Flu vaccination service All you need to know to make a success of the new service. Alastair Buxton Leyla Hannbeck Fin Mc Caul

Transcription

1 Flu vaccination service All you need to know to make a success of the new service Alastair Buxton Leyla Hannbeck Fin Mc Caul

2 Objectives: Understand exactly how the service will work and how to make your declaration of competence Familiarise yourself with the data capture requirements for the service Know how to get patient consent and claim for payment Meet the pharmacist responsibilities for delivering a PGD service Understand the importance of difference vaccine excipients Understand your indemnity insurance Take advantage of the full range of support available for pharmacists

3 Introduction Commissioned as the 5th Advanced Service in England Aims: to sustain uptake of flu vaccine by building the capacity of community pharmacies as an alternative to general practice; to provide more opportunities and improve convenience for eligible patients to access flu vaccinations; and to reduce variation and provide consistent levels of population coverage of community pharmacy flu vaccination across England by providing a national framework. psnc.org.uk/flu #getreadyforflu

4 Introduction Another national service commissioned at a time where the focus is increasingly on local developments NHS England has responded to our calls for national commissioning So pharmacy needs to respond positively As the NHS wants us to provide this service extensively psnc.org.uk/flu #getreadyforflu

5 Introduction And we need to for the sake of patients and the public 2014/15 data at-risk groups 50.3% pregnant women 44.1% carers 45.1% psnc.org.uk/flu #getreadyforflu

6 Service timings Runs from September until the end of February Start date Focus of vaccination continues until December Apply clinical judgment if offering vaccination in January/February Expectation that the service will be commissioned on an ongoing basis psnc.org.uk/flu #getreadyforflu

7 Service documentation Service specification Secretary of State Directions Patient Group Direction PSNC Briefing 053/15 psnc.org.uk/flu #getreadyforflu

8 The national PGD One national PGD not a locally authorised PGD Make sure you access the PGD via the PSNC website Download; read; understand; sign Authorising manager declaration If you sign a copy of the wrong PGD, it won t be legally valid Eligible patient groups ONLY those in Annex A of the service specification psnc.org.uk/flu #getreadyforflu

9 Patient eligibility People aged 65 years and over (including those becoming age 65 years by 31 March 2016) Pregnant women* Carers* (this does not include care workers); Household contacts of immunocompromised individuals* People aged from eighteen to less than 65 years of age in clinical risk groups * Aged 18 years or over psnc.org.uk/flu #getreadyforflu

10 Patient eligibility People living in long-stay residential care homes or other long-stay care facilities; however, consent will need to be obtained from the local NHS England team If patients are not eligible for the Advanced Service: but are eligible for NHS vaccination, refer to GP practice and not eligible for NHS vaccination, potentially offer them a private service psnc.org.uk/flu #getreadyforflu

11 Premises requirements Pharmacy must have a consultation room in which: the patient and the pharmacist can sit down together; they can talk at normal speaking volumes without being overheard by staff or customers; and the room is clearly signed as a private consultation area psnc.org.uk/flu #getreadyforflu

12 Training requirements National minimum standards for Immunisation Training and Core Curriculum Must complete a practical training course before self-declaration list of training providers on PSNC website Face to face injection technique and basic life support training required every 2 years Declaration of Competence (DoC) Seasonal Influenza Vaccination Advanced Service psnc.org.uk/flu #getreadyforflu

13 DoC Developed by the CPCG/CPPE Make sure you complete the right DoC! Print off the DoC self-assessment framework which explains the competency requirements for pharmacists providing the service Review competencies and learning Sign the DoC statement to acknowledge professional responsibility that you are competent to provide the service Undertake every 2 years psnc.org.uk/flu #getreadyforflu

14 Practicalities Arrangements for disposal of clinical waste Hepatitis B vaccinations SOP Needle stick injury procedure Anaphylaxis telephone card Anaphylaxis pack Service availability over full opening hours psnc.org.uk/flu #getreadyforflu

15 Paperwork Notification to NHS England via the NHS BSA website of intention to provide the service Flu vaccination record and consent form Patient questionnaire (the basis for evaluation of the service) GP notification form Use of IT systems psnc.org.uk/flu #getreadyforflu

16 Payments 7.64 per administered dose of vaccine Plus an additional fee of 1.50 per vaccination (i.e. a total of 9.14) Reimbursement of vaccine costs at basic price (list price) of the individual vaccine administered + an allowance at the applicable VAT rate Claim form sent to the NHS BSA at month end psnc.org.uk/flu #getreadyforflu

17 Promoting the service to patients Posters, counter top notice, leaflets, flyers Template letters Must comply with NHS brand guidelines Cannot offer free gifts to encourage people to get vaccinated psnc.org.uk/flu #getreadyforflu

18 Implementation Read all the documentation Use the PSNC checklist to guide preparation Get all the team involved in the process Use the promotional materials available psnc.org.uk/flu #getreadyforflu

19 Flu vaccinations: All you need to know to make a success of the new service Leyla Hannbeck Head of Pharmacy Services NPA

20 Compliance Anaphylaxis and basic life support Flu Training Vaccines Equipment & facilities

21 Clinical knowledge SOPs / procedures / paperwork Staff engagement Service promotion In addition...

22 Compliance Copy of the PGD readily available to access You have signed the PGD Patient assessment must be based on the PGD criteria Patient consent Notifying the GP the same day or the following day Record keeping via specific form & patient questionnaire Pharmacy owner declaration of competency opening hours Needle stick procedure Access to relevant reference sources (NPA, SPC, BNF, Stockleys etc.)

23 Vaccination training This is a mandatory requirement for all pharmacists providing vaccination services face to face training every two years NPA practical vaccination training covers Vaccination techniques for different routes of administering flu vaccines Intramuscular, Subcutaneous, Intranasal Basic life support Anaphylaxis management Online training modules cover Influenza Vaccination programme Basic life support and anaphylaxis management

24 Equipment & Facilities Consultation room Privacy and confidentiality (Chaperon policy) Suitable size space to manage patient if they faint/collapse Safe administration of vaccine(s) Storage of paperwork (data protection) and equipment Equipment Sharps container (within easy reach to throw the syringe in immediately) Vaccination kits including cotton ball Telephone/mobile (to call for ambulance without leaving patient) Immediate access to anaphylaxis management equipment and information (adrenaline, anaphylaxis algorithm)

25 Procuring vaccines Vaccines to be procured by the pharmacy Wholesalers Ordering and supply information How many vaccines to order When to order Storage NPA SOP on cold chain and resource on vaccine availability and ordering

26 Anaphylaxis Anaphylaxis is relatively uncommon but life-threatening Anaphylaxis occurs in 1 in 3,500 of the UK population each year Most fatalities due to airway obstruction Most healthcare professionals will never encounter it The first time you see it may well be the last - you may only get once chance to get it right!

27 Between 1997 and 2003, 130 reports of anaphylaxis or anaphylaxis-type reactions following immunisation (all ages) were made to the UK Medicines and Healthcare products Regulatory Agency (MHRA) 1 No deaths as a result of the reactions were reported during this period Anaphylaxis In the same period, over 117 million doses of vaccines were supplied to hospitals and GPs¹ Department of Health 2007

28 Importance of different vaccine Excipients such as: Antibiotics Ovalbumin excipients Latex (not in vaccine but can be in packaging) may cause allergic reactions in susceptible patients

29 Antibiotics Antibiotics such as: Gentamicin Neomycin Kanamycin Polymyxin may be present in trace amounts in flu vaccines All flu vaccines are contra-indicated in patients who have had a confirmed anaphylactic reaction to these antibiotics

30 Egg allergy Flu vaccines which are ovalbumin-free or have a very low ovalbumin content (<0.06mcg per 0.5ml dose) may be considered in patients with an egg allergy Fluenz Tetra can be used to vaccinate most egg-allergic children (private PGD) Optaflu is ovalbumin-free and suitable in patients from the age of 18 years! Refer patients with severe anaphylaxis to egg to specialists for immunisation in hospital

31 Latex Contra-indicated in patients with severe latex allergy!! Latex may be present in the packaging (tip cap and/or rubber plunger and/or stoppers) of the flu vaccines, or the vaccines may be exposed to latex during the manufacturing process For latex allergies other than anaphylactic allergies (such as history of contact allergy to latex gloves), vaccines containing in vials or syringes that contain latex can be administered

32 Do s Ensure that the service is provided: From a GPhC-registered pharmacy premises Alternative premises permitted In a designated consultation room/area By a GPhC-registered pharmacist who has completed relevant training and signed the authorisation section(s) of the PGD(s) With appropriate procedures in place to deliver the service safely

33 Do s Ensure immediate availability of anaphylaxis algorithm and information regarding adrenaline dosage Ensure immediate access to at least: 2 x adrenaline 1:1000 ampoules with necessary syringes and needles for all age groups AND/OR 2 x pen devices each of 150mcg, 300mcg and 500mcg strengths Ensure procedures for safe disposal of sharps and clinical waste are in place and implemented

34 Do s Store the vaccines in a suitable fridge with temperature monitoring system Have appropriate SOPs in place covering safe storage of vaccines to ensure maintenance of cold chain, fridge temperature monitored and recorded, what to do if temperature falls outside required range With sufficient space Be aware of and meet requirements of the NPSA rapid Response on vaccine Cold Storage

35 Do s Ensure ready access to all necessary information references/sources such as SPCs, BNF, PGD(S), consent forms, record-keeping document Ensure that you are operating within the legal and ethical requirements of the service, the PGD(s) criteria and PGD legislation at all times Ensure that you provide the service in line with GPhC principles and standards at all times Ensure you have professional indemnity cover

36 Do s Provide information to all members of the pharmacy team regarding the flu vaccination service Proactively identify which of your regular patients/customers may be eligible for the flu vaccination Communicate availability of the NHS flu vaccination service from your pharmacy with local GP surgeries Promote the service locally Consider a chaperon policy in your pharmacy If you are providing the service offsite it is advisable to be accompanied by another member of the pharmacy team.

37 Don t Don t administer vaccine(s) to anyone if adrenaline 1:1000 is not immediately available / in stock in the pharmacy Don t administer any vaccine which has not been stored properly / when there has been a breach of cold chain Don t operate outside the PGD(s) criteria Delegate your responsibilities as a pharmacist according to the PGD and service requirements to other members of the pharmacy team Commence service provision until you have completed all elements of the required training, signed the PGD authorisation and prepared the consultation room to deliver the service safely

38 Indemnity insurance for vaccination services NPA professional indemnity insurance covers pharmacists to provide a PGD service (private and/or NHS), both from the registered pharmacy premises as well as from off-site provided that all the PGD requirements are fulfilled correctly

39 How will a private flu vaccination service fit in with the NHS service? By supporting the NHS service, not replace them Offers a private supply option for patients with an identified clinical condition to access flu vaccinations directly through an approved route other than their GP/NHS service Suitable for patients not eligible for the NHS flu vaccination service

40 NPA Resources Resources to support NPA Members in the provision of the national flu vaccination service include: Hand hygiene SOP Dealing with needlestick injuries and biohazard spillages SOP Flu information pack 2015/16: vaccine information Flu information pack 2015/16: vaccine ordering and availability Flu information pack 2015/16: pharmacy staff guide Flu information pack 2015/16: guidance (coming soon) Chaperone policy Record of adverse events following vaccination (coming soon) Vaccine cold chain SOP Template flu service SOP to support the delivery of the NHS National Flu Vaccination Advanced Service (coming soon) Download from: SOPs--Resources/

41 Questions?

42 The future of the NPA We want your thoughts and ideas and together we will shape the NPA s future #NPACrowdsourcing

43 Upcoming events: NPA Stepping Up Together Conference 20 September, Manchester #npasteppingup

44 Upcoming webinars: Motivating and Retaining (the right) Staff - 1 October, 7.30pm How to make the most from the Pharmacy Show - 13 October, 7.30pm Top tips for GPhC inspections 10 November, 7.30pm