On August 23, 2021, the FDA approved the first COVID-19 vaccine. The Pfizer- BioNTech COVID-19 vaccine is now approved for individuals 16 years of age and older and will be marketed as Comirnaty. Individuals that are 12 to 15 years in age are still able to get the vaccine at this time under the emergency use authorization (EUA). With this approval, it confirms that the vaccine is safe, effective, and meets manufacturing quality.
COVID-19 Booster shots are now becoming available!
The COVID-19 vaccines have shown to be effective in decreasing hospitalization, severe illness, and death. Overtime, individual’s protection to the virus may decrease, especially with the new variants such as the Delta variant. A booster shot would ensure that you remain protected. This fall, only those that received the Pfizer-BioNTech or Moderna COVID-19 vaccines would be eligible to receive a booster shot.
Who will be eligible for a booster shot?
Patients that received their second dose of Pfizer-BioNTech or Moderna vaccine 8 months ago will be eligible. The plan will be to start administering the booster shot in the fall.
Who will get the booster shot first?
Similar to the initial rollout of the vaccine, booster shots will be offered to those that are at the most risk for COVID-19. These individuals include healthcare workers, long-term care residents, and other older adults.
What if I received the J&J/Janssen COVID-19 vaccine?
While there is no booster shot currently available for those that received the J&J/Janssen COVID-19 vaccine, it is expected that there will be one available next year. Since the J&J/Janssen vaccine was offered to the public after the Pfizer-BioNTech and Moderna vaccine, the data is not yet available.
What is the difference between a booster shot and an additional dose?
A third dose of the vaccine is for certain individuals that are immunocompromised and did not build enough protection from the first two doses of the vaccine. These individuals can receive the vaccine at least 28 days after second dose of the Pfizer-BioNTech or Moderna COVID-19 vaccines.
On the other hand, booster shots are being offered because individuals were once fully protected from COVID-19, but now that protection is starting to decrease. The Pfizer-BioNTech and Moderna COVID-19 booster shots will be offered to individuals 8 months after their second dose.
Information is accurate as of 8-29-2021
A. Viral vectors use a modified version from a different virus to deliver information to cells. The viral vector COVID-19 vaccine uses a different, harmless virus to enter cells in the body in order to produce the spike protein of the COVID-19 virus. This spike protein is harmless
Similar to the mRNA vaccines effects, our cells present the spike protein on its surface so that our immune system recognizes this foreign protein and can start producing antibodies against it
A. There is currently insufficient data to determine whether there are vaccine-associated risks in those who are pregnant or breastfeeding.
However, the CDC states that if you are pregnant you may choose to be vaccinated as there is no evidence that the antibodies formed from COVID-19 vaccination can cause any problem with pregnancy. The CDC is continually updating its guidance on COVID-19 vaccination
A. Individuals with a known history of severe allergic reaction to any components of the Janssen COVID-19 vaccine are contraindicated
A. There is no data available regarding the use of the Janssen COVID-19 vaccine to complete another vaccination series
A. There is currently no data available regarding the use of this vaccine with other vaccines
Q: What are the benefits of receiving a COVID-19 vaccine?
A: Getting vaccinated will decrease your risk of contracting and getting sick from the COVID-19 virus like the influenza vaccine decreases your risk of contracting the flu virus. The benefits of receiving the vaccine far exceed the risks of contracting COVID-19 and potentially having serious, life-threatening or life-long complications. Being vaccinated will help stop the pandemic in combination with following CDC guidelines.
Q: Vaccines usually take years to develop. The COVID-19 vaccines have been developed in under a year, how do I know they are safe?
A: The Phase 3 trials that took place for the COVID-19 vaccines were of similar size and nature to the Phase 3 trials that have taken place for other vaccines and medications.
Here is what the process looks like:
The data gathered from Phase 3 trials is subject to extensive review by independent experts in multiple areas of science including immunology, statistics, infectious diseases, virology, and vaccinology.
Once a pharmaceutical or biotechnology company submits a vaccine to the FDA for Emergency Authorization Use, it undergoes another round of review by the Vaccine and Related Biologics Product Approval Committee (VRBPAC). This committee then provides advice to the FDA before any decision is made.
Once the FDA decides to approve a vaccine, it goes through another round of review by the Advisory Committee on Immunization Practices (ACIP). The ACIP then makes recommendations to the CDC on who should and shouldn’t get the vaccine.
Finally, once a vaccine is approved and individuals are deciding whether to get it, they will have access to information that summarizes the clinical trial findings. This includes data related to any side effects found during the trials and who should or should not get the vaccine.
Authorized Vaccines (as of 2/18/21)
Q: Can you get sick from receiving the SARS-CoV2 protein or the modified virus through the vaccine?
A: No, the proteins will not make you sick, however you may experience side effects from the vaccine.
Q: Will I experience side effects from receiving the COVID-19 vaccine?
A: Yes, it is possible to experience side effects from these vaccines much like the annual influenza vaccine or any other vaccination. These side effects can range from a sore arm to feeling warm or muscle aches. These are signs that an immune response is building in your body and are completely normal. Experiencing these side effects does not mean you have a mild form of the virus
Q: Will I have to receive multiple shots in order to gain the full immunity to COVID-19?
A: The Pfizer vaccine and Moderna vaccine both require the use of two vaccinations to gain the full effect. The Johnson & Johnson vaccine (currently under FDA review for emergency use authorization) will require a single vaccination.
Q: Should I get the vaccine if I already had COVID-19?
A: Yes, it is recommended. Previous COVID-19 infection is not considered a contraindication to receiving the vaccine. Antibody testing is not necessary or recommended prior to receiving the COVID-19 vaccination per CDC guidance.
Healthcare workers who tested positive for COVID-19 within the previous 90 days have a choice to delay receiving the vaccine until near the end of the 90 days to allow other healthcare workers to get vaccinated first. There is evidence suggesting reinfection of COVID-19 is not common 90-days post initial infection.
Q: Will the COVID-19 vaccine make me test positive for COVID?
A: No, the COVID vaccine will not cause you to test positive for a viral test. You may however test positive if the test is measuring antibodies. This is the desired result of the vaccine. The goal of vaccination is for your body to produce antibodies to be ready to fight COVID-19 once you are exposed.
Q: Once I receive the vaccine do I still have to wear a mask and follow social distancing guidelines?
A: Yes, it is recommended that even if you receive the vaccine that you still follow all guidelines set by the CDC. This is because it will take time to immunize the entire country to the point where there is no concern of transmission.
For Grane Rx’s full vaccine FAQ please visit our COVID-19 Vaccine Information Center.
Download your FREE guide to Surviving Allergy Season now.
Spring brings with it sunshine, warmer temperatures, flowers, and allergies. Although seasonal allergies, may make you want to hide inside, some important steps can be taken to help prevent and treat seasonal allergies, so you can enjoy Mother Nature at its finest.
Spring allergies are most often attributed to one major offender, pollen, which is given off by countless numbers of flowers, plants, and trees for fertilization. When the pollen is inhaled or settles on the skin, the body recognizes it as a foreign invader similar to bacteria and an immune response is initiated leading to release of histamine which accounts for the side effects of allergies including: itchy runny nose, itchy watery eyes, sneezing, and coughing.
During the spring and throughout the summer, it is important to monitor the daily pollen count which describes the concentration of pollen in the air.
During the spring and throughout the summer, it is important to monitor the daily pollen count which describes the concentration of pollen in the air. This can be found either by watching the local weather forecast or by going online to the Pollen & Mold Counts page on the American Academy of Allergy, Asthma and Immunology’s web site. Days when the pollen levels are particularly high especially dry, breezy days may be days you may want to try and avoid prolonged times outside or take allergy medicine prophylactically. Pollen levels do tend to be lower following rain, so that may be a better time to be outside.
If you have never been officially diagnosed with seasonal allergies, allergy specialists can use an allergen skin test to determine specifically what substances you are allergic to. Knowing specifically what you are allergic to can help you in your avoidance strategy. In addition to avoidance, another nonpharmacological option is using saline solution to help rinse out the nose. Neti pots have been shown to be quite useful in helping to relieve nasal inflammation caused by allergies. For best results, irrigation should be done as close as possible to exposure to help rinse out the allergens from the nose before they cause symptoms. Another nonpharmaceutical option is acupuncture which works by a mechanism not fully understood.
The first line option for itchy runny nose, sneezing, and itchy watery eyes caused by seasonal allergies is 2nd generation antihistamines such as loratadine (Claritin®), fexofenadine (Allegra®), and cetirizine (Zyrtec®). These work just as well as the 1st generation antihistamines diphenhydramine (Benadryl®) and chlorpheniramine at treating these symptoms, but do not have as high rates of sedation. All five of these agents are available over-the-counter.
If your symptoms seem to be primarily red, itchy, watery eyes, then you may want to consider antihistamine eye drops which are also available over-the-counter such Zaditor®, Alaway®, Naphcon A®, Opcon A®, or Visine A®.
Antihistamines do not treat nasal congestion well. If you have nasal congestion with your other allergy symptoms, you may want to try an oral nasal decongestant such as pseudoephedrine or phenylephrine which relieves congestion by constricting blood vessels around the nose. Note pseudoephedrine is restricted in how much you can purchase. Nasal decongestants should also be avoided if you have high blood pressure that is not stable. Another option is a nasal spray decongestant like oxymetalozine HCl (Afrin®) which acts locally to relieve congestion by vasoconstriction. These sprays however cannot be used for longer than 3 days as they cause rebound congestion.
Knowing specifically what you are allergic to can help you in your avoidance strategy.
If the agents listed above which are all available OTC do not seem to be working, then the prescription route may be pursued. Nasal corticosteroids (with the exception of triamcinolone (Nasacort®) which was recently approved as OTC) are prescription only. Nasal corticosteroids are very effective in relieving nasal allergies and inflammation, but do carry some of the risks of systemic corticosteroids including bone weakening and should not be given in children <12 without physician approval. Nasal spray antihistamines are also prescription only and include azelastine (Astelin®) and olopatadine (Patanase®). They should be used only when oral 2nd generation antihistamines are ineffective. Another prescription only option is to use a leukotriene receptor blocker such as montelukast (Singulair®). These medications help to prevent reactions to allergies by blocking another pathway which leads to inflammation.
Spring is a wonderful time of the year which everyone should be able to enjoy despite the challenges of seasonal allergies. We hope this article has given you a thorough overview of the options you have, so you can get outside and enjoy the nice weather.
For nearly 20 years, Grane Rx has been a leading Grane Rx is pharmacy supplier and professional clinical group for long term care communities and PACE providers throughout pennsylvania and beyond. Every day we help improve care for thousands of residents, improving medication adherence while expanding efficiencies and lowering costs. we really do know how to Make Pharmacy Simple.
Contact your Grane Rx representative at 866-824-MEDS or visit www.granerx.com for more information.
Download your FREE guide to Surviving Allergy Season now.
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Download your FREE guide to Preventing Anticoagulant Medication Errors now.
Anticoagulants are considered to be one of the most at risk classes of medication for adverse events. In fact, in U.S. emergency departments anticoagulants accounted for 33% of adverse drug events in the elderly, and approximately 34,000 medication errors are reported yearly in long-term care facilities with warfarin alone. Given its high use, warfarin accounted for 83% of errors with anticoagulants in a 2010-2011 study. Enoxaparin (Lovenox®) came in second place with 13% of errors. Dabigatran (Pradaxa®) and rivaroxaban (Xarelto®) which are being used more and more in place of warfarin also have major risk of adverse events especially in the elderly and unlike warfarin do not have a reversal agent.
Medication errors with anticoagulants are most commonly associated with giving the wrong dose or errors in follow-up care such as failure to order lab tests, communicate lab results, or change dose in response to INR. Compared to medication errors with other classes of drugs, medication errors with anticoagulants tend to be more common in patients over 75 years of age, occur more often in the documentation and monitoring phases of medication use, occur more often with follow-up care, occur often within 7 days after a transition into the LTC facility, and are more likely to be repeated.
There also are several other risk factors for errors in anticoagulation therapy.
Safe use of anticoagulants depends on communication between multiple healthcare professionals internal and external to the LTC facility. Nurses serve a central role in coordinating care between external prescribers, dispensing and clinical pharmacists, consultant pharmacists, and laboratory staff.
A residents response to warfarin can be constantly changing due to changes in diet, new drug therapies such as commonly used antibiotics, prior use of reversal agents, and changes in resident health status. It cannot be assumed that a resident will stay on a certain dose of warfarin once steady on therapy.
Elderly patients are at a particularly high risk when transitioning from one anticoagulant to another. For example, switching a resident from warfarin onto enoxaparin after surgery and then transitioning him back. Transition phases require intensive monitoring and communication with all care providers.
When a temporary hold order for warfarin is ordered for an elevated INR, often the dose is forgotten to be resumed.
Nurses cannot rely solely on consultant pharmacists to review INR levels as their visits are only once every 30 days. Patients who have highly fluctuating INR levels need to be monitored every 1-2 weeks.
The following are strategies to help prevent errors in residents who are on anticoagulation.
A facility-based anticoagulation protocol should be utilized to help ensure consistent and appropriate initiation, dosing, monitoring, and adjustment of anticoagulation therapy.
There also should be protocols for planned and emergency reversal for anticoagulation therapy. Grane Rx consultant and clinical pharmacists can be consulted to help your facility develop appropriate guidelines.
INR draws should be utilized for residents newly prescribed warfarin, new admissions on warfarin, and residents returning from the hospital on warfarin therapy. Baseline hemoglobin, hematocrit, platelet count, liver function tests, and renal function tests should be performed on residents prior to initiating warfarin and periodically while resident is on warfarin therapy. A set protocol should be developed for monitoring and follow-up of INR levels for residents on warfarin therapy.
All residents should have a set INR goal determined by prescribers based upon clinical indication. This goal should be communicated to clinical and dispensing pharmacists as well as written on the resident’s MAR.
A standardized process for communicating lab results to the prescriber and pharmacist within 2 hours of receipt should be established. Nurses should directly consult the prescriber and pharmacist anytime the INR is outside of target range, or when renal function tests, liver function tests, hemoglobin/hematocrit, or platelet count results are outside of established limits.
Anticoagulation logs or flow sheet should be used to help track the dose and INR for residents on warfarin, so trends can be easily seen.
The pharmacy should dispense exact doses needed whenever possible. Clear dosing instructions should be listed on the MAR.
Warfarin should be administered at a time which allows for appropriate review of test results and dose adjustments before administration time.
As a last line of safety, nurses should review the previous INR and any documented dose changes prior to warfarin administration to make sure necessary interventions have not been overlooked.
When a hold order is written, the prescriber should indicate the reason for the hold, when and what dose to resume, and any other resident specific instructions. These instructions should be included in the pharmacy profile and in the nursing MAR. INR draws should be continued according to prescriber instruction and physicians and pharmacists should be notified when levels return to normal.
Warfarin has the potential to interact with numerous other medications which may result in subsequent increases or decreases in INR. When new orders are being received for residents on warfarin, remind physicians of the resident’s warfarin therapy and last INR. Additionally, watch for communications from the pharmacy concerning potential interactions and management strategies.
The following chart lists many of the drug, herbal, and dietary interactions that may cause a resident’s INR to fluctuate and potentially go outside of the therapeutic INR range of 2 to 3 or 2.5 to 3.5. The chart is by no means all inclusive, but lists the most prominent drug interactions that you should monitor for in your practice setting. It also gives information on how these interactions will affect the INR as well to what clinical signs to look for and how to manage them.
For nearly 20 years, Grane Rx has been a leading Grane Rx is pharmacy supplier and professional clinical group for long-term care communities and PACE providers throughout pennsylvania and beyond. Every day we help improve care for thousands of residents, improving medication adherence while expanding efficiencies and lowering costs. we really do know how to Make Pharmacy Simple.
Contact your Grane Rx representative at 866-824-MEDS or visit www.GraneRx.com for more information.
Download your FREE guide to Preventing Anticoagulant Medication Errors now.
]]>
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Download your FREE Flu Management Guide now.
October is upon us — and so is the start of flu seasonAs you know, older adults (and their caregivers) are at greater risk for influenza and related complications. Between now and May, the Centers for Disease Control and Prevention (CDC) recommends that nursing homes take a multifaceted approach to prevent the spread of influenza. Of course, the first step is administering flu vaccine to both residents and caregivers. In fact, it’s the most effective way to reduce the risk.
There are other ways as well, including implementing respiratory hygiene and cough etiquette, managing ill residents appropriately and adhering to infection control precautions for all resident-care activities. Even simple things such as washing your hands properly can make a big difference. Common sense plays a big role as well; for example, if a caregiver is sick, don’t come to work.
Our goal is to make managing flu season as simple as possible for you, so we’ve prepared a handy guide on page 2. Please feel free to make copies and display it prominently in the common areas of your facility. If you have any questions, just let us know.
If you’d like specific advice on prevention and treatment options for your facility, our pharmacy consultants can work with your Infection Control Committee to develop the best approach for you. This may include, for example, how to treat residents with special conditions, such as kidney or liver disease.
“Every flu season, some new challenge appears.
That’s why we’re here.”
— Jen Devinney, PharmD. Director of Consulting and Medical Records Grane Rx
“Flu season can be a stressful time for facilities,” said Jen Devinney, PharmD., Director of Consulting and Medical Records at Grane Rx. “Many reach out to us each year for the latest information and specific recommendations. We do all we can to ease the burden.” This includes helping facilities prepare for and manage not only this year’s flu season, but also next year’s as well. “For example, some nursing homes order vaccine in advance,” she said. “Every flu season, some new challenge appears. That’s why we’re here.”
Sick staff members and visitors should stay home until well.
The CDC recommends the following Droplet Precautions:
Grane Rx is the complete pharmacy solution for 32 long-term care communities serving 4,500 residents in Pennsylvania. Known for technological innovation and putting the needs of customers first, Grane Rx simplifies pharmacy services in a changing and challenging healthcare world.
Contact your Grane Rx representative at 412-449-0504 or visit www.granerx.com for more information.
Download your FREE Flu Management Guide now.
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In the 1980s, change was in the air. A small group of nursing home leaders began to ask themselves, “What can we do to provide a more home-like setting for our residents?” That simple question started a movement, leading to the Culture Change mission of today. It began with something as simple as referring to patients as residents — and understanding that residents live in their homes, not an institution. Now, long-term care nursing homes across the country are embracing resident-centered care. It’s about dignity: giving residents more freedom to decide how they live their lives. At the heart of that choice is deciding when to take their medications. When residents have the freedom to choose, it improves quality of life. Grane Rx makes flexible medication pass times not only possible, but simple — and that’s change for the better.
The aim of culture change is to mirror what a resident would do if he or she were still living at home. “When would she take her medications at home?” asked Nancy Boyd, RN, BSN, Consultant Pharmacy Nurse for Grane Rx. “If possible, residents should have the choice to take their medications at the same time they did when living at home. That’s what flexible medication pass times are all about.”
Instead of traditional, rigid medication pass time schedules — say at 8 am and 4 pm — flexible schedules allow for a range of possibilities that residents can choose from, such as:
“Of course, medication pass times still have to follow doctor’s orders,” Boyd explained. “And, if the pharmacist has special instructions — such as taking the medication with food — the pharmacy makes sure the schedule accommodates that. But above all, flexible medication pass times help facilities achieve what they want most: to provide a more like home-like setting for their residents.”
Grane Rx supports culture change in long-term care. For facilities ready to advance their resident-centered care options, we will support them with the transition.
Consider the facility benefits:
“Perhaps best of all, it doesn’t cost one extra cent,” Boyd said. “This is simply about doing what’s right for residents. That’s why we’re all here.”
“We want our residents to make as many of their own choices as they can,” said Kathie Jacob, RN, Evening Supervisor and Pharmacy Liaison for Vincentian Home in Pittsburgh. What is the primary choice that residents want to make? “How they manage their time,” Jacob said. “And when they take their medications is an important part of that. It’s about being resident-centered, not medicine-centered. So we coordinate with Grane Rx to manage flexible medication pass times. Grane Rx has truly become a part of our team and has been most helpful in making the change. It’s wonderful.”
As part of its Culture Change program, flexible medication pass times provide Vincentian Home the freedom to give residents more of what they want most: choice in how they live. “It works for every type of resident,” Jacob explained. “Even short-term residents benefit, because they don’t have to adjust to our medication schedule and then go back home to change again. With flexible medication pass times, we can mirror their home schedule while they’re here.” And that’s just the beginning of why the program was the right choice for Vincentian Home:
With any major change, there’s always some concern about disruption — but strong planning will make the transition seamless. And that’s just what happened, as the clinicians from Vincentian Home and Grane Rx worked to customize the right program for the facility. “The biggest factor was our nurses working with Grane Rx nurses,” Jacob said. While the team continues to make ongoing improvements, there’s no question that flexible medication pass times work. “Plus, it’s compliant, as our recent visit from the Department of Health demonstrated. They approved our new approach. Clearly, it has been a positive change for everyone.”
Set in a park-like campus in Pittsburgh’s North Hills, Vincentian Home is a continuing care retirement community (CCRC). Part of the Vincentian Collaborative System, Vincentian Home includes independent living for seniors at Vincentian Villa retirement community, personal care for 50 residents and skilled nursing and rehabilitation.
Grane Rx is the complete pharmacy solution for 32 long-term care communities serving 4,500 residents in Pennsylvania. Known for technological innovation and putting the needs of customers first, Grane Rx simplifies pharmacy services in a changing and challenging healthcare world.
Contact your Grane Rx representative at 412-449-0504 to learn how we can support your journey to resident-centered care. Or visit www.granerx.com for more information.
Download a PDF of our Freedom of Choice story now.]]>
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