Program Name:
Planning Committee:
Manitoba Administration of Injections Training Program
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Theresa Bowser, RN, BN
Cindy Chen, B.Sc. (Pharm), R.Ph. CDE
Melissa Gobin
Alexandra Henteleff, MED, BN, RN
Christoper Louizos, B.Sc. (Pharm)
Kim McIntosh, B.Sc. (Pharm)
Casey Sayre, PharmD
Lavern M. Vercaigne, PharmD
Accrediation Information:
This version of the program is unaccredited and intended for
informational purposes only. An accredited version is available
online at www.AdvancingPractice.com until June 15, 2013.
Sponsor:
This module was developed in partnership by the Manitoba
Pharmaceutical Association, and the University of Manitoba
Faculty of Nursing and University of Manitoba Faculty of
Pharmacy.
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The following content is unaccredited and intended for informational purposes only.
An accredited version is available online at www.AdvancingPractice.com until June 15, 2013.
1
Introduction
Welcome to the Manitoba module of the Administration of Injections Training Program for Manitoba
Pharmacists. Successful completion of this component is one of the requirements for pharmacists
wanting to obtain certification in injection administration in Manitoba. This module was developed in
partnership by the Manitoba Pharmaceutical Association, and the University of Manitoba Faculty of
Nursing and University of Manitoba Faculty of Pharmacy.
Learning Objectives
Upon successful completion of this module, the pharmacist will be able to:
1. Describe the applicable sections of the new Pharmaceutical Act and Regulations and integrate
the Manitoba Pharmaceutical Association’s practice direction related to administering injections
into their practice
2. Explain the recommended immunization schedule in Manitoba
3. Examine the ideal routes of injection administration for medications and drugs that a
pharmacist may need to administer that are not vaccinations
4. Explain proper procedures when reconstituting and preparing medications for injection
5. Discuss the key sites and factors affecting needle choice for intramuscular, subcutaneous, and
intradermal routes of administering injections
Administration of Injections Training Program Requirements
At this time, pharmacists who want to obtain certification in the administration of injections must
successfully complete the following components:
1. The online CCCEP-accredited program, “Immunization Competencies Education Program” (ICEP)
available now through Advancing Practice at the following website:
http://www.advancingpractice.com/p-68-immunization-competencies-educationprogram.aspx) – prerequisite to Item 3.
2. The online Manitoba-specific module- prerequisite to Item 3
3. The in-person practical skills workshop.
IMPORTANT: The successful completion of all Administration of Injections Training Program
requirements does not grant pharmacists authorization to administer injections. Once legislation that
allows pharmacists to administer drugs is passed in Manitoba, pharmacists must apply for authorization
from the Manitoba Pharmaceutical Association in order to administer injections. Please contact the
MPhA for more information.
Members must also have completed CPR Level C or CPR Level HCP (Health Care Provider) and
Emergency or Standard First Aid from an accredited training program in order to participate in the
workshop.
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It is extremely important that the pharmacist who is administering injections is knowledgeable on the
management of post- injection adverse events. The following two websites need to be reviewed, in
addition to completing the CPR and First Aid requirements:
Anaphylaxis vs Vasovagal Reaction – A Comparison of Signs and Symptoms
http://www.wrha.mb.ca/professionals/immunization/files/AnaphyvsVasReactionTable.pdf
Management of Anaphylaxis in Non-Hospital Settings
http://www.gov.mb.ca/health/publichealth/cdc/protocol/anaphylactic.pdf
Bill 41 – The New Pharmaceutical Act and Regulations
Bill 41, the new Pharmaceutical Act in Manitoba was passed and received Royal Assent on December
7th, 2006. The new Act, however, will not come into effect until it is proclaimed by the government.
Proclamation will occur once regulations, bylaws and a Code of Ethics are prepared and approved by the
membership and then government. The full document can be viewed here.
It is imperative that injection pharmacists are knowledgeable on the applicable sections of the 2010
Pharmaceutical Regulations Policy Document. The full document can be viewed here and the sections
related to administration of drugs and injections are highlighted below:1
PART 13 – ADMINISTRATION OF DRUGS
Administration of drugs by members
91(1) Any member or intern may administer a drug listed in the manual or has been issued a drug
identification number or natural health product number under the Food and Drugs Act (Canada) to a
patient:
(a) orally, including sublingual and buccal;
(b) topically, including ophthalmic, otic and intranasal; or
(c) via inhalation.
Certification in drug administration
91(2) The council may approve a training program to certify members in other methods of drug
administration that includes enhanced safety measures and emergency resuscitation, and specifies the
frequency and criteria by which the certification must be renewed.
Use of titles
91(3) No person may represent that they are certified in drug administration unless they hold current
certification under subsection (2).
Advanced drug administration
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91(4) A member who has current certification in drug administration, or under training and direct
supervision as described in section 91(2), may administer a drug:
(a) through intradermal injection;
(b) through subcutaneous injection;
(c) through intramuscular injection;
(d) intravenously through an established central or peripheral venous
access device; or
(e) rectally.
Drug administration record
92(1) A member who administers a drug to a patient must make and retain a record in the pharmacy of:
(a) the name of the patient;
(b) the address of the patient;
(c) the name of the drug and total dose administered;
(d) the identification of the manufacturer, lot number and expiry date of the drug;
(e) the route of administration;
(f) the name of the member administering the drug;
(g) the date and the time of the administration;
(h) any adverse events, and
(i) the price, where there is a charge for administration.
Method of keeping drug administration records
92(2) The information required by subsection (1) may be recorded and retained in a readily retrievable
manner electronically or in written form.
Introduction to MPhA Practice Directions
Bill 41, The Pharmaceutical Act December 2006, defines a “practice direction” as follows:
"practice direction" means a written statement made by the council for the purpose of giving
direction to members and owners about the conduct of their practices or pharmacy operations.
Practice Directions carry similar legal significance to Regulations, and thus it is required that members
who will be administering injections are familiar with the Administration of Drugs Practice Direction:
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MPhA Practice Direction
Standard # 9: Administration of Drugs
Part 13 Regulations
Members must ensure proper procedures, environment and the interests of the patient
when administering a drug.
Document Number: PD-SP-C- 7.01
1.0 Scope and Objective:
1.1 Expected Outcome
This document is a practice direction by Council concerning the implementation of the
principle of Administration of Drugs through the authority of The Pharmaceutical
Regulations to The Pharmaceutical Act and The Pharmaceutical Act
1.2 Document Jurisdiction (Area of Practice)
Administration of drugs can be done by all licensed pharmacists under section 91(1) of the
regulations and by certified pharmacists under section 91(2).
1.3 Regulatory Authority Reference
Section 49 of regulations to the Act allows Council to create this practice direction.
2.0 Practice Direction
2.1 A pharmacist administering a drug must:
2.1.1 Collaborate with the patient and receive permission;
2.1.2 Be satisfied there has been compliance with Standard #4 in relation to the
appropriateness of the drug being administered;
2.1.3 Take appropriate steps to ensure the patient is given the right drug, for the right
reason, in the right dose, at the right time and using the right route;
2.1.4 Possess current certification in emergency first aid and “CPR Level C”;
2.1.5 Ensure the pharmacy creates and maintains a policy and procedure manual that
includes administration of drugs and emergency response protocols;
2.1.6 Ensure the pharmacy maintains a readily accessible supply of epinephrine
syringes (“pens”) for emergency use, diphenydramine, cold compresses and
non-latex gloves;
2.1.7 Be certified under section 91(2) when administering a drug under section 91(4)
and has received informed written consent from the patient.
2.2 Before Administration:
2.2.1 The pharmacist must perform basic assessment of the patient proportional to
the complexity of administration, that includes:
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2.2.1.1 History,
2.2.1.2 Overall condition, e.g., vital statistics,
2.2.1.3 Appropriate information if administering a drug through injection e.g.
Immunization records, and
2.2.1.4 Condition of the administration site.
2.2.2
The pharmacist must assess the appropriateness of the drug for the specific
patient, including but not limited to:
2.2.2.1 Indication
2.2.2.2 Dose
2.2.2.3 Allergy status
2.2.2.4 Risk factors and contraindication
2.2.2.5 Route of administration including:
2.2.2.5.1 Appropriateness for the patient
2.2.2.5.2 Appropriateness of the drug
2.2.2.5.3 Drug and route follows established protocols, if applicable
2.2.3
The pharmacist must obtain permission from the patient to administer the drug.
2.2.4
The pharmacist must wash hands before (and after) caring for the patient.
2.2.5
In addition to the above, and before administering a drug under section 91(4),
the pharmacist certified under section 91(2) must:
2.2.5.1 obtain informed consent from the patient including the:
2.2.5.1.1 Name of the drug to be administered,
2.2.5.1.2 Indication for the drug,
2.2.5.1.3 Benefits and risks of the administration,
2.2.5.1.4 Expected reaction,
2.2.5.1.5 Usual and rare side effects,
2.2.5.1.6 Rationale for the 15-30 minute wait following the
administration and
2.2.5.1.7 Contacts for follow-up or emergency.
2.2.5.2 ensure the pharmacy creates and maintains a clean, safe, appropriately
private and comfortable environment within which the injection is to be
administered.
2.2.5.3 be satisfied the drug to be injected is stable, has been prepared for
administration using aseptic technique, has been stored properly and is
clearly labelled.
2.2.5.4 insure the route of administration and the site has been appropriately
prepared for the administration.
2.3 After Administration:
2.3.1 The pharmacist must:
2.3.1.1 Ensure the patient is appropriately monitored;
2.3.1.2 Respond to complications of therapy, if they arise;
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2.3.1.3 Ensure devices, equipment and any remaining drug is disposed of safely
and appropriately
2.3.1.4 Document the administration of the drug as required by the regulations;
and
2.3.1.5 Provide relevant information to other regulated health professionals
and provincial health agencies as appropriate.
2.4 Restrictions:
2.4.1 A pharmacist must not administer an injection to a child under five years old.
2.4.2
A pharmacist must not administer a drug to a family member unless there is no
other alternative.
2.5 Infection Control:
2.5.1 The pharmacist must use precautions for infection control, which includes:
2.5.1.1 Handling all body fluids and tissues as if they were infectious, regardless
of the patient’s diagnosis,
2.5.1.2 Washing hands before and after caring for the patient, and after
removing gloves; and wearing gloves to prevent contact with body
fluids excretions or contaminated surfaces or object;
2.5.1.3 Proper disposal of waste materials
2.5.1.4 Maintaining a setting for administration that is clean, safe, comfortable
and appropriately private and furnished for the patient
2.5.1.5 Management of needle stick injuries.
3.0 Compliance Adjudication
All documentation must be readily accessible and open to regulatory review.
All references to patient would include a person who is authorized to make decisions on
behalf of the patient.
4.0 Appendices
Not applicable
Immunization in Manitoba
The Immunization Competencies Education Program comprehensively reviews the different
immunizations that are provided to patients in Canada. However, each province has its own routine
immunization schedule. Pharmacists who are providing vaccinations in Manitoba must be familiar with
Manitoba’s immunization schedule. This information, along with other useful information in
immunization, can be found on the “Communicable Disease Control” section of Manitoba Health’s
website:
http://www.gov.mb.ca/health/publichealth/cdc/div/index.html
It is important for an injection pharmacist to know which immunizations are included and are not
included in the schedule. A chart of the schedule can be found on Manitoba Health’s website by
clicking here and a summary of the recommended schedule is outlined below:2
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Recommended Immunization Schedule in Manitoba
Age
Vaccines
2 months
 Diphtheria, Tetanus , Pertussis, Polio, Haemophilus influenzae type b
(DTaP-IPV-Hib)
 Pneumococcal Conjugate 13 valent (Pneu-C-13)
4 months
 Diphtheria, Tetanus , Pertussis, Polio, Haemophilus influenzae type b
(DTaP-IPV-Hib)
 Pneumococcal Conjugate 13 valent (Pneu-C-13)
6 months
 Diphtheria, Tetanus , Pertussis, Polio, Haemophilus influenzae type b
(DTaP-IPV-Hib)
 Pneumococcal Conjugate 13 valent (Pneu-C-13)
12 months
 Measles, Mumps, Rubella, Varicella (Chickenpox) (MMRV)
 Meningococcal C Conjugate (Men-C-C)
18 months
 Diphtheria, Tetanus , Pertussis, Polio, Haemophilus influenzae type b
(DTaP-IPV-Hib)
 Pneumococcal Conjugate 13 valent (Pneu-C-13)
4-6 years
 Measles, Mumps, Rubella (MMR)
 Tetanus, Diphtheria, Pertussis, Polio (Tdap-IPV)
Grade 4
 Meningococcal C Conjugate (Men-C-C)
 Hepatitis B (HB) – 3 doses
Grade 6
 Human Papillomavirus (HPV) – 3 doses – Females only
14-16 years
 Tetanus, Diphtheria, Pertussis (Tdap)
All adults
 Tetanus, Diphtheria (Td) – Every ten years
65 years
 Pneumococcal Polysaccharide (Pneu-P-23)
Please note:
1- The seasonal influenza program varies each year and is not included in the above chart. Please
click here for current information on the influenza vaccine.
2- Pharmacists in Manitoba cannot administer injections to children under the age of five years.3
Administration Routes of Drugs other than Vaccines
Pharmacists in Manitoba have the authority to administer drugs other than immunizations (see
Regulations for more detail). Pharmacists can find the recommended route of administration of specific
medications in the drug monograph located in the Compendium of Pharmaceuticals and Specialties from
the Canadian Pharmacists Association. The recommended routes of administration are provided by the
drug product manufacturer.
The following table includes an extensive list of medications and their ideal route of administration.4,5,6
Pharmacologic-Therapeutic Classification
Antihistamines
First-Generation Antihistamines
Anti-infective
Agents
Antibiotics
Aminoglycosides
Drug
Diphenhydramine
Promethazine
Amikacin sulfate
Gentamicin sulfate
Streptomycin
Route
IM
Deep IM
IM
IM
Deep IM
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Cephalosporins
Carbapenems
Penicillins
Anti-infectives
Antineoplastic Agents
Autonomic Drugs
Parasympathomimetic Agents
Parasympatholytic
Agents
Antispasmodics
Sympathomimetic
(Adrenergic) Agents
Selective Betaadrenergic
Agonists
Alpha- and BetaAdrenergic
Agonists
Sympatholytic Agents
Blood Formation
and Coagulation
Non-Selective
Alpha-Adrenergic
Blocking Agents
Skeletal Muscle Relaxants
Antianemia Drugs
Iron Preparations
Coagulants and
Anticoagulants
Anticoagulants
Tobramycin
Cefazolin sodium
Cefepime HCl
Cefotaxime sodium
Ceftazidime
pentahydrate
Ceftriaxone sodium
Cefuroxime sodium
Imipenem
Ampicillin
Cloxacillin
Penicillin
Piperacillin
Bacitracin
Clindamycin
Methotrexate
Neostigmine
Phenylephrine HCl
Atropine
Isoproterenol HCl
Ephedrine
Epinephrine
into large
muscle
mass
IM
IM
IM
IM
IM
IM
Deep IM
into large
muscle
mass
Deep IM
IM
IM
IM
IM
IM
Deep IM
IM or Intraarterial
IM
IM or SC
IM, SC or
Intraosseous
IM or SC
Glycopyrrolate
Scopolamine
Phentolamine mesylate
IM or SC
SC
(preferred)
or IM
IM
IM or SC
IM
Succinylcholine chloride
Iron
Dalteparin
Enoxaparin
Heparin
Deep IM
IM
SC
SC
SC
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Hematopoietic Agents
Cardiovascular
Drugs
Central Nervous
System Agents
Cardiac Drugs
Analgesics and
Antipyretics
Anti-arrhythmics
Cardiotonic
Agents
Non-steroidal
Antiinflammatory
Agents
Opiate Agonists
Procainamide HCl
Digoxin
SC
SC
SC
Intraarticular
IM
IM
Ketorolac
Slowly via
deep IM
injection
Codeine
Fentanyl citrate
Hydromorphone
Meperidine
Morphine
Nalbuphine
Naloxone HCl
Pentazocine
Phenobarbital
Chlorpromazine
Flupentixol
Fluphenazine
Haloperidol
Loxapine
Methotrimeprazine
Olanzapine
Risperidone
Diazepam
Lorazepam
Midazolam
Hydroxyzine
Sumatriptan
IM or SC
IM
IM or SC
IM or SC
IM or SC
IM or SC
IM or SC
IM or SC
IM
IM
IM
IM
IM
IM
IM
IM
Deep IM
(gluteal or
deltoid)
IM
IM
IM
IM
SC
Anticholinergic Agents
Diuretics
Benztropine mesylate
Furosemide
IM
IM
Miscellaneous
Omalizumab
SC
Dimenhydrinate
IM
Opiate Partial
Agonists
Anticonvulsants
Psychotherapeutic
Agents
Barbiturates
Antipsychotics
Anxiolytics, Sedatives,
Hypnotics
Benzodiazepines
Antimigraine Agents
Electrolytic,
Caloric, and
Water Balance
Respiratory Tract
Agents
Gastrointestinal
Darbepoetin alfa
Epoetin alfa
Filgrastim
Lidocaine HCl
Antiemetics
Miscellaneous
Selective
Serotonin
Agonists
Antihistamines
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Drugs
Antisecretory Agents
Hormones and
Synthetic
Substitutes
Prokinetic Agents
Androgens
5-HT3 Receptor
Antagonists
Histamine H2Antagonists
Androgen
Receptor
Antagonists
Adrenals
Prochlorperazine
Ondansetron
IM
IM
Ranitidine
IM
Metoclopamide
Cyproterone acetate
IM or SC
IM
Betamethasone
IM, intraarticular,
intralesional,
local or soft
tissue
IM, intralesional or
soft tissue
IM
Intraarticular,
intralesional,
IM, Intrasynovial or
soft tissue
Intraarticular,
intra-bursal
or IM
IM
IM
SC
IM or SC
Dexamethasone
Hydrocortisone
Methylprednisolone
Triamcinolone
Androgens
Estrogens
Antidiabetic Agents
Antihypoglycemic
Agents
Pituitary
Somatotropin Agonists
Progestins
Oxytocics
Vitamins
Vitamin B Complex
Glycogenolytic
Agents
Testosterone
Estrogens, conjugated
Insulins
Glucagon
Desmopressin
Vasopressin
Somatropin
Medroxyprogesterone
Progesterone
Carboprost
tromethamine
Oxytocin
Cyanocobalamin
IM or SC
IM or SC
SC (pen
may be SC
or IM)
IM
Deep IM
Deep IM
IM
IM or deep
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Folic Acid
Miscellaneous
Therapeutic
Agents
Vitamin C
Vitamin K Activity
Antidotes
Disease-modifying Antirheumatic Drugs
Pyridoxine
Thiamine
Ascorbic Acid
Vitamin K
Leucovorin
Abatacept
Adalimumab
Anakinra
Etanercept
Gold Sodium
Thiomalate
SC (avoid
dermis and
upper sc)
Deep IM or
SC
IM or SC
IM
IM or SC
IM or SC
IM
SC
SC
SC
SC
IM
(preferably
gluteal)
Required Reading and Video
Members who will be participating in an upcoming practical injection training workshop are required to
review the resources on medication and needle preparation listed below.
 Read the following document:
o Vaccine Storage and Handling Toolkit, available at
http://www.dhhs.nh.gov/dphs/immunization/documents/vpd.pdf

Review the following website:
o Manitoba Health Cold Chain Protocol – Immunizing Agents and Biologics, available at
http://www.gov.mb.ca/health/publichealth/cdc/coldchain/protocol.html

Watch the following video:
o “Amps and Vials” available by clicking the “Amps and Vials” link on the following website
http://umanitoba.ca/faculties/nursing/current/undergrad/4year/2130_videos.html
Intramuscular Injection Practice Notes
The following serves as a short summary on intramuscular (IM) injections.
Site and Needle Choices:
IM vaccination in patients <12 months are done in the vastus lateralis (VL) site.7 (Reminder that
pharmacists cannot administer injections in children under the age of five years).
IM vaccination in patients 12 months and older is done in the deltoid unless there is particular reason to
continue to use the VL.7
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It is a common misconception that a shorter needle decreases injection pain.8 It is important that the
needle be inserted deep into the muscle and that it does not result in subcutaneous administration.
Administration of medications through the wrong route can result in increased pain, reduced immune
response, and abscess.9
Although one should always try to avoid hitting bone, if this happens, the administrator should pull back
slightly on the syringe/needle to move the needle tip into the muscle and then inject. Most often the
patient will be unaware that bone was contacted if the administrator does not react to it.
Needle choices are made based primarily on the length of the needle rather than the gauge. A 21-25G
needle is appropriate for IM injections. Viscous medications must be administered with a wider needle
(for example: 21G).7
Overview of Needle Length Recommendations7
Population
Needle Length Guideline
Babies 4 mo- <1year
1” – Vastus Lateralis
1 year old - children
7/8th-1” ” deltoid
Adolescent and Adult
1” – 1 ½ “deltoid
Adult Vastus Lateralis for emergency medication
1-1 ½” VL
 These are only guidelines. Each individual must be considered looking at their height, weight and
composition. A woman who is very short but less that 90kg will likely require a 1” needle for
example.
 Point of note: The Canadian Immunization Guide recommends a 7/8” needle where these
suggest 5/8”. The WRHA does not supply 7/8” needles. Where such a needle were available it
would be appropriate.
Aspiration
Historically, intramuscular injection technique has involved the practice of aspiration – pulling back on
the plunger to ensure that you will not inadvertently be injecting into a blood vessel.8
More recent studies have determined that evidence for the effectiveness of this practice is questionable
due to a combination of reasons. Common consensus now is that only with the dorsogluteal (DG) site
might this be valuable. The DG is no longer a recommended administration site for ANY IM injections
and is NEVER an appropriate site for immunization.9
The Canadian Immunization Guide currently cites that aspiration is up to practitioner preference, but
not a necessity. In some environments, the syringes used for vaccination are incapable of aspirating.7
Given the lack of evidence of benefit of aspirating and the fact that it prolongs the procedure, increasing
patient anxiety and discomfort, most administrators now omit this step.8
------Subcutaneous Injection Practice Notes
The following serves as a short summary on subcutaneous injections.
Skin Prep:
Much research now indicates that cleansing the skin with a disinfectant is unnecessary. Although it
decreases bacteria on the skin prior to injection, it does not actually change the rate of post injection
infection. In many places, current recommendation is to cleanse the site with soap and water if it is
dirty. This is true of subcutaneous injections, intradermal injections and intramuscular injections. In
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Winnipeg, currently no organizations have adopted this policy and cleansing with an alcohol pad is still
the common practice.8
Site and Needle Choice:7,8
For all injection site choices, assess the skin to find an area that is correctly landmarked, and free of
lesions, inflammation, swelling, bruising, scarring and tenderness, and which has not been often
injected. These conditions can decrease absorption and increase discomfort.
For vaccine administration, the upper outer aspect of the arm and triceps area is the site of choice.
A short needle is required. Needle choice is made initially by length. Typically a 5/8” needle is used. A
5/8” needle is 25G. A shorter needle would be appropriate if available.
The practitioner must make every effort to avoid inadvertently administering the subcutaneous injection
intramuscularly (IM) or intradermally (ID). By far, the greater risk is accidental IM injection. The dermis
and epidermis are only 1-3mm deep, so it is very unlikely that the needle is injected so shallow that the
subcutaneous injection goes ID.
For people who have very little subcutaneous tissue, the risk of going IM is significant. For these
patients, the tissue must be pinched up during needle insertion and this pinch can be maintained if
there is serious concern about going IM.
Intradermal Injection Practice Notes
The following serves as a short summary on intradermal injections.
Site and Needle Choice:7,8
The flexor surface of the forearm is most commonly used for intradermal injections. This area can be
found about a hands width above the wrist and three to four finger widths below the antecubital space.
For some vaccines, the upper arm beneath the insertion of the deltoid is recommended. Review the
product monograph of the drug that you are injecting for guidance.
With this route of administration, your needle choice relies more on gauge than needle length. The
entire length of the needle is not inserted.
Supplemental Readings and Additional Resources
It is strongly recommended that the following articles and resources are reviewed before attending the
workshop:
 Canadian Immunization Guide - Public Health Agency of Canada
o http://www.phac-aspc.gc.ca/publicat/cig-gci/index-eng.php
 Effective communication about immunization (benefits and risks)
o http://www.phac-aspc.gc.ca/publicat/cig-gci/p01-04-eng.php
o http://www.wrha.mb.ca/professionals/immunization/03-01.php
 Immunization Competencies for Health Professionals - Public Health Agency of Canada
o http://www.phac-aspc.gc.ca/im/ic-ci-eng.php
 Informed consent guidelines and documentation
o http://www.gov.mb.ca/health/publichealth/cdc/div/info.html
 Injection-related pain and anxiety reduction techniques
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The following content is unaccredited and intended for informational purposes only.
An accredited version is available online at www.AdvancingPractice.com until June 15, 2013.
14
o


http://www.wrha.mb.ca/professionals/immunization/03-03.php (under Pain
Management)
Manitoba Health – Communicable Disease Control website on Immunizations
o http://www.gov.mb.ca/health/publichealth/cdc/div/index.html
Reporting Adverse-Events Following Immunization (AEFI) and other immunization problems
(under guidelines and reporting/monitoring)
o http://www.gov.mb.ca/health/publichealth/cdc/div/info.html
Pharmacists should also be familiar with policies and guidelines applicable to the administration of
injections that may be in place within your place of employment or organization.
Key Learning Points
1. Pharmacists administering injections must follow the rules, regulations and applicable practice
direction(s) of the Manitoba Pharmaceutical Association.
2. Pharmacists providing immunizations should be familiar with the recommended immunization
schedule for Manitoba.
3. Pharmacists should be knowledgeable on the preparation and reconstitution of injectable
medications.
4. Pharmacists should be familiar of the common sites of administration of each injection route.
----Post-Test
Instructions to the Learner
1. You must score 70% or higher on the post-test to successfully complete the module
requirements.
2. If you receive 70% or higher on your first try:
o
The corrected post-test answers will be displayed for review.
o
After having completed the post-test, proceed to the Course Evaluation. It is a
mandatory component for successful completion of the module.
3. If you do not receive 70% or higher on your first try:
o
You will immediately be notified on-screen that you did not meet the minimum
requirements.
o
You will be given another opportunity to review course materials and try the post-test
again.
4. If you do not receive 70% or higher on your second try:
o
You will be ineligible to take the post-test again and will not be able to receive credit for
this module. You will need to contact the Manitoba Pharmaceutical Association for further
information.
--------
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The following content is unaccredited and intended for informational purposes only.
An accredited version is available online at www.AdvancingPractice.com until June 15, 2013.
15
The Brown family is planning a vacation to Mexico for Christmas. While going through their to-do list,
they realize they forgot to make sure that their immunizations were up-to-date. You informed them a
couple weeks ago that as a pharmacist, you can now administer injections. Tyler Brown (32), his wife
Sheila Brown (30), and their two children Paige (6) and Matthew (4) head down to your pharmacy to
receive their injections. After checking the Public Health Agency of Canada travel website
www.travelhealth.gc.ca or consulting with the WRHA Travel Health Information for Health
Professionals website at http://www.wrha.mb.ca/community/travel/professional.php and reviewing
their patient profiles, you see that only Paige and Matthew need their immunizations.
1. Tyler and Sheila ask if both of their children can be immunized today. What is your
response?
a) I can immunize both children, and you can go home immediately afterwards.
b) I cannot immunize any children, so unfortunately I cannot administer the
injections.
c) I can immunize Paige, but not Matthew because he is under 5 years of age.
d) I can immunize both children, but they will have to wait here for 15-30 minutes
after the injection.
e) I can immunize both children, but I will need to notify Matthew’s primary
physician since he is under the age of 5.
2. While gathering immunization supplies, your pharmacy technician hands you a
previously reconstituted vial. What should the label on the vial include?
a) Date and time of reconstitution
b) Amount of diluent added
c) Type of diluent added
d) Expiry date
e) All of the above
3. Why should the protective cap be kept on a single-dose vial until it is being used?
a) Someone could spill coffee on it and contaminate the vaccine
b) It is a good way to ensure that the rubber seal hasn’t been punctured
c) To stop bacteria from entering the vaccine
d) The vaccine could leak if the protective cap isn’t on securely
e) All of the above
4. Doses should be drawn from the vials how long before administration?
a) At the time of administration
b) Always keep a supply of pre-filled syringes for quick access
c) A day before suspected use to allow it to settle
d) Two hours before use to eliminate air bubbles
e) None of the above
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The following content is unaccredited and intended for informational purposes only.
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16
5. After injecting the vaccine, you notice Paige is sweating and feeling a bit faint. What do
you do?
a) Call 911 immediately
b) Apply a damp cloth to her face and neck
c) Have her sit with her head between her knees for several minutes
d) Ask her parents to take her home to rest
e) Both B and C are correct
6. The Browns are ready to go home, but before they leave you want to make sure
everything has been documented. Which of the following does NOT need to be
documented?
a) The route of administration
b) The lot number on the vaccine
c) Price of the vaccine (if applicable)
d) Any adverse events that occurred
e) All need to be documented
7. Precautions for infection control do NOT include:
a) Properly managing needle stick injuries
b) Washing hands before and after administration of injections
c) Properly disposing of waste materials
d) Sanitizing needles and vials for re-use
e) Handling all bodily fluids as if they are infectious
Robert Smith, who is 40 years of age, enters your pharmacy to receive his vitamin B12 injection.
8. Which route can you use for this injection?
a) Dermis
b) Intravenous
c) Deep subcutaneous
d) Intramuscular
e) Both C and D are correct
9. Where is this injection typically given in a 40 year old male?
a) Vastus Lateralis
b) Deltoid
c) Gluteal region
d) Forearm
e) Wrist
10. Administration of medications through the wrong route can result in:
a) Increased pain
b) Reduced immune response
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An accredited version is available online at www.AdvancingPractice.com until June 15, 2013.
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c) Abscess
d) None of the above
e) All of the above
----References
1. Manitoba Pharmaceutical Association. 2010 Pharmaceutical Regulations Policy Document.
Available: http://mpha.in1touch.org/uploaded/38/web/documents/RegsPolicyDocOct08.10.pdf
(accessed 2012 June 19).
2. Manitoba Health. Communicable Disease Control. Diseases and Immunization (Vaccination).
2012. Available: http://www.gov.mb.ca/health/publichealth/cdc/div/index.html (accessed 2012
June 19).
3. Manitoba Pharmaceutical Association. MPhA Practice Direction Standard #9 – Administration of
Drugs. 2012.
4. Ontario College of Pharmacists. Draft Appendix: B1 Routine Injections for Administration by
Pharmacists. Available:
http://www.ocpinfo.com/Client/ocp/OCPHome.nsf/object/BILL_179/$file/Appendix+B1+and+B
2.pdf (accessed 2012 June 18).
5. LexiComp Online. Available: http://online.lexi.com/crlonline (accessed 2012 June 2).
6. e-CPS. Canadian Pharmacists Association. Available: http://www.e-therapeutics.ca (accessed
2012 June 19).
7. Public Agency of Canada. Canadian Immunization Guide. 7th ed. 2006. Available:
http://www.phac-aspc.gc.ca/publicat/cig-gci/index-eng.php (accessed 2012 June 19).
8. Diggle, L. Injection technique for immunization. Practice Nurse 2007;33(1):34-7.
9. Malkin, B. Are techniques used for intramuscular injection based on research evidence? Nursing
Times 2008;104:50/51,48-51.
© Copyright 2012
The following content is unaccredited and intended for informational purposes only.
An accredited version is available online at www.AdvancingPractice.com until June 15, 2013.
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