Trust-wide. Minor Change. Major Change

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1 Policy Number 110 This document has been reviewed in line with the Policy Alignment Process for Liverpool Community Health NHS Trust Services. It is a valid Mersey Care document, however due to organisational change this FRONT COVER has been added so the reader is aware of any changes to their role or to terminology which has now been superseded. When reading this document please take account of the changes highlighted in Part B and C of this form. Part A Information about this Document Policy Name Administration of Pneumococcal Vaccine Policy Type Board Approved (Trust-wide) Trust-wide Divisional / Team / Locality Action Approval No Change Minor Change Major Change New Policy No Longer Needed As Mersey Care s Executive Director / Lead for this document, I confirm that this document: a) complies with the latest statutory / regulatory requirements, b) complies with the latest national guidance, c) has been updated to reflect the requirements of clinicians and officers, and d) has been updated to reflect any local contractual requirements Date: 14/12/18 Signature: Part B Changes in Terminology (used with Minor Change, Major Changes & New Policy only) Terminology used in this Document New terminology when reading this Document Liverpool Community Health NHS Trust Mersey Care NHS Foundation Trust- Community Division Part C Additional Information Added (to be used with Major Changes only) Section / Paragraph No Outline of the information that has been added to this document especially where it may change what staff need to do Part D Rationale (to be used with New Policy & Policy No Longer Required only) Please explain why this new document needs to be adopted or why this document is no longer required Part E Oversight Arrangements (to be used with New Policy only) Accountable Director Recommending Committee Approving Committee Next Review Date March 2019 LCH Policy Alignment Process Form 1

2 SUPPORTING STATEMENTS This document should be read in conjunction with the following statements: SAFEGUARDING IS EVERYBODY S BUSINESS All Mersey Care NHS Foundation Trust employees have a statutory duty to safeguard and promote the welfare of children and adults, including: being alert to the possibility of child / adult abuse and neglect through their observation of abuse, or by professional judgement made as a result of information gathered about the child / adult; knowing how to deal with a disclosure or allegation of child / adult abuse; undertaking training as appropriate for their role and keeping themselves updated; being aware of and following the local policies and procedures they need to follow if they have a child / adult concern; ensuring appropriate advice and support is accessed either from managers, Safeguarding Ambassadors or the trust s safeguarding team; participating in multi-agency working to safeguard the child or adult (if appropriate to your role); ensuring contemporaneous records are kept at all times and record keeping is in strict adherence to Mersey Care NHS Foundation Trust policy and procedures and professional guidelines. Roles, responsibilities and accountabilities, will differ depending on the post you hold within the organisation; ensuring that all staff and their managers discuss and record any safeguarding issues that arise at each supervision session EQUALITY AND HUMAN RIGHTS Mersey Care NHS Foundation Trust recognises that some sections of society experience prejudice and discrimination. The Equality Act 2010 specifically recognises the protected characteristics of age, disability, gender, race, religion or belief, sexual orientation and transgender. The Equality Act also requires regard to socio-economic factors including pregnancy /maternity and marriage/civil partnership. The trust is committed to equality of opportunity and anti-discriminatory practice both in the provision of services and in our role as a major employer. The trust believes that all people have the right to be treated with dignity and respect and is committed to the elimination of unfair and unlawful discriminatory practices. Mersey Care NHS Foundation Trust also is aware of its legal duties under the Human Rights Act Section 6 of the Human Rights Act requires all public authorities to uphold and promote Human Rights in everything they do. It is unlawful for a public authority to perform any act which contravenes the Human Rights Act. Mersey Care NHS Foundation Trust is committed to carrying out its functions and service delivery in line the with a Human Rights based approach and the FREDA principles of Fairness, Respect, Equality Dignity, and Autonomy

3 Title Protocol on the Administration of 23-valent Pneumococcal Polysaccharide Vaccine to Adults by Health Care Assistants & Other Health Care Support Workers (HCSWs) Policy reference number 110 Aim and purpose of Policy Author Type To enable suitably trained Health Care Assistants (HCAs) and other Health Care Support Workers (HCSWs) working for or on behalf of Liverpool Community Health who have undertaken relevant training, to administer Pneumococcal Polysaccharide vaccine to adults. Vaccination and mmunisation Lead Nurse New Policy Reviewed Policy Review date March 2019 (3 month extension agreed at Clinical Policies & Procedures Group 11/12/18) Person/group accountable for review Type of evidence base used Issue date Authorised by Clinical Standards Group Vaccination and Immunisation Lead Nurse Evidence which includes published and/or unpublished studies and expert opinion (Limited scientific evidence). November th October 2016 Equality Undertaken Analysis Yes Evidence collated

4 Version Number: 6 Ratified by: Clinical Standards Group Date of Approval: 25 th October 2016 Name of originator/author: Immunisation Lead Nurse Approving Body / Committee: Clinical Standards Group Date issued: November 2016 Review date: October 2018 Target audience: Name of Lead Director / Managing Director: Changes / Alterations Made To Previous Version: Relevant health care professionals including Health Care Assistants (HCAs) and other Health Care Support Workers (HCSWs) working for or on behalf of Liverpool Community (NHS) Health who have undertaken relevant training, to administer Pneumococcal Polysaccharide vaccine to adults. Director of Nursing Minor change to front cover sheet and 3 month extension noted

5 ` Contents 1. Purpose of Protocol 2. Rationale 3. Principles 4. Authority to proceed a. Staff groups b. Consent 5. Training/ Skills a. Training programme b. Continuing training requirements 6. Eligibility Criteria a. Criteria for inclusion b. Criteria for exclusion/ further advice/action c. Treatment, route administration and legal status d. Special circumstances e. Recordkeeping and audit f. Significant Events 7. Appendices 1. Purpose of Protocol To enable suitably trained Health Care Assistants (HCAs) and other Health Care Support workers (HCSWs) working for or on behalf of Liverpool Community Health (LCH) who have undertaken relevant training (section 5), to administer appropriately

6 inactivated Pneumococcal vaccine to adults aged 16 years and over. The vaccine would be administered as a single dose, as a duty authorised and assigned by the Registered Nurse or GP (LCH employee) under a Patient Specific Direction (PSD). It will ensure that all staff employed by LCH or on behalf of the Trust, provide optimal service delivery to this population group. The advice and guidance contained within this protocol is based upon the latest research-based evidence (Department of Health, Immunisation Against Infectious Disease. The Green Book (2006) on line version available at: National and local policy documents i.e. The DH Green Book (2006, updated on line version), and the LCH Clinical Policy for Vaccine) and Protocol for Administration of Inactivated Influenza Vaccine should be read in conjunction with this protocol. Website links are referred to within this document.. 2. Rationale Role redesign is part of the governments agenda to modernise the NHS workforce, allowing staff to work differently to provide care. HCAs and other HCSWs are able with appropriate training and support, to undertake tasks that were previously performed by registered staff. This in turn enables registered staff to extend their roles in an appropriate manner when authorised to do so via a Patient Specific Direction (PSD). LCH has developed a training programme tailored to HCA/HCSWs individual needs based on HPA National Minimum Standards and Core Curriculum for Immunisation Training, Training is also in line with the more recent publication, the National Minimum Standards and Core Curriculum for Immunisation Training of HCSWs (2012) available at: es/immunisation/1205nationalstandardsimmunisationtraininghcsw/ The Health Protection Agency (HPA), now Public health England (PHE) has set out to standardise HCSW immunisation training and to facilitate high quality and safe practice. It has been noted that the roles of non-registered staff have already started to expand, in some cases without the necessary protocols and training programmes in place. The management of this identified risk is an essential element in the development of this protocol, to meet an agreed standard of risk management underpinned by recognised competencies. In addition, there is a clear expressed need that any future flu pandemic will require a workforce that can be mobilised to support the implementation of public health contingency plans, in particular the giving of Pneumococcal and Influenza vaccinations.

7 The aim is to ensure patients receive the highest possible level of care by developing an education and training programme that ensures consistency and credibility whist remaining sustainable. Anaphylactic reactions to vaccines are very rare but have the potential to be fatal. In the event of anaphylactic shock occurring in an adult patient/ client in relation to these delegated duties, the HCA /HCSW must be competent in the delivery of emergency basic life support and treatment including the administration of adrenaline. 3. Principles The vaccination by suitably qualified HCAs /HCSWs will be administered under a Patient Specific Direction (PSD), (section 4c). A PSD is a written instruction by a prescriber, usually the GP or nurse with extended prescribing rights and is written for each individual patient. This may take the form of a list of patients (several named patients) who require vaccination. This instruction may be hand written or entered into each individual patient s electronic notes/ record. HCAs and HCSWs will undertake bespoke training as developed by the LCH Vaccination and Immunisation Training Lead / Immunisation Trainer. Achievement of basic life support training to include the recognition and treatment of anaphylaxis is a pre requisite. HCAs and HCSWs will undertake as a pre requisite Demonstrate the ability to study at level 3 More information is available on the Skills for Health NHS career framework available at: Complete bespoke LCH V & I Foundation Training Achievement of basic life support training to include the recognition and treatment of anaphylaxis Further information is available at 4. Authority to Proceed Staff groups Health Care Assistants and other Healthcare Support Workers 4a. Consent Consent must be obtained prior to proceeding with vaccination. Refer to Liverpool Community Health (LCH) Consent Policy at:

8 For further information refer to the Clinical Policy for Vaccine Administration 4b. Patient identification 4c. Patient Specific Direction An adult must consent to their own treatment. The Mental Capacity Act 2005 sets out how treatment decisions should be made for people of 16years of age or older who do not have the capacity to make such decisions This is required prior to administration of a vaccine. Patient must confirm: Name, date of birth, and home address HCA/HCSW must confirm that the client is eligible to receive the vaccination as per Green Book inclusion criteria A Valid Patient Specific Direction (PSD) must be obtained. A PSD is a written instruction from an independent prescriber (doctor dentist or independent nurse prescriber) to another healthcare professional, to supply and/or administer a medicine directly to a named patient, or to several named patients. This must be obtained prior to administration of the vaccine. 5. Training / Skills

9 5a. Initial Training Completion of Consent to Treatment training Completion of Basic Life Support training Completion of Infection Control Training The above training will be completed as a pre-requisite to Completion of HCA training course on administration of Influenza and Pneumococcal vaccines to adults Completion of period of supervised practice and assessment against competencies as per National Minimum Standards and Core Curriculum for Immunisation Training of HCSWs (2012) Immunisation training of healthcare support workers: national minimum standards and core curriculum - Publications - GOV.UK Training and competence in the correct procedure of administering medication via intra-muscular injection with reference to LCH guidelines competency framework available in the appendix Basic Life Support recognition and treatment of anaphylaxis Training to include maintenance of patient/client privacy and dignity at all times and the demonstration at assessment of awareness of different possible injection sites if client has any physical disability eg. Amputation Knowledge of the management of Anaphylaxis in the community. Refer to the green book: The National Resuscitation Guidelines on Anaphylaxis, 2008 (annotated with NICE guidance July 2012) can be found at: Access to and knowledge of the DH guidance Immunisation against infectious disease Green book is available at:

10 Topics covered 5b. Continuing training requirement Patient / client communication - demonstrating an awareness of Equality & Diversity Appropriate anatomy, physiology and immunology Correct procedure for the administration of the vaccine via intra-muscular injection Vaccine delivery, storage and stock control requirements, maintaining the cold chain Cautions and side effects related to the administration of inactivated Pneumococcal and Influenza vaccination Correct disposal of waste Documentation and policy including accountability, delegation and PSDs Legal aspects of drug administration including consent for further information: Response and treatment of adverse reactions including anaphylaxis and Basic Life Support Cold Chain Response and treatment of adverse reactions including anaphylaxis and Basic Life Support Access to and Knowledge of current infection control polices Annual update in Basic Life Support and treatment of anaphylaxis. Demonstration of competence in relation to this medication within the Personal Development Plan (PDP) and appraisal process (Performance Development Review). Attendance at annual Vaccination & Immunisation update/ refresher as per LCH requirements Any relevant mandatory training introduced by LCH The immuniser will in conjunction with this protocol refer to all current related infection control policies and Maintenance of the Cold Chain Policy available on the clinical policies website: 6. Eligibility Criteria and condition to be treated 6a. Criteria for Inclusion

11 Clinical condition to be treated Active Immunisation Against Pneumococcal Disease to all High-risk patients/clients as per Green Book recommendations: /public-health-england/series/immunisation-against-infectiousdisease-the-green-book Criteria for inclusion All patients aged 65 and over Any adult (16 years and over) who has a confirmed diagnosis of one of the following diseases: Chronic heart /respiratory disease Nephrotic syndrome, chronic kidney disease at stages 4 and 5 and those on kidney dialysis or with kidney transplantation. Diabetes mellitus Chronic liver disease Immunosuppression i.e. HIV, Asplenic. etc. Cochlear implants CSF shunts including those with cerebrospinal leaks as a result of injury or major skull surgery Certain Occupational groups (see Green book updated on line chapter as above link) This list is not exhaustive, referral to a clinician/gp for a clinical judgement re: the benefit of vaccination can be made 6b. Criteria for Exclusion/ circumstances for further advice/action Criteria for exclusion Patients with any of the following: No valid consent or unable to give informed consent Aged under 16 years will be appropriately signposted to alternative sources of treatment with appropriate healthcare professionals Current acute illness Previous severe allergic reaction to any vaccine or pneumococcal vaccine or any component. Discuss with GP. Healthy adults under the age of 65yrs Previous Pneumococcal vaccination (please note, an exception applies to those individuals with absent or dysfunctional spleen or chronic renal disease and these patients management and any subsequent vaccinations should be discussed with the GP). Haemophiliacs - HCAs and other HCSWs will need to seek advice as the administration technique required may be deep sub-cutaneous and therefore require assistance from another healthcare registered professional skilled in this technique Circumstances for further Consent refused: Counsel with regards to the risks of

12 advice/action Pneumococcal infections and the protective effect of the vaccine. Document advice given. Severe allergic reaction to any vaccine or Pneumococcal Polysaccharide vaccine or any vaccine component; refer to Clinician/GP/ registered nurse Pregnancy or breast feeding is not a contraindication to receiving Inactivated Pneumococcal vaccination, however pregnant women should be offered the opportunity to discuss their pregnancy in relation to vaccination; seek advice to allow for discussion with the Clinician/GP/ registered nurse around risk vs. benefit and management Acute febrile illness; rearrange vaccination at a later date Previous vaccination for those patients with absent or dysfunctional spleen, discuss vaccination management with GP. Immunosuppressed clients seek advice Maintain all clients dignity at all times. If client is an amputee utilise available alternate limbs. If no alternative limb is available do not proceed, seek advice from the Immunisation Lead /GP/ registered practice nurse as applicable 6c.Treatment, route, administration and legal status Recommended treatment: Route and legal status Pneumococcal Polysaccharide Vaccine to be administered by intramuscular injection into the deltoid muscle (individuals with an uncontrolled bleeding disorder refer to Clinician/GP/registered nurse for subcutaneous vaccination). If administering Influenza vaccination at the same time, use different site/limb for injection Further information can be obtained from: Prescription Only Medicine (POM) Dosage Adults 0.5mls Frequency of administration & maximum dosage Follow-up and advice In accordance with Department of Health Immunisation Schedule, refer to Green Book and Patient Specific Direction (PSD) Normally a once only injection Routine booster every 5 years for those with no spleen, splenic dysfunction or chronic renal disease with a valid PSD. Re -immunisation is not normally advised except in special circumstances. The patient/client should be referred to the GP for advice

13 Side effects and their management Local effects: Redness, swelling, hardness at injection site, pain, bruising Systemic side effects: Low grade fever recommended treatment with paracetamol Pyrexia, headache, tiredness, muscle & joint pain etc. Counsel patient that these reactions are rare and usually disappear within 1-2 days. If they do not, or more serious symptoms develop, then the patient should contact the GP Extremely rare side effects: Immediate reactions e.g. Urticaria, angio-oedema, bronchospasm and anaphylaxis see protocol for treatment of anaphylaxis for appropriate management This list is not exhaustive refer to current BNF and SPC for complete list. See Adverse Reaction section for all suspected adverse reactions vaccines 6d. Special Considerations Up to here Special considerations/ Concurrent medication Adverse reactions No drug interactions known The immune response to Pneumococcal Vaccination is reduced in those who are immunosuppressed or immunodeficient, including HIV patients. Patients should be individually assessed by the GP in relation to the risk vs. benefit of immunisation Immunosuppressant therapy e.g. oral corticosteroids Chemotherapy or radiotherapy may result in reduced antibody response. The benefits are such that immunisation should be considered. Refer to GP for advice Ensure that Anaphylactic shock pack is available If general adverse reaction occurs: Record in patients notes Inform patients GP as soon as possible Local reactions should be seen by a Registered Nurse Immuniser, GP/ Registered Nurse Inform line manager and complete DATIX incident form If anaphylactic reaction occurs:

14 Give treatment according to LCH HCA/HCSW protocol/ policy on anaphylaxis and DH guidance and LCH SOP Record in patients notes Inform patients GP as soon as possible Complete LCH Datix, IR1 Incident Report electronic form All suspected adverse reactions to vaccines occurring in individuals where vaccines are labelled with a black triangle ( ) and serious adverse reaction to vaccines should be documented and reported to the Medicines Healthcare products Regulatory Agency (MHRA) via yellow card system. 6e. Record Keeping and Audit Items to be recorded in patient s notes Please refer to LCH Record keeping Policy available at: Name of drug, dose, route and site of administration Date of administration Legible batch number/s and expiry date (from outer vaccine box packaging) Printed name & legible signature of person administrating drug (written or electronic) and designation Contraindications checked Action taken if patient refuses vaccine Reactions to vaccination and action taken (see completion of yellow card in adverse reactions section) Audit Health Care Assistants and HCSWs will be expected to participate in audit/evaluation in relation to patient outcomes and the development of this extended role. The LCH Vaccination & Immunisation Lead/ Trainer will monitor adherence of LCH staff to this Protocol during attendance at training that will include: Annual review with LCH Clinical Audit Annual Update Q & A Maintenance of database with record of training Annual Review of Protocol 6f. Significant Effects

15 Significant Events vaccine error, interruption of cold chain ), Needle Stick Injury and Near misses Any significant event which occurs during or as a result of administration of a vaccine must be reported to the LCH Manager/Registered Nurse. All HCAs /HCSWs signing up to this protocol will be expected to: Participate in audit in relation to patient outcomes and the development of this role according to local governance arrangements Comply with the requirements of all relevant LCH policies applicable to their area of operation and local governance arrangements Report and record incident to the Registered Nurse or Nurse Manager Report and record incident via LCH DATIX reporting system Report and record all potential near misses or adverse incidents in line with Trust Risk Management policy following the protocol for vaccine error or interruption of the cold chain Relevant Clinical policies can be accessed at: HCAs /HCSWs must be familiar with: 1. NMC Guidelines for the Administration of Medication 2007/ NMC Guidelines for Records and Record keeping 3. UK Guidance on Best Practice in Vaccine Administration (2001) 4. National Minimum Standards and Core Curriculum for Immunisation Training of Healthcare Support Workers (HPA April, 2012) and LCH documents as follows: Policy for Vaccine Administration (vaccine error flowchart) Policy for maintaining Cold Chain (cold chain error flowchart) Consent to Treatment Needle stick Injury Policy Personal Protective Equipment Policy Hand Hygiene Policy

16 Protocol on the Administration of 23-valent Pneumococcal Polysaccharide vaccine to Adults by Health Care Assistants and Health Care Support Workers (HCSWs) Agreement for Health Care Assistants and Health Care Support Workers within LCH or working on behalf of LCH This protocol is to be read, agreed and signed by all Health Care Professionals/ Assistant Practitioners and other HCSWs and it applies to: Approved base:.. Staff name: Designation: Signature:.

17 Date:.. Managers signature: Date:. The Health Care Assistant and other HCSWs should retain a copy of the document after signing and the original be retained in their personal file. This protocol has been devised by: Signature: Date: Signature: Date: This protocol has been accepted by the Clinical Policies Governance Team and LCH Medicines Management Group: Signature Date: Review: It is the responsibility of the lead of the staff groups to whom this protocol applies to ensure the review process takes place. This protocol becomes valid on [ INSERT DATE] and becomes due for review on [INSERT DATE]

18 8. Appendices Appendix 1

19 Cold Chain Policy for Medicines (esp. vaccines) for staff involved in immunisation October Version 3.Clinical Policies Group Vs. 3 Appendix 2 Patient Group Directions for Vaccination & Immunisation Consent Process Checklist for Pneumococcal Immunisations (photocopy for GP notes)

20 Individual organisations may wish to use an alternative consent form or may record the outcome of the discussion with the patient on consent directly onto the clinical system To be completed by the patient and/or nurse Name of patient M/F Address. Date of Birth. Name of GP.. Do you feel unwell today? *Have you ever had the Pneumococcal vaccine before? YES/NO YES/NO Did you have a reaction to pneumococcal vaccine or have you had a reaction to any other vaccine?.yes/no **Are you pregnant or breast feeding? YES/NO ***Do you have lowered immunity caused by disease or treatment? E.g. no spleen (or a dysfunctional spleen), steroids, HIV, chemotherapy or radiotherapy YES/NO If you have answered YES to any of the above questions please speak to the nurse before you are given your immunisation Have the advantages/disadvantages of this immunisation been discussed with you? Have you had advice about side effects, temperature control? YES/NO YES/NO Has a patient information leaflet been provided? YES/NO Please note a written signature is not a statutory requirement. Valid consent is a process and referral or completion of this checklist will assist in the demonstration of this process. Signature of patient for consent to immunisation Revaccination is only recommended in patients with no spleen or dysfunctional spleen or chronic renal disease. Children under 5 who had the conjugate pneumococcal vaccine for children will need 1 dose of the vaccine (pneumococcal polysaccharide vaccine) for older children and adults. ** Pregnancy is not a contraindication but is a special consideration, please seek advice. *** Lowered immunity may result in reduced vaccine response. The benefits of immunisation are such that they usually outweigh any risks. Please check / take advice from GP or Registered nurse

21 Immuniser Competencies for Non Registered staff administering Influenza IM, Pneumococcal Polysaccharide Vaccine and Shingles (herpes zoster) Claire Ashley Immunisation Trainer IMMUNISER COMPETENCIES

22 The national Minimum Standards for Immunisation training and the Core Curriculum for Immunisation Training for healthcare professionals involved in Immunisation describe the standards and list the essential topics which should be incorporated into all immunisation training for registered healthcare professionals. Both these Minimum Standards and the Core Curriculum have been used as the basis for this guidance for HCSW Immunisation training. It is recommended that only HCSWs who have achieved education and training to Level 3 of the Qualifications and Credit Framework ( QCF ) or equivalent in England and Wales with at least 2 years experience as a HCSW should be considered for training in vaccine administration. HCSW s working at this level are likely to be Level Three or above of the NHS Career Framework or the NHS Wales Skills and Career Development Framework for Clinical Healthcare Support Workers. This document adheres to these published principles and aims to build upon the Foundation course outcomes to ensure that practitioners continue to work safely and effectively by applying learning in all of the 14 core curriculum areas of knowledge. Objectives are attained through the Practitioners understanding of immunisation policy and their ability to transfer theory to practice by applying: Multidisciplinary approach Proactive practice to increase sphere of influence Partnership working Evidence based practice Research findings and sharing them with others Active reflection and development Health Care Competencies These are linked to the Skills for Health National Occupational Standards. Workforce competence CHS3 specifically relates to the Administration of Medicines to Individuals. These standards are continually evolving, please refer to the Skills for Health website at for further guidance. Learning outcomes and objectives relate to the 14 core curriculum topics divided into 14 content sections and have been mapped to the six Knowledge and Skills framework (KSF ) core dimensions from Levels 1 through to 3 1. Communication 2. Personal and People Development 3. Health safety and security 4. Service Improvement 5. Quality 6. Equality and Diversity Post Immunisation foundation course, as Practitioners acquire skills, knowledge, understanding and confidence in their field they are able to demonstrate how they meet increasingly challenging levels of competence.

23 Health and well-being (HW) Map to Health and well-being KSF dimensions HWB1, B2, B3, B5, B6, B7 and all 6 core dimensions Section Core areas of knowledge KSF Core dimensions Specific dimensions - applying knowledge and understanding at appropriate level 1 The aims of Immunisation: national policy and schedules 2 The immune system and how vaccines work 1, 2, 3, 4, 5 & 6 HWB1, HWB3, HWB7 1, 4 & 5 HWB1, HWB3 3 Vaccine preventable diseases 1, 3, 4, 5 & 6 HWB1, HWB3, HWB7 4 The different types of vaccines used and their composition 5 Current issues and controversies regarding vaccination and immunisation 6 Communicating with the public (patients/clients, parents and carers) 1, 3, 4 & 5 HWB1, HWB3, HWB7 1, 4, 5 & 6 HWB1, HWB3, HWB5 1, 4, 5 & 6 HWB1 & HWB3 7 Legal aspects of vaccination 1, 4, 5 & 6 HWB2, HWB3, HWB5 & HWB6 8 Storage and handling of vaccines 9 Correct Administration of Vaccines 10 Anaphylaxis and other adverse events 11 Documentation record keeping and reporting 12 Strategies for improving immunisation rates 1, 3, 4, & 5 HWB1, HWB3, HWB7 1, 3, 4, 5, 6 & 7 HWB3, HWB5 HWB6 & HWB7 1, 3, 4, & 5 HWB2, HWB3 & HWB7 1, 4, 5 & 6 HWB1, HWB3 & HWB5 1, 4, 5 & 6 HWB1 & HWB3

24 WHAT IS COMPETENCE? Competence is acquiring and using evidence based scientific and humanistic knowledge and skill in the application of therapeutic interventions in the current practice of nursing (Roach, 1984) The following document contains a self- assessment section and a section for completion by a mentor and is to be used as a tool to measure and agree competency. Staff will need to identify a mentor who is a registered practitioner and experienced in delivering immunisation programmes. Potential Immunisers should be assessed against all the listed competencies, except where they are only required to use specific techniques eg: intra- dermal vaccination for BCG injection ( TB team ) or intra- nasal Flu vaccinations. In these instances, the documentation should clearly state for which vaccine the assessment has been carried out. If staff work in a signposting role, as opposed to an active immunisation role, they and their assessors need to identify which competencies are applicable to them. Staff evolving from an advisory/support role to an active Immunisation administration role will need to be fully assessed against all competencies and may require further training to accomplish this. After completion of training and a period of supervised practice the practitioner should complete the self- assessment column to state that they feel competent to immunise independently. The mentor should review this self-assessment, having observed them perform immunisations and indicate if each competence is met. If the mentor has cause to write in the attainment pending column, a clear action plan must be put in place that will help the practitioner to attain the required level of competence and a review date should be agreed. When the mentor and the practitioner agree that the practitioner is competent in all areas, the section at the bottom of the register should be signed off. November 2015

25 2a 2b 2c 2d 2e 2f 2g 2h Staff with a clinical professional registration Knowledge base Must attend a relevant Adult or Child Services Vaccination & Immunisation Foundation course via Liverpool Community Health or accredited external agency. Can evidence successful completion of all course MCQ tests during the relevant Foundation training. Can access the Green Book online, aware it is updated electronically only. Seeks advice from appropriate personnel should queries arise re: vaccine eligibility, spacing or error. Demonstrates awareness of the national and local immunisation programmes and vaccine preventable diseases. Understands vaccine types eg: can explain live and inactivated vaccines and demonstrates knowledge of different delivery routes eg: subcutaneous, intra-nasal. Understands the need for booster doses, vaccine spacing and the rationale behind the flu vaccine being administered annually. Knows the vaccination targets, locally and nationally and understands the importance of uptake data. N/A to current area of practice Self assessment record Attained Mentor review record Attained (A) Attainment pending (AP) Action plan for attainment ( if pending ) Review date November 2015

26 3a 3b 3c 3d 3e Essential core skills for Immunisation Demonstrates knowledge and understanding of the need for cold chain maintenance. Can access LCH Cold chain policy, if LCH employed. Can access local cold chain policy if GP employed. Understands how to action and correctly report any cold chain failure that occurs on or off LCH premises. If vaccine transportation is an integral part of role can demonstrate ability to safely transport vaccines ensuring cold chain maintenance throughout the immunisation session. Is in date with mandatory CPR and anaphylaxis training training is on an annual basis for LCH staff. Knows what course of action should be taken if the Immuniser is out of compliance with mandatory CPR. Aware of local protocols for the transportation of adrenaline. Can advise where emergency kits are held at different clinical locations, if applicable. Demonstrates good hand hygiene and Infection prevention techniques. Knows the local reporting responses to clinical/procedural incidents eg: needlestick injury. Knows how to access and complete Datix or equivalent. Knows how to access relevant policies/protocols on the LCH Intranet if access is available or else can identify locally held policies/protocols. Adheres to local guidance and best practice in relation to sharps/equipment disposal. Works to aide-memoir from LCH V & I policy if November 2015

27 4a 4b 4c 4d LCH employed or from local SOP ( Standard Operating Procedure ) if GP employed. Understands limitations of own role and knows where to seek advice with any queries. PROCESS / PROCEDURE Determines patients immunisation history by carrying out appropriate identity and record checks, using GP data systems, checks EMIS if all previous checks reveal no immunisation history. Is able to correctly state which vaccines patient is eligible for, according to the UK programme. Demonstrates the ability to give comprehensive vaccine advice to ensure best practice for informed consent. Uses leaflets/aids to compound information given verbally. Can contact LCH or external Interpreter services if language barrier exists to ensure informed consent takes place. Demonstrates a clear understanding of the risks and benefits of vaccination. Is able to address queries and clarify any controversial issues eg: the use of porcine gelatin in certain vaccines. Able to address misconceptions and certain myths eg: flu vaccine causes flu, 2015 flu vaccine didn t work. Understands consent requirements, demonstrates knowledge of the Mental Capacity Act and Gillick Competence. Always ensures consent is appropriately obtained prior to vaccination and documents accordingly. Understands best interest concept and can name appropriate staff members to help with November 2015

28 4e 4f 4g 4h 4i 4j 4k 4l this. Always documents consent prior to procedure. Demonstrates some awareness of childhood consent issues ( Childhood flu programme only )eg: who has parental responsibility. Awareness of safeguarding issues eg: therapeutic holding. Knows to refer to registered practitioner if any doubt/ confusion arises eg: looked after children. Understands contra-indications/cautions and successfully follows check list /algorithm to check it is safe to proceed with vaccination. Contacts relevant registered/medical practitioner if any doubt exists. Understands a Patient Specific Direction ( PSD ) is the authority to proceed with vaccination, checks it is current, signed by a prescriber and completed correctly before immunisation session begins. Can name all advanced prescribers in the relevant clinical area. Understands that PGD for intra-nasal child vaccine covers the supply of the vaccine only. Robust protocols should be in place locally to cover the administration of this vaccine. Checks vaccines have been stored correctly, uses Summary of Product Characteristics ( SPC ), checks vaccine box for damage and checks expiry date. Uses correct position, site and route of administration for individual vaccines. Demonstrates correct intra- muscular injection technique for Flu/Pneumococcal vaccines. November 2015

29 4m 4n 4o 4p 4q Demonstrates correct intra-muscular technique for Shingles vaccine. Demonstrates correct technique for childhood vaccines. ( Minimum 10 ) Completes necessary documentation. Records; date, vaccine type, manufacturer, dose given, batch no:, expiry date, injection site ( if injectable ), eg, administered via PGD or PSD, name and signature of Immuniser. Uses EMIS correctly. Understands how and when to report reactions to vaccines to the MHRA via the Yellow card system. Also understands the local procedures for reporting adverse events. Understands the Anticipated Effects Following Immunisation ( AEFI s ) and can offer advice on symptom control. Provides patient/parent with a copy of post immunisation advice sheets. Knows how to order advice leaflets from Orderline. November 2015

30 REFERENCES Liverpool Community Health Vaccination & Immunisation Policy Liverpool Community Health Meds Management Cold Chain Policy Royal College of Nursing ( 2015 ) Supporting the delivery of immunisation education.london: RCN Health Protection Agency (2005 )National Minimum standards and core curriculum of immunisation training of health care support workers. London: Public Health England (previous HPA) Available at -minimum-standards NMC Code of Conduct Green Book Roach,M.S. (1984 )Caring: The Human Mode of Being, Implications for Nursing.Ottowa: The Canadian Hospital Assosciation Press NMC 2010 Standards for Medicines Management Public Health England ( 2015 ) National Minimum Standards and core curriculum of immunisation training of health care support workers. London. Public Health England ( previous HPA ).Available at : -core-curriculum 30