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Running a travel clinic in community pharmacy – the problem-solving approach.

Are you thinking about starting up a travel clinic in community pharmacy? Here we look at the organisation involved in setting up a travel service, and how to make a success of your clinic without it having an adverse effect on your day to day community focused responsibilities.

We’re all under immense pressure to provide a sparkling service 100% of the time – but how should we manage a situation when things go wrong? And what can we put in place to ensure the same issue doesn’t reoccur? We are medical professionals and therefore expected to never mess up – but in reality, working life is tough and mistakes sometimes happen. It’s how we deal with the situation which will set us apart from the travel clinic down the road offering the same service.

I’ve messed up many a time – mainly concerning vaccine schedules and stock management, with the odd incorrect appointment time thrown in to test my patience! All the aforementioned can be easily rectified with an apology and some quiet thinking time to figure out the logistics, so nothing to fret about! Incorrect vaccine selection however, cannot be reversed – once that jab is in, it’s in. Thankfully something I have never made a mistake with, but it’s a potential error that I’m very aware of, and an error I believe could easily happen with a slip of concentration. Many of the vaccines we offer are made by the same pharmaceutical company – and the cause of many dispensing errors – the packaging is very similar. An example of this is Typhim Vi (typhoid vaccine) and Avaxim (Hepatitis A vaccine). Both come in identical boxes of 10, no distinguishing features apart from the name and a green stripe vs. a pink stripe. Also amazingly similar are adult and child vaccines – such as Engerix B and Twinrix – you can see from the photo how easy it would be to select the wrong vaccine.

When we’re really busy, we rush – we’re all guilty of it – and so it’s very important to organise our fridge (and ourselves!) with the vaccine tasks ahead. We organise our dispensary alphabetically, so why not arrange the fridge in the same way? Limit staff access as you would the CD cabinet, and know your stock. Back to basics but start this way and you will continue in this manner. It’s hard to put a process in place once a service has been running for 6 months, so instil the rules now and you won’t go far wrong.

I’ve learnt the hard way – from having to refund patients to panic organising a pharmacist from head office to vaccinate when I’ve been on holiday – such simple methods started from the get go can make a difference to the success of your travel clinic, and your confidence in running a tight service.

My 3 simple organisational top tips which need to be set in stone from day 1 are:

  1. Take control of your stock – know what you’re ordering, and from where. Do you have a vaccine quota? Do you need to set up an account with a supplier? If a patient enquires about a full course of 3 Hepatitis B vaccines, your answer needs to be yes, we can offer that. If you can’t answer confidently and truthfully on the spot, you’ll risk losing the custom.
  2. At the point of agreeing to vaccinate (post risk assessment etc) make sure you have the stock, or can easily obtain it within 48 hours. Often community pharmacies offer a discount if a full course is purchased – for example typically 10% discount is applied if all 3 vaccines are purchased at the point of dose 1 (Hep B, Rabies etc). If I don’t have the vaccines in stock, I always call the suppliers in front of the patient before taking payment. Supply of vaccines is sometimes troublesome, so don’t over promise and under achieve.
  3. When a patient pays for a course of vaccines, separate these follow up doses – store in a basket at the bottom of the fridge with the patient’s name and dose details g. Mr X, Hep B dose 2 & 3. I cannot stress how imperative this is! I always show the patient when I do this – it creates reassurance and trust that their follow up dose is ready and waiting….just remember to check the date if the vaccine is due in a couple of months’ time.

Which brings us on to schedules. Vaccine schedules. What. A. Nightmare.

Each of my patients have their own plastic wallet which contains:

  • All consent forms (one needed per vaccine appointment stating the correct date)
  • Downloaded ‘prescription’ – although you’re more than likely working from a PGD, you can usually print a list of vaccines (from the supporting company you’re using e.g. Pharmadoctor) to be administered which will help your vaccine plan. Like flu vaccines, travel vaccines have a peel-able sticker often with the vaccine name, expiry date, and batch number (I stick this on the print out as a cross reference and reassurance).
  • Copies of till receipts – you will often see patients over a 6-month period – so print a copy of each receipt at point of payment and write their name at the top. So simple, but has supported me greatly when a patient has queried remittance. Also, hugely useful to keep track if the patient prefers a pay-as-you-go approach.
  • Vaccine schedule planner – I fill this in as I go, and supply a copy to my patient so we can work through the schedules together.

I’ve found my vaccine schedule planner really useful as I can see at a glance where I’m up to. I’ve attached mine (adult and child) for you to look at (and use!).

Jane Chiodini’s schedule reference guide can always be trusted – it’s updated regularly and is a great reference source to refer to.

When running a travel clinic in community pharmacy, planning and organisation is paramount. Look after yourself, and work to your ability. If you start off organised and with a clear and achievable aim, the rest will fall into place, and in time you’ll be running a successful service.

Written by Siân Humphreys – Community Pharmacist, Wednesday 27th February 2019