prednisone without knowing about it. For live shots, if you feel any worry, either consult with their primary or have them check with their primary. The good news is, we now have Shingrix! It's dead so it doesn't matter, and no one is going to ask for Zostavax anymore. Also, I've given one MMR vaccine in my entire career for a patient that came from out of country, so people aren't banging down your door for this one.

5-Also, how do you know what to do if the patient happens to mark something off as yes on the sheet?
Here's a link to the sheet they use at walgreens, questions 7-14 are for live vaccines. If they say yes to any of these questions then they should NOT receive the live vaccine, right? For MMR II, having thrombocytopenia is on the screening paper question 7 so I would think its a contraindication... but as per the package insert it seems to be a case where vaccinating with MMR II might worsen it, but it isn't a contraindication.... it says to evaluate risk vs benefit before administering.. so what do you do as a pharmacist?

Oh, you work at Walgreens, use the immunization tool on every patient first. Also, you will probably never give an MMR vaccine, so the one time you ever do, you can spend plenty of time looking up all the random interactions and effects. The chances you have someone that has a contraindication and wants you to give them an MMR shot is so small that you should not even be worried about it.


5a) What's considered a high dose for methotrexate?

I would only be worried if taking daily, again it's just for live which isn't much concern.


5b) What about question 12-Do you have a history of thymus disease (including myasthenia gravis), thymoma or prior thymectomy? (Yellow fever only)

For the yellow fever package insert it says "Thymic disorders associated with abnormal immune cell function (e.g. myasthenia gravis, thymoma) may be an independent risk factor for the development of yellow fever vaccine-associated viscerotropic disease, (see WARNINGS section)"....
so is it still considered a contraindication (CI) or just a warning even though its listed under the CI?

You will not be giving yellow fever shots unless you have a special stamp from the government. You have to be registered with the CDC and go through additional training to give these shots... so don't worry about it!


5c) For yellow fever PI page 6 bottom, it talks about the risk of Yellow fever vaccine-associated viscerotropic disease which can lead to multi organ failure/death and how its risk is higher if you immunize someone 60+.... at the end it says "The decision to vaccinate individuals 60 years of age and older needs to weigh the risks and benefits of vaccination and the risk for exposure to yellow fever virus."
As a community pharmacist, again, how are you supposed to weigh that risk v. benefit even if the patient says theyre going to an area that has high exposure to yellow fever virus? How do you cover yourself if the fact that theyre 60+ can increase their risk for viscerotropic disease and ultimately organ failure/death? Refuse to give it?

Again, don't worry about it!


6) For question 11." Have you received a transfusion of blood or blood products or been given a medicine called immune (gamma) globulin in the past year?"
Do we just not administer live vaccines or is there a certain amount of time we should defer it by?

simple google search answers this
https://www.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/a/mmr_ig.pdf


7) For the second page of the walgreens screening paper, section D number 3a, it asks to list any high risk conditions a patient may have. What are you supposed to even list if the patients already marked off what they do or dont have?

HIV, Hepatitis, I dunno, if you discovered anything in the initial evaluation, write it down.


TL|DR: Most of your concerns are on vaccines that you will probably not even be giving. This means you are spending an inordinate amount of energy worrying about things that may never even be a problem for you. Work on your technique, follow the same technique every time, use the safety features on your syringes and make sure you run the encounter with the patient. You tell them what to do and they will follow it. Hopefully this helps a bit.

 

[PolarPop]

Go to this website Ask the Experts: Experts from CDC Answer Questions About Vaccines

Pick the vaccine you have questions about and read. There’s an adult and child section. If you learn everything there or even just use it as a reference you’ll know more than most pharmacists and doctors about immunizations.

 

[MARX22]

did you have to take some kind of immunization course after you became a licensed pharmacist and started working at walgreens? i took the apha immunization training but i'm not sure if that's enough to start giving vaccines. or if there is additional training that is required. if anyone knows please let me know, thanks

Just apha but clearly i didnt absorb much from it haha. Also need to get ur cpr training n send proof to get ur immunizer certification

 

[MARX22]

You are right this is a long post. Trying to make heads or tails of who gets what vaccine when and what dose? It looks like you work for walgreens so good news check out intercom plus find the immunizations tab. This area will provide a lot of guidance. Next study the CDCs pink book. Also consider contacting your clinical coordinator for the area- the person who tries to get everyone to work for free at health fairs etc. In the end you have to satisfy state law, company policy and procedure, FDA approval i.e. age, and the CDC recommendations.

Some pointers rxs prescribed have different restrictions vs under protocol at least in my state, always ask the shingles vaccine candidates if they are experiencing an outbreak, use the right diluent with the right reconstituted vaccine, and don't forget the components in multiple component vaccines.

If theyre experiencing a shingles outbreak and asking for the vaccine, is this a no no? Sorry but we barely focused on immunizations in school and i dont work at Walgreens i jus found this sheet handy as a screening tool

 

[MARX22]

We should've never been granted the "right" to immunize. It just doesn't fit into the retail model. This is more evidence. Not saying your are one of them but there are many pharmacists I know who have no business immunizing patients. Anyhow don't worry too much the patient signs a waiver removing you from any liability. It's just like the one you sign when you jump out of an airplane.

Haha, no, I agree I’m not one to immunize. I don’t like touching people and I also dont understand how one could keep track of this in a retail setting... we don’t have their full history/background. However, I didn’t know we wouldn’t be liable

 

[MARX22]

You need to get certified to immunize. That process should resolve 90% of this.

Haha, guess the professors who gave the course didn’t do a good job as many of my friends are also clueless. The only difference is they dont give a ****

 

[MARX22]

Flavyflav.... that’s so kind of u to actually respond to everything one by one! I dont work at walgreens but thought the sheet would be handy. I’m actually scared to work at a chain for this reason, haha!!!!

I’m not home but i’ll look up the prevnar pneumovax 1 yr thing and get back to u because I could have sworn I saw that somewhere... and methotrexate.. I don’t think it’s ever daily

Ur right, I do spend a lot of energy worrying about this stuff. I guess its because we’re not in a clinic, its a pharmacy for crying out loud. Idk how one would even ensure that the patient is getting the right number of doses/on time since they could have gotten anything elsewhere in the past. Oh well

So, I'm in Florida which means I'm only licensed to vaccinate 18 and up, I don't know if you are able to go under that but I won't be able to speak well to ages under 18.

1-I have a phobia of needles but also am very worried about the actual ins and outs of immunizations in terms of knowing who is eligible for what vaccine and how often they can get it. Like tdap vs td, the meningitis shots, different flu shots fluad vs fluvirin, pregnancy etc...

Your phobias and worries require practice and repetition to get over. You should always keep a healthy awareness of needles as this will prevent needlestick injuries. I don't know what chain you work for, but we have safety needles at walgreens that retract when you press a button. You should start by developing a habit that covers all steps of the immunization process, if you have another pharmacist that is practiced in this, ask them to show you their technique and develop yours off of that. Knowing which shots to give is also a matter of reading the material and... practice. You won't know what to do until you actually dive in and figure it out. Some quick ones based off what you listed, I only give tdap as I've never run into a patient that couldn't have the pertussis shot, and everyone should be covered for whooping cough. Meningitis is normally college-aged kids, but I think I've only done like one of those, so I won't say much more.

Fluad and Fluzone are for 65+. Fluad is a normal trivalent flu shot that includes an adjuvant and fluzone is a quadruple concentrated dose. Both are designed to increase effectiveness in elderly population. It doesn't matter which one you pick. Fluvirin is the basic shot, trivalent, most of your population will receive this. Fluarix is the quadrivalent shot (4 strains), we give this to people who ask for it or we run out of Fluvirin. Some elderly will sometimes want the quad shot over the high dose. There is no more flumist (the nasal spray) that I know of as it wasn't effective. Pregnant women still get a flu shot, just make sure it's preservative free (all of our shots these days are single dose which means preservative free, just avoid the multi-dose vial for pregnant women).

2- For example, how do you know which pneumococcal vaccine to give if the tech at drop off just types and chooses or asks u which to choose? Without asking patients about risk factors, how would you even know which to give first--prevnar or pneumovax? My preceptor just always gave pneumovax and told the tech its always pneumovax when the tech asked what to choose lol.... but i know it depends on what condition the patient has, then you go by that to determine whether they get prevnar first or pneumovax

Prevnar 13 and Pneumovax 23 are both indicated for anyone 65 and up. Pneumovax can be given below 65 with certain medical conditions (asthma, copd, asplenia, many more). When a normal, healthy patient reaches 65, they will receive a dose of Prevnar. As little as a month later they can receive a dose of Pneumovax (Medicare will only pay for it after a year wait though). And this is it. They don't receive another shot of either one. The 5 year wait is if they receive a dose of Pneumovax before they reach 65, then they get another dose in 5 years or when they reach 65 (but give Prevnar first), whichever comes last. That is the course you follow for every patient for pneumonia shots, easy to remember.

3- Depending on whichever is given first, you still need to separate prevnar and pneumovax by 1 yr but the two pneumovaxes by 5 yrs...so if a year passes since pcv 13 which was given a yr after pneumovax, you still have to wait five years since the first pneumovax to give it again even if itl be >1 yr after prevnar, right? The 1 yr gap is probably between the first dose of pneumovax and prevnar, not between the prevnar and second dose of pneumovax (only way it makes sense, i know im overthinking lol)

Answered above

4- For the screening paper live vaccine questions, do u jus go by what they checked off on the screening sheet or do u also check their medication profile to see if they've been on prednisone >20 mg or equivalent for more than 2 weeks?

You can check their profile, but most people aren't receiving huge doses of prednisone without knowing about it. For live shots, if you feel any worry, either consult with their primary or have them check with their primary. The good news is, we now have Shingrix! It's dead so it doesn't matter, and no one is going to ask for Zostavax anymore. Also, I've given one MMR vaccine in my entire career for a patient that came from out of country, so people aren't banging down your door for this one.

5-Also, how do you know what to do if the patient happens to mark something off as yes on the sheet?
Here's a link to the sheet they use at walgreens, questions 7-14 are for live vaccines. If they say yes to any of these questions then they should NOT receive the live vaccine, right? For MMR II, having thrombocytopenia is on the screening paper question 7 so I would think its a contraindication... but as per the package insert it seems to be a case where vaccinating with MMR II might worsen it, but it isn't a contraindication.... it says to evaluate risk vs benefit before administering.. so what do you do as a pharmacist?

Oh, you work at Walgreens, use the immunization tool on every patient first. Also, you will probably never give an MMR vaccine, so the one time you ever do, you can spend plenty of time looking up all the random interactions and effects. The chances you have someone that has a contraindication and wants you to give them an MMR shot is so small that you should not even be worried about it.


5a) What's considered a high dose for methotrexate?

I would only be worried if taking daily, again it's just for live which isn't much concern.


5b) What about question 12-Do you have a history of thymus disease (including myasthenia gravis), thymoma or prior thymectomy? (Yellow fever only)

For the yellow fever package insert it says "Thymic disorders associated with abnormal immune cell function (e.g. myasthenia gravis, thymoma) may be an independent risk factor for the development of yellow fever vaccine-associated viscerotropic disease, (see WARNINGS section)"....
so is it still considered a contraindication (CI) or just a warning even though its listed under the CI?

You will not be giving yellow fever shots unless you have a special stamp from the government. You have to be registered with the CDC and go through additional training to give these shots... so don't worry about it!


5c) For yellow fever PI page 6 bottom, it talks about the risk of Yellow fever vaccine-associated viscerotropic disease which can lead to multi organ failure/death and how its risk is higher if you immunize someone 60+.... at the end it says "The decision to vaccinate individuals 60 years of age and older needs to weigh the risks and benefits of vaccination and the risk for exposure to yellow fever virus."
As a community pharmacist, again, how are you supposed to weigh that risk v. benefit even if the patient says theyre going to an area that has high exposure to yellow fever virus? How do you cover yourself if the fact that theyre 60+ can increase their risk for viscerotropic disease and ultimately organ failure/death? Refuse to give it?

Again, don't worry about it!


6) For question 11." Have you received a transfusion of blood or blood products or been given a medicine called immune (gamma) globulin in the past year?"
Do we just not administer live vaccines or is there a certain amount of time we should defer it by?

simple google search answers this
https://www.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/a/mmr_ig.pdf


7) For the second page of the walgreens screening paper, section D number 3a, it asks to list any high risk conditions a patient may have. What are you supposed to even list if the patients already marked off what they do or dont have?

HIV, Hepatitis, I dunno, if you discovered anything in the initial evaluation, write it down.


TL|DR: Most of your concerns are on vaccines that you will probably not even be giving. This means you are spending an inordinate amount of energy worrying about things that may never even be a problem for you. Work on your technique, follow the same technique every time, use the safety features on your syringes and make sure you run the encounter with the patient. You tell them what to do and they will follow it. Hopefully this helps a bit.

 

[FlavyFlav]

Flavyflav.... that’s so kind of u to actually respond to everything one by one! I dont work at walgreens but thought the sheet would be handy. I’m actually scared to work at a chain for this reason, haha!!!!

I’m not home but i’ll look up the prevnar pneumovax 1 yr thing and get back to u because I could have sworn I saw that somewhere... and methotrexate.. I don’t think it’s ever daily

Ur right, I do spend a lot of energy worrying about this stuff. I guess its because we’re not in a clinic, its a pharmacy for crying out loud. Idk how one would even ensure that the patient is getting the right number of doses/on time since they could have gotten anything elsewhere in the past. Oh well

Methotrexate can be given daily for some cancers.

As for pneumonia, you're right, CDC says 1 year, but when prev-13 first came out I know we had guidance recommending it could be given at a much shorter interval. The only reason we didn't was because Medicare would not pay for it.

As for patients and what to give, that's not on you to remember their shot record for them. However you can't mess up by overimmunizing with dead vaccines. Better to be overprotected than under.

 

[MARX22]

Methotrexate can be given daily for some cancers.

As for pneumonia, you're right, CDC says 1 year, but when prev-13 first came out I know we had guidance recommending it could be given at a much shorter interval. The only reason we didn't was because Medicare would not pay for it.

As for patients and what to give, that's not on you to remember their shot record for them. However you can't mess up by overimmunizing with dead vaccines. Better to be overprotected than under.

Good point about dead vaccines!! I need to look into MTX