Vaccination and Immunisation of School Aged Children within Schools and Community Settings Standard Operating Procedure

Transcription

1 Vaccination and Immunisation of School Aged Children within Schools and Community Settings Standard Operating Procedure DOCUMENT CONTROL: Version: 2 Ratified by: Quality and Safety Sub Committee Date ratified: 3 July 2017 Name of originator/author: Programme Lead Clinical Lead Name of responsible Clinical Quality Group committee/individual: Date issued: 5 September 2017 Review date: July 2020 Target Audience Children s Care Group. Vaccination and Immunisation Team, 5-19 service.

2 Section Contents Page No 1. Aim 4 2. Scope 4 3. Link to overarching policy and/or procedure 4 4. Procedure Prior to session Consents Admin / liaison Spread sheet populating Staffing Consent packs Completed consents Checking consents Outstanding consents Ordering equipment Vaccine ordering Vaccine storage Fridges Portable fridge Preparation and transportation of vaccine to session 4.5 Risk assessment 7 5. Procedure session day Session Preparation Vaccination Self Consent Sharps disposal Disposal of General waste from session Vaccine spread sheet Adverse Events Risk to service user/patient Anaphylaxis / allergic reaction Sharps injury Wrongly administered vaccination Roles and Responsibilities regarding Vaccination and Immunisation Team 7.1 Role of the Programme Lead Role of Clinical Lead Role of Designated Lead Role of Vaccinating Nurse Page 2 of 18

3 7.5 Role of Support Worker Unused Vaccine Procedure for Using the Health Bus Links to any associated documents Appendices 14 Appendix 1 Immunisation Flowchart 15 Appendix 2 Stock Order sheet 16 Appendix 3: Pathway for the administration of Nasal Flu by Health Care Support Worker Appendix 4 Assessment of Capacity to Consent to Vaccination Page 3 of 18

4 The role of the Vaccination and Immunisation team is to offer and deliver the school age and seasonal flu vaccination programme to all eligible children and to increase the uptake of these vaccines by raising the profile of the National Immunisation programme through health promotion activities in schools and in the community. To do this they work in partnership with schools and other agencies to share information with and increase the uptake in the eligible population including the more vulnerable and hard to reach children. The team adhere to the core service specification for the national immunisation programme (PHE, 2017) and implement NICE (2017) Quality Standard. 1. Aim The aim of this document is to inform all staff working within Rotherham, Doncaster & South Humber NHS Foundation Trust (RDaSH) of the procedure, policies and patient group directions (PGDs) relating to administration of vaccination and immunisation to the school aged population that RDaSH are contracted to deliver to. This Standard Operating Procedure (SOP) outlines recommended good practice, ensuring that all Children and Young People (CYP) receive safe and effective immunisation. 2. Scope This standard operating procedure relates to staff within RDaSH Children Care Group 5 19 and Vaccination and Immunisation Team, who carry out vaccination and immunisation in line within the national childhood schedule. Prior to undertaking the administration of immunisations, the nurse should attend an approved training course based on the National Minimum Standards for Immunisation Training (2005), enabling them to achieve competence in the following areas of practice. Practitioners are responsible for ensuring that they adhere to the Code of Conduct (NMC, 2015) 1. Understanding the principles of immunisations under Patient Group Direction 2. Supplying and administering of immunisations 3. Storage of immunisations, including cold chain procedure 4. Understanding the principles of valid consent and implied consent 5. Taking a medical history to ascertain if client able to have a certain immunisation 6. General advice on the different types of immunisations 7. Documentation 8. Anaphylaxis and resuscitation 9. Safe disposal of sharps and clinical waste 10. Indications. Contraindications and adverse reactions of specific immunisations 11. Supplementary information 3. Link to overarching policy and/or procedure This SOP is used in conjunction with the overarching policy; Policy for the Safe and Secure Handling of Medicines. The framework of the Doncaster Page 4 of 18

5 Community Services CYP&F a Framework for the Healthy Child Programme 0-19yrs 4. Procedure prior to session date see immunisation process flowchart Appendix Consents Administrator or school nurse liaises with school to obtain up to date class list for year group receiving vaccination and negotiates a date for the immunisation session within school. The class list is forwarded to Child Health to update electronic systems before the session Admin prepare files prior to the session which include an up to date copy of the class list, two tracking forms, two plastic folders, one for refusals and one for those consented but not given on the day. The Clinical Lead will ensure/oversee the ordering of leaflets and consent forms for the eligible population. Please note this can be delegated to other staff within the team The Clinical Lead will ensure that sufficient staff from the vaccination and immunisation team, are available to cover all sessions. If necessary consideration can be given to the use of bank staff and the public health school nursing team who are required to maintain their skills through practice The Vaccination and Immunisation team will work with admin to prepare the necessary consent packs. The team will ensure that the packs include the correct number of consents for all eligible children within each school. Packs will then be delivered to school prior to the scheduled immunisation session, providing adequate time for the distribution and return of consents. This may be carried out by RDaSH Logistics for the Flu Programme The Designated Lead (within the vaccination and immunisation team) for each school will organise collection of completed consent forms in advance of the session allowing time for triage and any follow up if required. During Flu programme consents may be picked up by RDaSH logistics The will ensure all consent forms are triaged prior to the session. Checks should include that all details are present on the consent form, consent form is signed and dated and no contraindications are noted. Received consents are marked against the class list. Where any relevant additional information is added e. g. medical information, the signatory is contacted to discuss and gain further information. If necessary document the outcome of the conversation in the designated space on the consent form. Where contraindications or significant concerns are noted, contact the signatory and document the conversation within the young person s record including advice given and any follow up required The Designated lead to work in partnership with school to increase consent return, follow up outstanding consents and action issues that are impacting on uptake. They will also ensure schools have enough consents to cover opportunistic consenting. Page 5 of 18

6 4.2 Ordering equipment An order stock sheet is available (Appendix 2). The Clinical Lead is to oversee/ delegate ordering of all equipment. The order stock sheet is designed to give guidance regarding level of items required to be kept in stock for sessions. The Clinical Lead to ensure the equipment stock levels are maintained. Ordering is completed via admin as required and order numbers are on the stock list. 4.3 Vaccine ordering Vaccine orders will be completed by the Clinical Lead and/or Programme Lead. In unforeseen circumstances where neither are available a delegated member of the team will need to obtain an Immform account to be able to complete ordering of vaccine prior to session. Ordering Vaccine is ordered from the Immform website at Orders are to be placed no later than am on Tuesday for delivery on Thursday, two days after ordering. Orders placed on ImmForm are sent to the Distributor within minutes To avoid potential delays to your order, it is recommended that you place your order at least two working days prior to delivery day. NB - Your usual delivery day is displayed in the 'Scheduled Dispatch Date' field when you click on 'Add New Order' Order process Click on new order Select child and adult vaccines or Fluenz tetra for the child flu programme Search for vaccine to be ordered Add quantity required (be mindful some are ordered as single vaccines others as multiple packs) Submit order Full, easy to follow instructions on how to order are available on the Immform website. Vaccine is usually delivered between 9am and 4pm on the usual delivery date, therefore a member of the team who has been instructed on the receiving and storage of vaccine must be available to accept the order. In case of problems with your delivery, contact Movianto customer care on : Page 6 of 18

7 4.4 Vaccine Storage All immunisations have a predetermined shelf life and expiry date clearly marked on the outer packaging of the immunisations. Stock should be rotated in order to ensure that lowest dates are used first. All vaccine should be stored in designated fridge spaces; within clinical area, the cold chain must be adhered to; details of storage temperature (4.4.1) is contained in specific vaccine headings in RDaSH Patient Group Directions for Vaccination and Immunisations Fridges Fridge temperature during vaccine storage should be maintained between +2 o C and +8 o C. Fridge temperatures must be checked on a daily basis, when in use, with all temperatures logged; taking care to log the maximum temperature and the minimum temperature within the period since last temperature measurement. Any fridge which has been outside the cold chain temperature within a designated time space should be reported to the Clinical Lead and /or Programme Lead. In their absence please inform the Clinical Manager for the service. The Clinical or Programme Lead will take responsibility to contact vaccine manufacturers to check the viability of vaccine Portable Fridge Preparation and transportation of vaccine to session Portable fridges (LABCOLD VACCINE CARRIER RPDF0012D) for transporting vaccine from base point to area of administration should be plugged in 12 hours prior to using; therefore this should be completed in base the day prior to session. Portable fridges alone should be used for transporting vaccine to maintain cold chain. Fridges must be plugged in the car during transport, then at vaccination session to ensure continuous temperature. 4.5 Risk Assessment The Delegated lead will complete a risk assessment of the venue prior to the session to ensure both staff and young people s safety. 5. Procedure:- Session Day 5.1 Session Preparation The Delegated Lead will ensure arrangements have been confirmed with school for the planned session and will either ensure vaccines, equipment and consents are taken to the session or delegate this responsibility in their absence. The team will meet at base and transport the equipment and vaccine to the session using the team lease car or co-wheels vehicles whenever possible. The Clinical Lead will ensure sufficient staff have been allocated to attend the session and will ensure practice policy and procedures are followed. Page 7 of 18

8 Any unused vaccine should remain in portable fridges LABCOLD VACCINE CARRIER RPDF0012D throughout session and should be transported back to main fridge within base point to maintain cold chain. Surfaces should be cleaned using approved method (refer to Infection control policy). Couch role should then be used to provide a clean, clinical area. Vaccinators should prepare their table with the required equipment e.g. sharps bin, disposal bags, hand gel, cotton wool, tissues, patient information leaflet. 5.2 Vaccination A risk assessment is completed on the day prior to the session starting by the designated session lead. The session lead must establish first aid arrangements in the setting before the session commences. Young people should be invited to the session at a time pre-arranged and coordinated with school. They should be given their consent form and transferred to a vaccinating nurse. The nurse should clarify that they have the correct consent, their reason for attendance, check understanding of the vaccine and ensure that they give informed consent. When the nurse is satisfied all checks are complete and the young person is ready to proceed the vaccine should be administered following guidelines set out in patient group directive. Children receiving the nasal flu spray may receive the vaccine from a Health Care Support Worker after a registered Practitioner has supplied under a PGD (please see Appendix 3). The session lead must ensure that the anaphylactic shock pack containing the adrenaline is available and its location is known to all vaccinators. Vaccinators should ensure that mobile phones are charged and turned on ready to use in the event of an untoward incident. 5.3 Self Consent Prior to gaining self consent from any young person, practitioners must be conversant with section 5.4 within RDaSH Patient Group Directions for Vaccination and Immunisations. Obtaining consent, contained in the following text box. Obtaining consent has two functions: Clinical function: to foster trust and cooperation with patient Legal function: to ensure that a person s right to autonomy has been addressed in order to prevent a charge of battery. To have competence to consent a person must be able to: Comprehend and retain information: Believe it Consider the facts and make an informed decision Guidance from the DoH in 12 key points on consent: The Law of England advises that in order to ensure consent is valid, patients Page 8 of 18

9 must be given adequate information on which to base their decision to proceed with or refuse treatment. Consent can be given verbally, in writing or be implied. Before obtaining consent patients should be given the opportunity to ask questions about: The risks associated with any immunisations the patient is given Any side effects associated with the immunisation All adults are assumed to have capacity to consent unless it can be demonstrated that they do not meet the criteria outlined above. If any adult lacks the capacity to consent, the law does not allow for the consent or refusal by one adult e.g. relative on behalf of another. The DoH states that Before examining, treating or caring for a child, you must also seek consent. Young people aged 16 or 17 are presumed to have competence to give consent for themselves. Younger children who understand fully what is involved in the proposed procedure can give consent (although their parents will ideally be involved). Documentation about Fraser competences should be completed. Young people attending the session requesting vaccination without consent signed by parent / carer should be offered the opportunity to self-consent (please see Appendix 4). Each young person should undertake an assessment of competence to consent, this should be documented onto form; assessment of capacity to consent. This form should be attached to the consent form for scanning to records. Where a young person is deemed not to have capacity to consent for treatment following requesting vaccination without consent, the decision and actions of follow up should be discussed with the young person; consider requesting consent from parent / carer, and document into the young person s health record. 5.4 Sharps disposal It is the responsibility of the practitioner to safely dispose of sharps into a designated sharps bin; each practitioner must have safe reach of a bin for individual use. Practitioners should, prior to undergoing a vaccination session, ensure they are aware of the RDaSH sharps policy safe use and disposal of sharps and management of contamination injuries. 5.5 Disposal of general waste from session Any waste not containing bodily fluids or sharps can be disposed of within normal every day contaminates. It is acceptable to discuss with school staff to arrange for this to be taken to school refuge disposal site. Large amounts of clinical waste e. g. blood stained cotton wool and gloves are placed in yellow tiger striped bags which are then returned to base for correct disposal. Page 9 of 18

10 5.6 Documentation The session lead to ensure all consents are collected and placed in the file and the tracking form is completed with required information. The session lead to ensure someone is delegated to deliver completed consents to Child Health Information Service (CHIS) for in putting onto electronic records and ensuring that a copy of the tracking document is returned to admin staff to update their records on refusals and absence on the day. 6.0 Adverse events 6.1 Risk to service user /patient Any near misses, actual harm or adverse events should be dealt with immediately and action should be taken to minimise harm. Where an adverse event has occurred it should be documented within the service user/patient records, notified to the designated session lead who will notify a manager and subsequently a safeguard should be completed. 6.2 Anaphylaxis / allergic reaction Any young person showing signs of an extreme adverse reaction / anaphylaxis to administration of vaccine should be treated as follows:- They should be continually monitored by a member of the vaccinating team. The young person should be given reassurance, attempting to maintain calm. School staff should be utilised to suspend the session and remove all other young people away from the session to avoid any risk of harm and maintain dignity. Where reaction is escalating one member of the team should dial an ambulance, whilst a member of the team prepares adrenaline 1:1000 Give treatment in accordance with RDaSH Patient Group Direction for administration of adrenaline in the management of anaphylaxis On arrival of ambulance / paramedic provide handover of information name, date of birth and age, vaccine administered, reaction observed and treatment given; adrenaline. Ensure that member of vaccination team, parent or member of school staff accompanies young person to hospital, the young person should make the key decision regarding who should accompany them, where they are able to show a preference. At school based sessions, school staff to contact parents and advise of reaction and arrange that parent travel to hospital to meet ambulance. If community based session parent to accompany young person to hospital. Record in patient s notes, including details of dosage and batch numbers of all medicines administered vaccine and adrenaline. Inform patients General Practitioner as soon as possible. Cancel the current vaccination session. Ensure a de-brief is organised for staff and any young people affected. Page 10 of 18

11 All cases should be reported to the Committee on Safety of Medicines using the Adverse Drug Reaction Yellow Card scheme by the immuniser Reorganise the vaccination session at a time convenient to school and vaccination team. Report the incident via the Trust electronic incident reporting system and inform Clinical and/or Programme Lead. NB Ensure any young person suffering any adverse reaction receives full follow up and referral to paediatrics for investigation regarding cause of reaction. It is the responsibility of A & E to make the referral. 6.3 Sharps injury A risk assessment regarding sharps injury should be undertaken for any vaccination session. Section 5.1 within the Sharps Policy - Safe Use and Disposal of Sharps and Management of Contamination Injuries as follows:- Step One Identify the Hazards Step Two Decide who might be harmed and how Step Three Evaluate the risks and decide on precautions Step Four Record your findings and implement them Step Five Review your assessment and update if necessary Any sharps injury to a service user/patient or practitioner; should be dealt with as an adverse event. Injury to any service user/patient should be dealt with immediately with first aid being given: Percutaneous injury (needle stick/punctured skin) all Gently encourage puncture wound to bleed Wash liberally with soap and water. Do not scrub or suck the wound. Dry and cover wound with a waterproof dressing Refer for follow up, advise to attend A&E or own GP. Member of staff Report incident to immediate line manager and attend the local Accident and Emergency Department for assessment. Report the incident via the Trust electronic incident reporting system. 6.4 Wrongly administered vaccination Administered in error and without consent Consent should be gained from parents or young person if deemed to have capacity to consent. Where a vaccination is administered to a person in error or consent has not been gained from the parent or young person an electronic incident report should be completed. The vaccination and lack of consent should be documented within the person s records. The vaccinator should: Page 11 of 18

12 Inform parent/carer and give advice re follow up with a medical practitioner Inform the GP of error Inform Clinical Lead and/or Programme Lead Inform Public Health England 7. Roles and Responsibilities of the Vaccination and Immunisation Team 7.1 Role of the Programme Lead It is the responsibility of the programme lead to provide leadership to the Vaccination and Immunisation team and ensure that all contracts and CQUINs are complied with, providing the required evidence and data as contracted. Complete PDR s and follow up review. Sickness Performance management Attend Immunisation Programme Board meetings Provide data and quality reports Upload data as required to Immform Order vaccines from ImmForm Ensure service is delivered within financial envelope Ensure all trust policies and procedures are adhered to 7.2 Role of the Clinical Lead The Clinical Lead will attend monthly meetings with the Programme Lead to share information and discuss programmes. They are responsible for disseminating all relevant information to the team. Coordinate programme delivery Provide clinical supervision and support to team members Organise staff rota s to ensure adequate staffing of vaccination sessions In partnership with the trusts training department, provide update training around Vaccinations and Immunisations Order vaccine via Immform Oversee - stock control, leaflets, consents etc Service user safety Personal safety Adhere to PGDs, protocols and trust policies Awareness of own responsibility during an adverse incident 7.3 Role of Designated Lead Ensure consents are delivered to schools within required timescales Ensure consents are picked up and triaged before arranged session Follow up any identified issues identified on consents Page 12 of 18

13 Coordinate the session with the vaccination and immunisation team members attending the session Undertake risk assessment of school premises where the session will be taking place prior to commencing Undertake relevant training and updates as necessary Adhere to PGDs, protocols and trust policies Awareness of own responsibility during an adverse incident Personal safety Service user safety 7.4 Role of Vaccinating Nurse Help in transfer of equipment and vaccines to sessions Personal safety Service user safety Adhere to PGDs, protocols and trust policies Awareness of own responsibility during adverse incident Undertake relevant training and updates as necessary. 7.5 Role of Support Worker Undertake the relevant training and updates as necessary Personal safety Service user safety Adhere to PGDs, protocols and trust policies Support the designated lead in the co-ordination and management of the session Support in the delivery and collection of consents 8. Unused, expired or out of cold chain vaccine Vaccine should be removed from portable fridges as close to delivery time as possible. All unused vaccine within a session should be stored in the portable vaccine fridge supplied, therefore remaining within the cold chain; C. Vaccine should be returned to main base point fridges and logged in. Vaccine not maintained within the cold chain should be discussed with the Clinical or Programme Leads; further discussions should be undertaken with manufacturers regarding the need for disposal of the vaccine. 9. Procedure for Using Health Bus Refer to The Health Bus Operational Guidance. Staff are required to book the health bus using the booking form within the operational guidance. It is the responsibility of the booking practitioner to organise a suitable venue and gain the appropriate permission for parking the bus. Children requiring catch up vaccinations for adolescent immunisations will be invited to attend the Health Bus. For children who missed their flu vaccination letters with catch up information will be given to schools to forward to parents. Page 13 of 18

14 Schools will also be asked to display the catch up timetable in reception. The dates will be also be shared by with GP surgeries. On arrival at venue, staff will move equipment from cars into the health bus and plug in the portable fridges to ensure cold chain is maintained. The health bus has a portable generator that provides power whilst it is stationary. In the event that the generator fails, the session will have to be suspended and the vaccine returned in the portable fridges to Rose Lodge. A member of staff will remain on site to relay apologies to anybody that might attend for vaccination. 10. Links to any associated documents Safe and Secure handling of medicines policy, Clinical Policies, Medicines - Patient Group Directions for Vaccination and Immunisation, Clinical Policies, Medicines Patient Group Direction for the administration of adrenaline, Clinical Policies, Medicines Infection control policy for the surveillance, prevention and management of infections, Clinical Policies, Infection Control Sharps policy safe use and disposal of sharps and management of contamination injuries, Clinical Policies, Infection Control Protocol for the administration of Nasal Flu vaccine by Health Care Support Workers The Health Bus Operational Guidance All of the above documents can be accessed via the RDaSH Intranet. Health Protection Agency (2005) National Minimum Standards for Immunisation Training. London: Health Protection Agency NICE, (2017) Quality Standard: Vaccine Uptake in under 19 s. Available online: [Accessed ] NMC, (2015) The Code: Professional Standards of Practice and Behaviour for nurses and midwives. London:NMC PHE, (2017) NHS Public Health functions agreement Core service specifications: National Immunisation Programme. Available online: [Accessed ] 11. Appendices Page 14 of 18

15 Immunisation flowchart Appendix 1 Request class lists from schools: Flu by the second week in September Adolescent by the second week of January Send the class list to Child Health to update electronic records Admin to prepare school files with class lists, tracking document x 2 and plastic wallets x 2 Session Lead to ensure all consents are placed in file following session, tracking documents completed and DNA s and refusals placed in plastic wallets Session Lead to ensure all consents are delivered to child health for inputting with one copy of tracking document and file returned to admin with DNA s and refusals and second copy of tracking document Child health to update patient record with vaccination information and then return consents to V & I admin for archiving Admin to record DNA s, refusals and enter data onto reporting spread sheet, to enable performance to be recorded on a monthly and quarterly basis Page 15 of 18

16 Stock Order sheet Appendix 2 Item Order Code Minimum Stock Cotton Wool EVG BAGS - 40 Hand Gel MRB bottles W/B W/B W/B W/B Couch Roll MRT140 6 Rolls Blue lid pharmacy disposal Sharps Bin 5lt Sharps Bin 2.5lt Sharps Bin 1 lt FSL067 FSL311 FSL316 1 bin 50 bins 30 bins Black Bags MVN186 4 rolls Yellow Bags MVN021 4 rolls Tissues MJT box Alco swabs MRB PER BOX Disp gloves FTG boxes Blue Needles FTR (30 boxes) Hand Cream MRB218 2 Hand Wipes VJT073 6 packs Green Needles 3000 (30 boxes) Clini wipes 4 packs Page 16 of 18

17 Appendix 3 PATHWAY for Administering of Live Attenuated Influenza Vaccine by a Health Care Support Worker under a PGD to supply the vaccine by a registered practitioner Patient Group Direction in place and authorised by the provider organisation in accordance with the legislative requirement Child is assessed by the registered practitioner to ensure they meet the criteria of the PGD and are suitable to have LAIV Registered practitioner will complete consent form to show that child is suitable for vaccine and sign the consent form to confirm that they are supplying vaccine as per PGD Registered practitioner will then give the consent form to the child and ask them to take it to a HCSW who is present in the same room Child takes their consent form to the waiting HCSW if deemed to have ability to hold and carry consent form If the child is unable hold and carry consent form, staff member will take child and consent to HCSW HCSW will confirm child s details with those on the consent form. Check that the form indicates the child is suitable to have LAIV and that the registered practitioner has signed to supply the vaccine. HCSW will administer vaccine as per training. HCSW signs the consent form to say they have administered the vaccine HCSW completes Date, Time, Batch Number and Expiry date of vaccine HCSW gives the child a Patient Information Leaflet and any other supporting information to take home to parents. Appendix 4 Page 17 of 18

18 Appendix 4 Assessment of Capacity to Consent to Vaccination Name (young person) Date of Birth NHS No Assessing capacity to consent The following tool is designed to assist the qualified nurse in assessing a young person s capacity to consent to routine immunisation within a school or community setting. Competency will be assessed in light of the following it is not enough that the young person understand the nature of the advice which is being given: they must also have sufficient maturity to understand what is involved Lord Scarman, 1985 Parental rights yield when the child reaches a sufficient understanding and intelligence to be capable of making up their own mind on the matter requiring decision Lord Scarman, 1985 Ability to comprehend, retain information and make an informed decision YES N O Summarise reasoning for your decision Does the young person understand the proposed procedure? Do they know why the vaccination is being given and the number of doses required? Does the young person receive any additional support in school; e.g. school action or school action plus? Can the young person recount the information discussed? Are they aware of the common side effects and risks? Is the young person aware of their medical history including allergies to any medications? Is the young person unhappy to involve their parents? Has discussion been undertaken regarding why no consent has been completed by parent? Consider delaying vaccination if this may lead to disagreement within family. Is the young person giving their own consent freely without coercion or pressure from others? Is the young person aware of where to access follow up if required? Advise re GP, A&E and discussing with an adult Any further comments Signature Print name.. Date Young Person s signature. Page 18 of 18