Recently, the NPA Pharmacy Services Team has been receiving queries from members regarding the service specification and patient group direction for the NHS community pharmacy influenza vaccination advanced service. NPA chief pharmacist Leyla Hannbeck answers two of the most commonly asked questions

The PGD states that the flu vaccine should be given by deep subcutaneous injection in individuals with a bleeding disorder, to minimise the risk of bleeding. Does “bleeding disorder” include patients who are taking anticoagulants or antiplatelet drugs?

NHS England has advised us that the term “bleeding disorder” is intended to mean conditions such as haemophilia, and is not meant to include patients taking, for example, aspirin or warfarin. Pharmacists need to carry out a risk assessment on individual patients and be satisfied that the route of administration is appropriate. However, the NHS Clinical Knowledge Summaries guidance states that, for patients with a bleeding disorder – “including people on warfarin” – the influenza vaccine should be administered by deep subcutaneous injection. The British National Formulary 69 states that patients “with bleeding disorders such as haemophilia or thrombocytopenia” should not be administered vaccines by the intramuscular route; the deep subcutaneous route should be used instead. We are seeking further clarification on this issue from Public Health England and NHS England. In the meantime, pharmacists should exercise caution when vaccinating patients taking anticoagulants or antiplatelets. If in doubt, pharmacists are advised to refer to the patient’s GP.

Patients with chronic heart disease are eligible to receive the advanced service vaccination. Does this include a patient taking a single drug for hypertension?

The PGD lists examples of chronic heart disease as “congenital heart disease, hypertension with cardiac complications, chronic heart failure, individuals requiring regular medication and/or follow-up for ischaemic heart disease”. This list is not exhaustive and pharmacists are required to make a clinical judgement as to whether a patient fits into this category. NHS England has advised that a patient taking a single drug for hypertension is unlikely to meet the criteria of “hypertension with cardiac complications”. NPA members can access a range of clinical resources to support the community pharmacy flu vaccination advanced service at www.npa.co.uk.