7.5: Scope of Practice for Other Health Professionals Involved in Immunizations
While Ontario is in the process of expanding the scope of practice for RNs to include prescribing authority for vaccines, NPs and physicians can currently prescribe vaccines to individual patients and may also develop directives that authorize other healthcare providers (such as RNs or registered practical nurses, or – if the ordering practitioner is a physician – physician assistants) to administer vaccines to a larger client population when certain conditions are met and specific circumstances exist. Directives must include a number of detailed components and should be supported by certain facility policies prior to implementation (CNO, 2018a).
To improve influenza vaccination rates, Ontario pharmacists, pharmacy students, and pharmacy interns became authorized to prescribe and administer influenza vaccines in 2012 to clients over the age of five. These pharmacists and pharmacists-in-training need to complete specific injection training requirements and be practicing at a pharmacy registered with Ontario’s Universal Influenza Immunization Program (Ontario College of Pharmacists, n.d.). In December 2016, this scope was expanded to include other vaccines including Hib, hepatitis A, hepatitis B, herpes zoster, HPV, Japanese encephalitis, meningitis, pneumococcal disease, rabies, tuberculosis, typhoid, varicella, and yellow fever (Ontario College of Pharmacists, 2016). In April 2019, the Ontario government announced it may further expand the scope of practice to allow pharmacists to administer influenza vaccines to children under five years of age (Jones, 2019).
Midwives in Ontario need to be aware of current guidelines for vaccination recommendations for pregnant people, who are at greater risk than non-pregnant people for more severe illness from some vaccine-preventable diseases (Association of Ontario Midwives, 2018). Midwives in Ontario may prescribe and administer certain vaccines to their clients, such as hepatitis B and MMR vaccines (College of Midwives of Ontario, 2014). However, other vaccines recommended in pregnancy, such as pertussis and influenza, may require a referral to another primary care provider. Similarly, providing routine childhood immunizations falls outside the midwifery scope of practice in Ontario. As you learned earlier in this resource, vaccinations typically begin at two months of age, and clients and their infants are discharged from midwifery care at six weeks postpartum. Clients may wish to discuss immunizations with their midwives in the prenatal period, and during their postpartum/newborn visits. As a result, midwives, like other health professionals, should be aware of the childhood immunization schedule in Ontario and where clients can find evidence-based information.