School Health Service PRINCIPLES 1. All those involved in the prescribing and/ administration of vaccines will have access to the following: a. Immunisation against Infectious Diseases. HMSO Current edition. Also available at : www.dh.gov.uk/policyandguidance/healthandsocialcaretopics/greenbook/fs/en All users should be aware that the most current information may only be available in the electronic format, and should check accordingly. b. British National Formulary (current edition) c. UK Guidance on Best Practice in Vaccine Administration. Vaccine Administration Taskforce, October 2001. See also: http://www.vaccine-administration.org.uk d. NHS Highland Needle Stick Injury Policy (Ensure current edition) e. NHS Highland Immunisation Policy (Ensure current edition) f. NHS Highland Policy, Guidance for Handling and Storage of Vaccines (Ensure current edition) g. All letters from the Chief Medical Officer, Scottish Executive Health Department relating to vaccination/immunisation. These should be retained and filed so as to be convenient for all relevant staff. h. Up-to date information regarding individual vaccines as is available on the most recent Summary of Product Characteristics (SPC) PROCEDURES 2. In advance: a. The responsibility lies with each nurse to check whether they meet training requirements and have the competencies to administer vaccines as outlined in the Patient Group Directions and NHS Highland Immunisation Policy. b. Arrange with other Team members availability for sessions in Schools. Minimum two nurses and a clerk for any session. Page 1 of 6
c. Arrange with school, dates and times for immunisation sessions and arrange use of appropriate rooms. d. Room to be used should be equipped with adequate space, seating and rest areas, lighting, heating, ventilation, hand-washing facilities, use of telephone near by or own mobile phone making sure reception at immunisation location is available and that phone is fully charged. e. Check that all necessary vaccination equipment is available (see Equipment and Documentation Checklist appendix 1) f. Check that all appropriate documentation is available (see Equipment and Documentation List appendix 1) g. Clerk requests the class lists of appropriate year group from the school secretaries/child Health Department. These are then collected by the clerks, School Nurses or posted to clinics/ bases. h. For each student the name and class is written on the front of the envelope in which is placed appropriate Immunisation Information Leaflet (IMM 1 for BCG or Teenage Immunisations ages 13 to 18. Your questions answered. Edition 2004, for DTP) and appropriate consent form (IMM 3 for BCG or IMM 4 for DTP) i. The above are taken into school by the School Nurse for distribution approx. four to eight weeks before Immunisation Session. They are returned to clinic/base by same route. j. Clerk compiles a list of consents, refusals and non-returns. k. A designated member of staff from each base will order the necessary vaccine. l. All pupils who remain unvaccinated at the end of the session should be invited again the following year. This also includes those for whom consent has been refused; it is important that they have opportunities to consent for themselves once they are deemed competent, (see NHS Highland Immunisation Policy). m. If no form is returned, consider sending a further copy into school or home with second form written on the envelope. n. Any forms returned which are not straight forward i.e. have queries or concerns identified, these should be clearly marked and given to the School Nurse for any further action. o. Clerks send out appointment letters (IMM 5) notifying parents of the date of sessions via child at least two weeks prior to session. Page 2 of 6
3. On the day on site a. At the session the clerk takes list of consents and current consent forms into school along with list of refusals and non-returns. Refusal forms must be kept completely separate. b. During immunisation sessions, classes should be asked to attend in numbers as can be safely managed by the Team. c. Care for vaccines during the immunisation session as directed in NHS Highland Guidance for Handling and Storage of Vaccines. 4. The procedure for immunisation: As students present themselves: a. They are given the consent form. b. The nurse goes through checklist questions, re-affirms informed consent prior to giving immunisation. c. For Heaf and BCG, follow Guidelines for Reading Heaf and Administration of BCG Vaccine (appendix 2) d. The site and batch number, manufacturer, expiry date and signature will be completed immediately. The Clerk/School Nurse will give each student who has been immunised a certificate of immunisation if appropriate, (IMM 6 for BCG). e. The student should either remain in area of immunisation for a minimum of 10 minutes following immunisation, or return to class if location is easily accessible from the room. Please note that there is no defined time limit during which reactions occur following immunisations. In the absence of any scientific evidence, best practice would dictate that the documentation is completed and the student is assessed to be feeling well before leaving the immunisation room. f. Immunisation Team to remain in School for 10 minutes following the last immunised student. g. Clean and tidy area, returning waste and sharps containers to base to dispose of in line with NHS Highland policy. h. Following the session, forms for those immunisations satisfactorily completed will be filed in the student s records. Ensure that data is entered on to SIRS, either locally or by the Child Health Department in Inverness. It is good practice to also inform the Page 3 of 6
student s GP that immunisation has taken place, in order to update their medical records. One mechanism for doing this is to send a photocopy of the consent form. i. For students who are absent at a session. A new consent form will be required if the previous form is more than twelve months out of date. A letter will be sent to parents of students not immunised outlining the reason (IMM 7 BCG or IMM 8 DTP). Immunisation will be offered again before students leave school. j. If student has not been immunised by fourth year, parents should be notified of appropriate action by letter (IMM 9) Page 4 of 6
Appendix 1 School Health Service Equipment and Document Checklist for Mass Immunisations in Schools EQUIPMENT Large alcohol wipes (to clean tables) Roll of paper sheeting Sharps Container Appropriate size syringes and needles Heaf guns and disposable Heaf heads (white) for Heaf Sessions Cotton Wool Disposable bin bags for clinical waste (yellow) and paper waste (clear). Gloves Appropriate vaccines Cool box, cool gel blocks or ice blocks and double quantity of large bubble wrap. Resuscitation equipment: two boxes containing appropriate anaphylaxis drugs, needles and syringes. Pocket facial masks and oxygen if available. Charged mobile phone Thermometer Plasters to use as required (only following administration of Td/IPV vaccine) Sellotape Pens Eye protection DOCUMENTATION Appropriate Patient Group Direction The Green Book, Immunisation against Infectious Disease BNF Patient information sheets on specific vaccinations Patient advice sheet on post vaccination side effects and management. Certificate of Vaccination if appropriate for session. Data collection forms child health immunisation record sheets Class Lists Signed consent forms Spare consent forms Blank letters to parents. Yellow Card Scheme Suspected Adverse Drug Reaction Cards Page 5 of 6
Appendix 2 School Health Service Guidelines For Reading Heaf and Administration of BCG Vaccine These should be read in conjunction with the Trust Patient Group Directive for Heaf and BCG Immunisation and in accordance with the current Department of Health Immunisation Against Infectious Diseases ( Greenbook ). Heaf Test Results and Action Results Grade 0 or 1 Grade 2 Grade 3 and above where there is no documented evidence of BCG immunisation or a characteristic scar Action Give BCG Immunisation taking into account previous history/scar (refer to green book ) No follow up required School Nurse to refer to Chest Clinic and notify parents. Guidelines For Repeated Heaf Testing A repeat Heaf Test is required when: An individual is absent for reading of initial test An individual reports an acute febrile illness during the time between the Heaf test and reading the result. Such illness is likely to depress the response and produce inaccurate results. Parents should be notified by letter (IMM 7) Test results are unclear. Parents should be notified by letter (IMM 7). History of Previous BCG Immunisation and Guidance for Repeated Administration of BCG A repeat administration of BCG vaccine is required when, (in spite of history of previous BCG immunisation), there is no characteristic scar AND Heaf test shows Grade 0 or 1 (reference 32.3.4 Greenbook ). The clinical advice of a Doctor may be sought ANY DOUBTS OR QUERIES ABOUT A CHILD S SUITABILITY FOR HEAF TESTING/BCG IMMUNISATION SHOULD BE REFFERED TO MEDICAL STAFF BY TELEPHONE, IF NOT IN PERSON, OR DEFFERED TO THE NEXT SESSION. Additional Guidelines After receiving BCG vaccine, no other immunisation should be given in the same arm for three months. All children should receive information relating to the care of the injection site (IMM 6) January 2004 Appendix 2 Guidelines for Reading Heaf and Administration of BCG Vaccine Page 6 of 6