Strategies to assist in vaccinating needle phobic children 2017

Transcription

1 Strategies to assist in vaccinating needle phobic children 2017 Deidre Brogan Clinical Nurse Consultant Immunisation NSW Immunisation Specialist Service (NSWISS) The Children s Hospital at Westmead, Sydney

2 NSWISS (NSW Immunisation Specialist Service) at The Children s Hospital, Westmead, Sydney Specialist Service: for in-depth consultation with a paediatrician experienced in immunisation Vaccination of needle phobic children Telehealth consultation with remote areas Drop in immunisation clinic staffed by experience nurse immunisers 1800 phone advice line to assist immunisation providers on vaccines safety and vaccination of patients with complex medical conditions

3 Why do we need a service for hard to vaccinate children? Children with a disruptive behavioural or developmental disorders can react with aggression or defiant behaviour when faced with a medical procedure There is an unacceptable risk of physical harm to the child or the person administering a vaccination to the child These children can remain unvaccinated or have to wait until they have a general anaesthetic to receive their vaccines Family assistance payments are now linked to immunisation status for Australian children

4 Australian Government Department of Health No Jab, No Pay New Immunisation Requirements for Family Assistance Payments From 1 January 2016: Only parents of children (less than 20 years of age) who are fully immunised or are on a recognised catch-up schedule can receive the Child Care Benefit, the Child Care Rebate and the Family Tax Benefit Part A end of year supplement Children with medical contraindications or natural immunity for certain diseases will continue to be exempt from the requirements. Conscientious objection and vaccination objection on non-medical grounds will no longer be a valid exemption from immunisation requirements. NO EXEMPTION OPTION To support these changes 1. Free catch-up for children less than 10 years of age on an on-going basis. 2. Free catch-up for young persons 10 to 19 years of age, of families who currently receive family assistance payments (time limited until 31/12/2017)

5

6 CASE STUDY 15yo male Background 110kg, very strong Autism, mostly non verbal aggressive behaviour, GORD, hypertension Medications: somac, melatonin, Olanzapine (prn) Overdue dose 2 MMR, MenC, dose 1 HPV Family financial incentive How can we safely vaccinate?

7 The current situation Child difficult to vaccinate Financial incentive Overdue or incomplete vaccines Safety concerns Previous attempts failed

8 How can we help? STAGE 1 TRIAGE Referral Information gathering, medical/vaccination history ASSESSMENT & PLANNING Initial consultation Discuss information gathered at triage Options discussed, distraction techniques, follow on appointment for +/- sedation PREPARATION Prepare the family and child Staff, equipment and environment

9 Medication plan

10

11 STAGE 2 VACCINATION Orientate child and family to treatment area and equipment Commence once appropriate level of sedation achieved ONE VOICE DISCHARGE Appropriate post vaccination observation time criteria met Plan for follow up vaccines arranged

12 CASE STUDY OUTCOME Olanzapine 5mg wafer before admission Presented NBM on day of vaccination Midazolam 10mg oral remained agitated Olanzapine wafer 5mg by mum VACCINATED! Observed 2 hours - sleepy

13

14 Clinic encounters by age Total N 26 Visit 1 Vaccinated 17 ( pharm 14, no pharm 3) Not vaccinated - 9

15 What next? For those unable to be vaccinated -evaluate current approach - investigate other pharmacological options -? Further counselling Australian Government consideration for exemption of children who have attempted but are unable to be safely vaccinated on time Develop resources that can be used to assist vaccination in the community setting.

16

17 Acknowledgements: Assoc Prof Nicholas Wood Dr Lucy Deng CNC Karen Orr Rosemary Joyce