Administering Drug Therapy by Inhalation or Injection

Administering Drug Therapy By Inhalation or Injection Standards of Practice

The following Standards of Practice describe the minimum expectations involved in administering inhalations or injections to patients and are intended to promote consistency in the provision of the service to the people of the province. These standards do not apply to the emergency administration of rescue medications such as epinephrine and naloxone.

Standards of Practice for the Administration of Drug Therapy by Inhalation or Injection

Apply For Authorization

Pharmacists and pharmacy technicians registered with the College of Pharmacy of Newfoundland and Labrador (CPNL) who wish to administer drug therapy by inhalation or injection can apply to do so through their account in the CPNL Registrant Portal.

Pharmacy students and pharmacy interns do not need to apply for authorization but can only administer drug therapy by inhalation or injection if they meet the eligibility requirements below and only administer the drug therapy under the direct supervision of an authorized pharmacist.

Eligibility

Must be registered with the College of Pharmacy of Newfoundland and Labrador.
Must have either:
graduated from a pharmacy program accredited by the Canadian Council for the Accreditation of Pharmacy Programs (CCAPP) where education and training on the administration of inhalation and injections is a component of the core curriculum, or
successfully completed an education and training program on the administration of injections that has received Competency-Mapped Accreditation by the Canadian Council on Continuing Education in Pharmacy (CCCEP) that was completed within one year of the date of application.
Must have completed certification in-person or blended learning First Aid and CPR courses at a level equivalent to the St. John Ambulance or Red Cross Emergency or Standard First Aid and CPR/AED Level C/HCP/BLS.

REQUIRED DOCUMENTATION

The following documentation is required to be submitted with the Authorization to Administer Drug Therapy by Inhalation or Injection Application.

Proof of administration of injection training as per eligibility requirements.
Proof of current first aid and CPR certification as per eligibility requirements.

Application

If you have determined you are eligible to apply for authorization and have obtained all the required documentation, you may apply through CPNL’s online registrant portal by following the steps below.

Click Registrant Portal in the Portal Login menu at the top right of the webpage.
Log into your account.
Click the Authorizations link on the side menu.
Click the Start New Application button under the Authorization Applications table.
Select the appropriate registration category from the Registration Type dropdown box.
Click the Select this Application button under the Administer Drug Therapy by Inhalation or Injection category.
Follow the instructions to submit the application and pay the application fee.

Completed applications are reviewed in the order they are submitted and may take 5-7 business days to process once all required documentation and fees are received. Applicants will be notified by email once a decision has been made. Applicants are to refrain from administering injections until approval has been received.

FAQ

Can all pharmacists and pharmacy technicians administer drug therapy by inhalation or injection?

No, only pharmacists and pharmacy technicians authorized by CPNL or pharmacy interns or pharmacy students practicing per the Standards of Practice for the Administration of Drug Therapy by Inhalation or Injection are permitted to administer drugs by inhalation or injection.

Pharmacists and pharmacy technicians who wish to be authorized must meet the required education requirements and apply for authorization as outlined above.

Can pharmacy students or interns administer drugs by inhalation or injection?
has successfully completed education and training and certification in First Aid and CPR in accordance with section 2) a) of the Standards
is appropriately registered with CPNL, including having current professional liability insurance; and
is under the direct supervision of a pharmacist who has received authorization from CPNL to administer drug therapy by inhalation or injection in accordance with section 2) b) of the Standards.

Where can I access an acceptable injection education and training program?

The Canadian Council on Continuing Education in Pharmacy (CCCEP) provides competency-mapped accreditation for injection education and training programs and maintains a list of programs that currently have accreditation on their website at: https://www.cccep.ca/pages/immunization_and_injections.html.

Once I am authorized to administer injections, what requirements am I expected to meet?

The Standards state that once authorized, pharmacists and pharmacy technicians must:

maintain competence and skill level in administering inhalations or injections by
ensuring clinical competency by reviewing the online learning modules, the latest Immunization Guides, and product monographs for the medications/vaccinations that they intend to administer and
ensuring technical competency by re-completing the live portion of the accredited program, shadowing another pharmacy or health professional, and/or asking that pharmacy or health professional to observe your technique and offer feedback;
maintain appropriate First Aid and CPR certification; and
administer inhalation and injections only in accordance with provincial guidelines, standards established by CPNL, and within limits of their own competence.

Once authorized, it is ultimately up to the pharmacy professional to ensure that they continue to meet the requirements of the Standards and, if not, to refrain from administering until such time as they are able to address the deficiency.

If my first aid or CPR certification expires after I am authorized, can I continue to administer injections until I get re-certified

No, if your first aid or CPR certification expires, you must refrain from administering injections until such a time as you are re-certified and you have uploaded the documentation to your profile on the CPNL Registrant Portal.

Do I have to be in a pharmacy to administer an injection to a patient?

The Standards do not restrict pharmacy professionals to administering injections within a pharmacy. The Standards were written intentionally to allow injections to be administered in locations other than a pharmacy, referencing the “physical environment” where the injection is administered rather than the “pharmacy”.

The expectation is that all of the standards are still met, and, as such, certain factors need to be considered when planning to administer off-site, such as:

Must take patient privacy into account.
The site must be clean, safe, suitably furnished, and equipped for the type of drug therapy being administered.
Pharmacy professionals must consider what supplies need to be brought to the site.
The site must be suitable for post-therapy observation, including the provision of any necessary aftercare or management of adverse reactions.
Must be able to complete assessment, documentation, and follow-up requirements.
Pharmacy professionals must determine how they will access the electronic health record if it is required to complete the patient assessment or documentation.
What types of supplies should I have on hand?

Pharmacy professionals must have ready access to all necessary supplies for the administration of injections as well as the drugs and supplies that would be required to treat emergencies or adverse reactions associated with the administration of drug therapy. Specific information on this is provided during the education and training program, as well as in the Canadian Immunization Guide. In Part 2 of this guide, under “Anaphylaxis and other Acute Reactions following Vaccination”, pharmacists can find a list of recommended items for an anaphylaxis management kit.

What reporting is expected in the event of an adverse reaction?

The Public Health Agency of Canada and the NL Department of Health and Community Services require that health professionals report any major or moderate adverse events that occur following the administration of an immunization. This can be accomplished by following the direction given in Section 1 of the Newfoundland and Labrador Immunization Manual.

Additional Resources

Immunization Resources for Health Professionals: Printable Awareness Products – Health Canada

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