Friday Five (November 26, 2021)

Administering COVID-19 and Influenza Vaccines to Patients Five Years of Age and Older

On November 17, 2021, Manitoba Health and Seniors Care announced that pharmacists who have certification of authorization to administer drugs and vaccines by injection can now administer COVID-19 and Influenza vaccines to those five (5) years of age and older effective immediately.

Please note that the expansion to administer vaccines from the age of five (5) years and older is only for COVID-19 vaccines and Influenza vaccines that are part of Manitoba’s Seasonal Influenza Immunization Program.

This change is also applicable to University of Manitoba College of Pharmacy students on rotations (for influenza vaccines only), and to certified pharmacy interns completing internship hours (for COVID-19 vaccines by interns who have been certified and approved by the College through this application, and for influenza vaccines).

The age for pharmacist administration of vaccines remains at seven (7) years of age and older for all other vaccines at this time.

Minimum Time Intervals Between COVID-19 Primary Series and Booster Doses

According to the Manitoba COVID-19 Vaccine: Clinical Practice Guidelines for Immunizers and Health Care Providers, third/booster doses are recommended to be given at least six (6) months after the last COVID-19 vaccine dose (regardless of which products were used for previous doses), unless otherwise explicitly stated.

Doses given earlier than the minimum required interval, including doses given for the primary series, are considered invalid when recorded in PHIMS, which may result in ineligibility to obtain fully vaccinated status. Pharmacists administering COVID-19 vaccines must diligently screen individuals and independently checking PHIMS for the most accurate information on the vaccination status of individuals.

Rapid Antigen Testing for COVID-19

As of November 23, 2021, a new Ministerial Order under The Regulated Health Professions Act (rapid testing) authorizes pharmacists to perform/administer rapid antigen tests and rapid molecular (non-PCR) COVID-19 tests for Manitobans for any reason, with the authorization for pharmacist test interpretation/communication of diagnosis. This new order replaces the previous one that only permitted rapid testing for travel purposes.

Pharmacies electing to offer this service will be responsible for acquiring rapid testing supplies, training staff and advertising the service at their site. The COVID-19 rapid antigen tests may be self-administered by the individual seeking the test or administered by the pharmacist and conducted within the pharmacy facility, with pharmacist test interpretation/diagnosis and documentation provided. Pharmacists offering this service must comply with the minimum applicable documentation requirements outlined in section 106 of the Pharmaceutical Regulation, the Test Interpretation Practice Direction, and the Records and Information Practice Direction.

Members of the public exhibiting signs or symptoms of COVID-19, or having tested positive using a rapid test, must be directed to a provincial testing site immediately. This will ensure that any diagnostic results are integrated with the health system, tracked and reported, and that positive test results immediately trigger Public Health interventions including expedited contact tracing.

Tacrolimus Formulation Change for New WRHA Adult Renal Transplant Patients

The Winnipeg Regional Health Authority (WRHA) has recently changed the policy on which tacrolimus formulation is prescribed for new kidney transplant patients. There is high potential for dispensing errors given the multiple formulations of tacrolimus available. As well, there is high potential for harm if the wrong formulation is dispensed.

Envarsus PA is a new, once-daily formulation of tacrolimus. It was added as a Part 3 EDS benefit by Manitoba Pharmacare in October 2020 (Bulletin 109). There are now four tacrolimus products marketed in Canada (Prograf, Sandoz-tacrolimus, Advagraf, and Envarsus PA). None of the formulations are considered interchangeable with each other in Manitoba.

Starting October 27, adult patients receiving a new, kidney transplant will be started on prolonged-release tacrolimus (Envarsus PA) as first-line therapy for immunosuppression. This change in formulation will not affect patients who are already stable on their current formulation of tacrolimus.

Health Canada has reported graft rejection and other adverse reactions when patients were inadvertently switched to a different formulation and did not receive adequate follow-up with levels and dosage adjustments if required. Tacrolimus and the Risk of Graft Rejection due to Medication Errors: Inadvertent Switching between Different Oral Formulations – Recalls and safety alerts (healthycanadians.gc.ca)

Pharmacists should be diligent in confirming the correct formulation prior to dispensing tacrolimus to avoid severe potential medication incidents.

Contacting the College Using the Staff Directory