Influenza Campaign (Wales) Code of Practice (The Flu Code)

Transcription

1 Influenza Campaign (Wales) Code of Practice (The Flu Code) May 2016

2 Public Health Wales Influenza Campaign (Wales) Code of Practice Purpose and Summary of Document: This code of practice sets out the minimum requirements of NHS Wales organisations in delivery of the annual influenza campaign. Ten standards are given against which all NHS Wales organisations may assess compliance. NHS Wales organisations should aim to demonstrate compliance with the essential criteria for each standard as a minimum. Compliance with all elements of this code of practice should be considered essential by NHS Wales organisations to build a strong annual influenza campaign. Date: 20 May 2016 Version: 1 Page: 2 of 22

3 Contents 1 INTRODUCTION SCOPE THE STANDARDS CRITERIA FOR COMPLIANCE APPENDIX 1 6 REFERENCES AND FURTHER READING... 22

4 1 Introduction 1.1 Influenza is a contagious disease that spreads rapidly especially in closed communities and is a major contributor to excess winter deaths each year 1.2 Influenza outbreaks occur most years, with large epidemics occurring intermittently 1.3 The timing, extent and severity of influenza can vary between years, with most cases occurring during an eight to ten week period in the winter. 1.4 Influenza vaccine generally becomes available towards the end of September each year and should continue to be given until flu is no longer circulating, which can be as late as April 1.5 Influenza immunisation is offered annually to those at increased risk of complications of flu due to pregnancy, age, or medical condition. It is also offered to healthcare workers and social care workers to protect their own health and that of the people they care for 1.6 Influenza immunisation is considered the best way to protect individuals from influenza 1.7 Annual immunisation is considered the most effective way of reducing spread of influenza. 1.8 Effective infection prevention and control is everyone s business, integral to everyday healthcare practice and based on the best available evidence. The NHS in Wales is committed to zero tolerance of preventable healthcare associated infections. 1.9 The code of practice for the influenza campaign in Wales ( The Flu Code ) sets out the minimum necessary standards for all NHS Wales organisations. The ten elements should be met in full. Compliance with these standards should be evident to service users, colleagues, other NHS organisations and Welsh Government 2 Scope 2.1 The Flu Code applies to all health boards (HBs) and trusts in NHS Wales, and to all NHS services provided in both primary and secondary care. It is acknowledged that NHS Wales organisations vary with respect to the services they provide and support, and some elements of the code may not apply to all of these organisations. 2.2 Non NHS Wales organisations are encouraged to refer to The Flu Code to inform appropriate standards for their organisations.

5 3 The Standards The ten standards are given here, details of how to assess compliance with these standards is given in section 4. Standard 1: Flu vaccination is an organisation priority Standard 2: There is a named flu lead at executive level Standard 3: Senior healthcare professionals lead by example Standard 4: The organisation should include a structured communications plan as an integral part of the campaign Standard 5: Flu vaccine is easily accessible for all eligible individuals irrespective of their condition, mobility, ethnicity or location Standard 6: Everyone eligible for a flu vaccine is offered one Standard 7: Healthcare staff actively encourage flu vaccination in eligible groups Standard 8: Knowledgeable staff are available to answer questions about flu vaccine accurately and in a timely way Standard 9: Accurate and timely information on flu vaccines administered is recorded and shared appropriately Standard 10: All health and social care staff are encouraged to complete an information session on flu annually. 4 Criteria for compliance NHS Wales organisations will need to demonstrate compliance with the criteria for each standard as a minimum. Compliance should be considered an essential part of their annual flu immunisation programme.

6 Standard 1: Flu vaccination is an organisation priority We expect to see Activities to demonstrate compliance 1.1 An organisation statement outlines collective responsibility for maximising immunisation of those at increased risks of complications of flu and frontline healthcare staff For HBs and trusts: this should be a board level statement 1.2 A governance and reporting structure actively challenges poor communication and demonstrably encourages organisation wide communication Evidence of a reporting structure that incorporates system wide communication. 1.3 Vaccine uptake data is shared in a timely, appropriate manner utilising Public Health Wales statistics, and include discussion on achieving objectives, challenging issues, and plans for improvement 1.4 Expert support and advice on flu immunisation is readily available Evidence of regular information sharing with key stakeholders should be summarised in regular reports Annual report includes a description of how flu immunisation is easily accessible by all. 1.5 Evidence of appropriate action and demonstration of support for vaccine uptake in all eligible groups. This may include an executive/senior figure e.g. medical/nursing director communicating individually to all relevant members of staff. Evidence of a range of methods and resources to raise awareness and improve accessibility, which may include: flu champions a named flu lead 1.6 Implement steps to monitor the risks of influenza to determine whether further actions are needed to prevent or control influenza risk, to include regular, timely reports on any flu outbreaks where relevant Evidence of actions taken to prevent and control influenza outbreaks, this may be in outbreak reports, or take the form of a risk assessment on the impact of flu as part of business continuity planning.

7 Standard 2: Activities to demonstrate compliance There is a named flu lead at senior/executive level 2.1 In each organisation there is a senior member of staff designated as flu lead. 2.1 The senior/executive flu lead ensures there is an inclusive, robust organisation wide seasonal flu plan, and demonstrates support for colleagues in progressing and supporting the flu immunisation programme and maximising flu vaccine uptake, facilitating the removal of barriers to individuals in receiving flu immunisation in a timely way with minimal inconvenience We expect to see A named flu lead. In HBs and trusts an executive board member holds the executive flu lead role and is identified on the NHS organisation web pages Inclusive flu plan is agreed and shared prior to the flu season (The end of July is suggested) Evidence of liaising and working with key stakeholders, which may include: service users director of public health, immunisation coordinator (HBs) or flu lead (trusts) occupational health teams infection prevention teams primary care colleagues Public Health Wales pharmacy colleagues and others

8 Standard 3: Senior healthcare professionals lead by example We expect to see Activities to demonstrate compliance 3.1 Senior healthcare professionals demonstrate sound knowledge of the benefits of annual flu immunisation, are actively involved in the development of the flu plan, and openly challenge inaccurate or misleading information Correspondence and communications demonstrate: a sound knowledge base challenging information that appears to be inaccurate 3.2 The promotion and increased awareness of the benefits of flu vaccination to individuals in eligible groups is actively and visibly supported by senior healthcare professionals across the organisation Correspondence and communications demonstrate active support and positive messages 3.3 Colleagues within the organisation are openly and actively supported by senior healthcare professionals and infection prevention teams to have appropriate knowledge and awareness of the benefits of flu vaccination. 3.4 Senior healthcare professionals facilitate the removal of barriers to staff and individuals in risk groups receiving flu immunisation and encourage new and innovative ways to promote and deliver flu immunisation services Correspondence and communications demonstrate active support for colleagues Annual training audit Correspondence and communications demonstrate support for: staff leaving the clinical area to be immunised Immunisers attending clinical areas

9 Standard 4: Activities to demonstrate compliance An annual influenza campaign communications plan is an integral part of the campaign 4.1 An inclusive flu communications strategy and plan is developed with key partners to support colleagues and stakeholders, and is discussed, agreed and supported (at board level for HBs and trusts) before the flu season starts 4.2 The flu communications plan: incorporates all elements of the annual flu campaign demonstrates collaboration with appropriate support organisations and using resources via a range of formats and platforms supports and enhances national policy and the national Public Health Wales/Welsh Government flu communications plans and strategies We expect to see The organisation flu communication strategy is agreed pre flu season (The end of July is suggested) Evidence of collaboration and working together in the communications strategy and plan 4.3 Service users have awareness of, and involvement in, the communications and also delivery plans and provision of flu immunisation Service users groups feedback is incorporated into plans

10 Standard 5: Flu vaccine is easily accessible for all eligible individuals irrespective of their condition, mobility, ethnicity or location We expect to see Activities to demonstrate compliance 5.1 The organisation supports and encourages adequate and appropriate vaccine supplies be secured and available in a timely way, to ensure targets can be achieved in all eligible groups. Examples might be: General practice orders enough vaccine to achieve target uptake rates Occupational health departments order enough vaccine to achieve target uptake rates in frontline staff Quadrivalent injectable vaccine available for children in risk groups who cannot receive LAIV Evidence of actions taken to ensure enough vaccine is ordered. This may include: Direct advice to primary care Support of primary care Advice to Welsh Government on requirements 5.2 Flu vaccine is available to individuals at various times and venues to accommodate different wants and needs. Flu vaccine availability is not limited to normal working hours within the organisation Systems are in place to encourage opportunistic flu vaccine if possible and information safely shared Evidence of a range of days, times and venues when vaccine is available Consideration of how to never miss an opportunity to encourage or administer flu should be included in plans 5.3 Systems are in place to ensure flu vaccine is available in a timely way to eligible individuals unable to attend a primary care setting to receive their vaccination, due to reasons such as: being housebound, do not have a permanent address not registered with a GP Plans include detail on how individuals may access immunisation; this may include working with the Third sector.

11 Standard 6: Activities to demonstrate compliance Everyone eligible for a flu vaccine is offered one 6.1 All those eligible for flu vaccine are personally invited annually at least once before 31 December in a way appropriate for them. If vaccination is declined the reasons behind this are explored and then recorded using a mechanism that facilitates audit All personal invitations are recorded on medical/occupational health notes using a mechanism that facilitates audit 6.2 Those eligible for flu vaccine due to pregnancy, medical condition, or being aged 65 or over who have not received flu immunisation during this season should be recalled before 31 January in an appropriate way 6.3 Carers are identified and offered immunisation before 31 December We would expect to see Annual audit of invitations, which includes consideration of: format and language how invitations are recorded how declining immunisation is addressed and recorded Annual audit of recall Annual audit of invitations includes carers 6.4 Social care settings employers are supported and encouraged to facilitate annual flu immunisation of their clients, and social care staff with direct client contact 6.5 The organisation website contains up to date information on which groups are eligible for flu vaccine and on the different ways that eligible individuals may access their flu vaccine locally The Care home report is shared with all care homes Care homes are advised of the care homes guidance at uguideforcarehomes Information is easily found on the organisation web pages on: which groups are eligible how to get a vaccine

12 Standard 7: Activities to demonstrate compliance Healthcare staff actively encourage flu vaccine in eligible groups 7.1 Healthcare professionals consistently demonstrate a sound knowledge of the benefits of annual flu immunisation and openly challenge inaccurate or misleading information 7.2 Healthcare workers are openly and actively supported to encourage flu vaccination, and support colleagues to identify and utilise effective ways to promote and deliver flu immunisation services 7.3 All healthcare staff know which groups are eligible for flu vaccine, or are able to signpost to someone who does know or an appropriate information resource We expect to see Correspondence and communications demonstrate knowledge, and also challenging information that appears to be inaccurate, this may include: personal correspondence websites Correspondence and communications demonstrate positive messages and support for colleagues. This may include: flu champions collaborative clinics Correspondence and communications contain accurate information, and/or signposting to an appropriate resource, such as: Organisation website Public Health Wales All those eligible for flu vaccination are advised to enable informed choice. This will include consideration of format and language of any information. Personal advice given is recorded where possible in an individual s notes using a mechanism that facilitates audit and research Correspondence and communication is recorded and demonstrates informed choice is supported and respected, this may include: personal correspondence Annual audit/survey of information recording and/or information resources

13 Standard 8: Knowledgeable staff are available to answer questions about flu vaccine accurately and in a timely way We expect to see Activities to demonstrate compliance 8.1 The organisation has a documented training and education delivery plan that includes accessible immunisation training and annual flu updates in a variety of formats 8.2 The organisation helps reduce barriers to training, and supports staff to access appropriate immunisation training and annual flu updates in a timely way 8.3 Staff who give flu immunisations are appropriately trained, up to date, and competent to advise on the benefits of flu vaccination as well as to immunise Training and competency assessment is in line with National Minimum Training Standards. Training delivery plan which incorporates a range of training formats Inclusive training delivery plan Annual audit of immunisers training and competency assessment 8.4 All healthcare staff have access to up to date accurate advice on the flu vaccine from their occupational health service, employer, flu champion or other 8.5 Accurate information is communicated with individuals in an appropriate and timely manner, and in confidence if it relates to a particular individual. A survey of knowledge and understanding pre and post specific interventions may be a useful component in the flu plan Staff have access to organisation intranet/web pages which contain accurate information Organisation webpage contains up to date information Up to date leaflets are widely available Correspondence and communications demonstrate sound knowledge base

14 Standard 9: Accurate and timely information on flu vaccines administered is recorded and shared appropriately We expect to see Activities to demonstrate compliance 9.1 All legal requirement must be met with regard to recording of immunisations administered Annual audit of flu vaccine administration and recording 9.2 The organisations training and education delivery plan incorporates the recording of immunisation and healthcare information 9.3 Systems are in place to ensure information on vaccines administered to eligible individuals outside primary care reaches primary care in a timely way Training delivery plan Annual audit/survey of vaccine recording is undertaken Annual audit/survey of vaccine recording and data sharing is undertaken 9.4 All vaccines given are recorded using a mechanism that facilitates audit Annual audit/survey of vaccine recording is undertaken 9.5 Accurate information is recorded in an appropriate and timely manner, and in confidence if it relates to a particular individual Annual audit/survey of vaccine recording is undertaken

15 Standard 10: All health and social care staff are encouraged to complete an information session on flu annually. We expect to see Activities to demonstrate compliance 10.1 The organisation has incorporated an information session on flu, such as FluOne e-learning module ( into its training and education delivery plan. (This may be a standalone module or part of broader infection prevention training.) Training plan delivery 10.2 All senior healthcare professionals and board members complete an information session on flu Annual survey audit/ 10.3 FluOne (or an alternative flu learning/awareness raising opportunity) is actively promoted via the Professional Organisation and Development team within the organisation 10.4 All new staff are encouraged to complete FluOne as part of the induction process Evidence on POD website of promotion FluOne advice included in staff induction pack Audit/survey of FluOne access/issues 10.5 Senior healthcare professionals and board members demonstrate support for appropriate methods and approaches to maximise staff accessing Flu updates and facilitate the removal of barriers to staff completing FluOne (or an alternative flu learning/awareness raising opportunity) Audit/survey FluOne alternative) access/issues of (or 10.6 The organisation actively monitors the number of staff who have accessed FluOne (or an alternative flu learning/awareness raising opportunity) and this information is shared with the team, executive board or appropriate sub-committee Audit/survey of FluOne (0r alternative) access/issues

16 5 Appendix 1: Groups included in the national flu immunisation programme Source: Welsh Health Circular WHC (2015) 029: The National Influenza Immunisation Programme (Revised) In , flu vaccinations should be offered to the following groups Eligible groups Further details Children Children aged two and three years to be offered vaccination through primary care (i.e. date of birth on or after 1 September 2011 and on or before 31 August 2013). Children aged four years (i.e. date of birth on or after 1 September 2010 and on or before 31 August 2011) who attend school in Reception class to be offered vaccination by the school nursing service. Those of this age range who do not attend school to be offered vaccination through primary care. Children in school years 1 and 2 to be offered vaccination through the school nursing service. For practical reasons, all children in the eligible school years should be offered vaccination irrespective of their actual date of birth. Children not in the age groups mentioned should be offered vaccination in line with eligibility outlined below. All patients aged 65 years and over Sixty five and over is defined as those 65 and over on 31 March 2016 (i.e. born on or before 31 March 1951).

17 Chronic respiratory disease aged six months or older Asthma that requires continuous or repeated use of inhaled or systemic steroids or with previous exacerbations requiring hospital admission. Chronic obstructive pulmonary disease (COPD) including chronic bronchitis and emphysema; bronchiectasis, cystic fibrosis, interstitial lung fibrosis, pneumoconiosis and bronchopulmonary dysplasia (BPD). Children who have previously been admitted to hospital for lower respiratory tract disease. Chronic heart disease aged six months or older Congenital heart disease, hypertension with cardiac complications, chronic heart failure, individuals requiring regular medication and/or follow-up for ischaemic heart disease. Chronic kidney disease aged six months or older Chronic kidney disease at stage 3, 4 or 5, chronic kidney failure, nephrotic syndrome, kidney transplantation. Chronic liver disease Cirrhosis, biliary atresia, chronic hepatitis. aged six months or older

18 Chronic neurological disease aged six months or older Stroke, transient ischaemic attack (TIA). Conditions in which respiratory function may be compromised due to neurological disease (e.g. polio syndrome sufferers). Clinicians should offer immunisation, based on individual assessment, to clinically vulnerable individuals including those with cerebral palsy, learning difficulties, multiple sclerosis and related or similar conditions; or hereditary and degenerative disease of the nervous system or muscles; or severe neurological disability. Diabetes aged six months or older Type 1 diabetes, type 2 diabetes requiring insulin or oral hypoglycaemic drugs and diet controlled diabetes.

19 Immunosuppression aged six months or older Immunosuppression due to disease or treatment, including patients undergoing chemotherapy leading to immunosuppression, bone marrow transplant, HIV infection at all stages, multiple myeloma or genetic disorders affecting the immune system (e.g. IRAK-4, NEMO, complement disorder). Individuals treated with or likely to be treated with systemic steroids for more than a month at a dose equivalent to prednisolone at 20mg or more per day (any age) or for children under 20kg a dose of 1mg or more per kg per day. It is difficult to define at what level of immunosuppression a patient could be considered to be at a greater risk of the serious consequences of flu and should be offered flu vaccination. This decision is best made on an individual basis and by the patient s clinician. Some immunocompromised patients may have a suboptimal immunological response to the vaccine. Asplenia or dysfunction of the spleen This also includes conditions such as homozygous sickle cell disease and coeliac syndrome that may lead to splenic dysfunction. Pregnant women All pregnant women at any stage of pregnancy (first, second or third trimesters).

20 People living in long-stay residential care homes or other long-stay care facilities. Vaccination is recommended for people living in long-stay residential care homes or other long-stay care facilities where rapid spread is likely to follow introduction of infection and cause high morbidity and mortality. This does not include, for instance, prisons, young offender institutions, or university halls of residence. Carers Those who are in receipt of a carer s allowance, or those who are a carer of an elderly or disabled person whose welfare may be at risk if the carer falls ill. Third sector carers Individuals who work on a voluntary basis (are not paid for their time and effort) providing care on a frequent basis to one or more elderly, disabled or otherwise vulnerable people whose welfare would be at risk if the individual became ill. These should be identified by a letter from their parent organisation naming the person and confirming their membership of, and role in, the organisation. (Please note this category refers to carers entitled to a free flu vaccine on the NHS, not professional health and social care workers who should be vaccinated by their employer as part of an occupational health programme).

21 Members of voluntary organisations providing planned emergency first aid. Individuals who work on a voluntary basis (are not paid for their time and effort) in organisations which provide planned emergency first aid at organised public events. (This does not include individuals who are qualified to provide first aid in other circumstances). These should be identified by a letter from their parent organisation naming the person and confirming their membership of, and role in, the organisation. Community First Responders Those who are active members of a Welsh Ambulance Service Trust (WAST) community first responder scheme providing first aid directly to the public. These should be identified by a letter from their parent organisation naming the person and confirming their membership of, and role in, the organisation. Health and social care staff Health and social care workers who are in direct contact with patients or /clients should be vaccinated by their employer as part of an occupational health programme. Locum GPs Locum GPs may be vaccinated at the practice where they are registered.

22 6 References and further reading Reference materials and further reading can be found via the Vaccine Preventable Disease Programme (VPDP) Public Health Wales intranet site at FluOne e-learning module Immunisation against infectious disease (The Green Book) Public Health Wales Immunisation and Vaccine (internet) Welsh Government The National Influenza Immunisation programme (Revised) WHC(2015) 029 Available at All)/3F649993EFB23B E5E005A3794/$File/WHC %20- %20National%20Influenza%20Immunisation%20Programme% %20(Revised)%20-%20PDF%20Version%20-%20English.pdf?OpenElement