4th Edition 2017
Contents Introduction 3 Who is the programme for? 3 Learning Outcomes 4 Notes for employers 4 Updating 5 Notes for students 6 What are the options for learning? 6 Brief overview of the units 7 How long will the programme take? 8 Assessment 9 Notes for Facilitators 10 Further information regarding the role of facilitator 11 Summary of PEIP Process 12 References 13 Information resource to support the implementation of Promoting Effective Immunisation Practice 14 Implementation action plan 15 Appendix 2: Example of a Competency Assessment Tool for Registered Healthcare Practitioners 19 2
Introduction Welcome to the Promoting Effective Immunisation Practice programme guide. This guide is designed to support students and their facilitators through the NHS Education for Scotland programme for all those involved in immunisation service delivery in Scotland. Who is the programme for? This resource is aimed at all registered healthcare practitioners involved in the Scottish immunisation programme. Whether you give advice about immunisation, administer vaccines, or do both, this course is for you. Immunisation is one of the most successful public health measures, often described as second only to the provision of clean drinking water in its impact. It is essential for all those involved in immunisation to be confident, knowledgeable. Educational Programme The content of the programme has been mapped across to the Public Health England National Minimum Standards and Core Curriculum for Immunisation Training for Registered Healthcare Practitioners (2018) as appropriate. The aims of the programme are to: 1. Enable registered healthcare practitioners to confidently, competently and effectively promote and administer vaccinations, 2. To support the recommendations of the Joint Committee on Vaccination and Immunisation (JCVI), as detailed in Immunisation against Infectious Disease the Green Book (https://www.gov.uk/government/ collections/immunisation-against-infectious-disease-the-greenbook), and implementation of these at local level by all those involved in immunisation. 3. Deliver evidence based knowledge to support registered healthcare practitioners in understanding immunisation policy and practice. 3
Learning outcomes On completion of this learning programme registered healthcare practitioners will be able to: 1. State the aims of immunisation national policy and schedules 2. Revise their understanding of the immune system and how vaccines work 3. Know the vaccine preventable diseases 4. Know the different types of vaccine used and their composition 5. Explore the current issues and controversies regarding immunisation 6. Consider the effective methods of communicating with patients and parents 7. Consider the legal aspects of vaccination 8. Understand the storage and handling of vaccines 9. Explain the correct administration of vaccines 10. Recognise anaphylaxis and other adverse events 11. Know the procedure for documentation, record keeping and reporting 12. Consider strategies for improving vaccination rates Notes for employers Employers are responsible for ensuring that their staff are competent for the roles they are expected to fulfil. This programme is subject to individual Boards/employers educational governance policy and procedures. NHS Boards/employers may wish to consider this programme s inclusion as a requirement for those individuals who administer vaccines as specified in a Patient Group Direction (PGD). Newly appointed staff It is strongly advised that provision should be made for staff newly appointed to a position in which they will give advice about immunisation and/or administer vaccines to undertake this programme prior to the commencement of such duties. Existing staff This programme may also be of benefit to staff already involved in the immunisation service delivery in updating their knowledge base. 4
Employers The NHS Knowledge and Skills Framework (The NHS KSF) Suggested mapping of this programme against the NHS KSF dimensions and levels as follows: C1 Communication Level 3 C2 Personal and people development Level 2 C4 Service Improvement Level 2 C5 Quality Level 2 HWB1 Promotion of health and wellbeing and prevention of adverse effects on health and wellbeing Level 2 HWB2 Assessment and care planning to meet health and wellbeing needs Level 2 HWB3 Protection of health and wellbeing Level 3 HWB4 Enablement to address health and wellbeing needs Level 3 IK1 Information Processing Level 1 IK3 Knowledge and information resources Level 1 Updating Policy and recommendations in immunisation change frequently, and it is essential that provision is made locally for a regular programme of updates. Some suggestions for updating include the following: Current issues in vaccination Recent epidemiology of vaccine preventable diseases Any changes to the national immunisation schedule Anaphylaxis recognition and management Review of current practice and identification of areas for improvement Q&A session for commonly encountered problems in practice. 5
Notes for Students What are the options for learning? This programme has been developed to be delivered via e-learning, and access to a computer and the internet is essential. It is not necessary to be online all the time, but there are links to other websites throughout the programme, and you need to arrange to access these. There are also links within the programme, such that if a topic is referred to in one Unit, you can quickly go to the Unit in which further detail is given, if you need to revise. You also need an Athens username and password to access the journal papers in NHS Scotland s Knowledge Network to which there are links. There are many references to the Green Book throughout the programme. You should ensure that you are able to easily access the electronic version on the Public Health England s website. See: https://www.gov.uk/government/collections/immunisation-againstinfectious-disease-the-green-book 6
Brief overview of the units The programme is divided into 12 units. Specific learning objectives are found at the beginning of each unit. An overview of each unit is provided below:-: 1. The aims of immunisation: national policy and schedules. A brief history of vaccine development, followed by a discussion of it s aims in relation to disease. Current methods of surveillance. 2. The immune system and how vaccines work This content of this unit is presented as a short video explaining how the body responds to infection and vaccines (Public Health England video* The immune system and how vaccines work Permissions received from Public Health England for its use) 3. Vaccine preventable diseases In this unit you are directed to resources about the specific diseases which vaccines can prevent. You will also learn about the beneficial impact of vaccination. 4. The different types of vaccines used and their composition This unit describes pre-licensing evaluation of a vaccine, the different types (live and non-live) that are available, and asks you to make notes about contraindications. 5. Current issues and controversies regarding immunisation This unit looks at the evidence concerning controversial topics such as pertussis, MMR and thiomersal, and demonstrates how important it is to objectively review the scientific literature. 6. Communicating with patients and parents The factors that influence parents decision making, and ways of addressing their concerns. 7. Legal aspects of vaccination The legal aspects of consent, prescribing and the use of Patient Group Directions, and confidentiality. 8. Storage and handling of vaccines The NES resource Storage and Handling of Vaccines is used to consider this topic. 9. Correct administration of vaccines Practical advice concerning the administration of vaccines, explaining why it is necessary to use the correct size of needle, and the optimum site and route. 10. Anaphylaxis and other adverse events Adverse events in general, and the systems in place for their reporting are included in this unit. Detailed advice regarding the recognition and management of anaphylaxis. It should be noted that this is an update of knowledge and does not exclude attendance at NHS Boards/ employers anaphylaxis training. 11. Documentation, record keeping and reporting Details of what needs to be recorded and where, and why. 12. Strategies for improving immunisation rates This unit looks at strategies for improving immunisation uptake and reviews the factors that have been identified as influencing vaccine uptake, and suggestions for you to consider in your workplace. 7
How long will the programme take? It is suggested that it takes an average of around 15 hours to complete all of the units including the recommended activities. If you are relatively new to immunisation it may take longer. The length of time it takes will also be influenced by your own personal interest in certain aspects that you may wish to explore in greater depth than required by the programme. It is recommended that you aim to complete the programme in 16 weeks. You must complete all the 12 units in the order in which they appear. Throughout the units there are a range of activities that include: ensuring that you have access to particular resources, for example, information leaflets making notes on a particular topic work place activities for example a discussion about how you organise your local immunisation clinics undertaking an audit of the cold chain discussions with your facilitator reference to the Green Book Material providing evidence that you have completed these activities must be retained in a Folder of Evidence. You can create an electronic folder on your computer to store these. 8
Assessment Your satisfactory completion of the programme will be assessed in following ways: 1. Completion of multiple choice questions. These are found at the end of some of the units and completed online, and marked electronically. You can collate your score sheet electronically and keep in your Folder of Evidence When your folder of evidence has been completed, your facilitator will sign your Certificate of Completion for the theoretical programme and where applicable, the practice element, and inform the person in your organisation who maintains records of education undertaken. 2. Folder of Evidence/Discussions with facilitator. When you meet/speak to your assigned facilitator you will be asked to discuss the notes that you have made, and records of the activities that you have undertaken, all of which should be in your Folder of Evidence 3. Supervised clinical practice. A period of supervised clinical practice will allow the application of theory to practice. You will work with an appropriate registered practitioner who is able to assess clinical skill in immunisation. An example of an assessment form which has been adapted from the National Minimum Standards and Core Curriculum for Immunisation Trainers (2018) produced by Public Health England, may be used for this purpose and can be found at the end of this document (Appendix 2). Once completed and signed off by your clinical supervisor you should retain in your Folder of Evidence and take to your facilitator for your final meeting 9
Notes for Facilitators Promoting Effective Immunisation Practice is primarily self-directed, with the student taking responsibility for managing their study time. Your role is to support the acquisition of new knowledge and competence. It is suggested that you meet/speak to the student before they commence the programme to ascertain their previous experience in immunisation, and negotiate the level of support that they require. If you are facilitating more than one person, it may be desirable to meet as a group to promote discussion. Facilitators will be expected to: Have an initial discussion with prospective students to negotiate the nature and frequency of support Monitor the student s progress throughout the programme, and provide support to assist completion within the suggested 16 weeks Identify and support students experiencing difficulties with the programme Support the application of theory to practice Identify a suitably experienced registered healthcare practitioner in the workplace who can assess clinical competence Confirm that the learning outcomes and identified competencies have been achieved, and that all activities have been undertaken Validate the student s statement of completion. (Please also refer to Appendix 1 for further detail) 10
Further information regarding the role of facilitator In ideal circumstances, all facilitators should have undertaken the programme prior to supporting others. However, it is recognised that initially this will not be possible. Therefore in any Board area, it is important that the individual chosen to facilitate the first cohort of students should be someone who already possesses a high level of knowledge regarding vaccination and immunisation. This person may be the Immunisation Co-ordinator, a Health Protection Nurse, or another individual with expertise in this area. In such circumstances the facilitator may undertake the programme whilst simultaneously facilitating others. Once the first cohort of students has successfully completed the programme, they may facilitate others in their locality, and it is therefore suggested that the first cohort of students are from different localities. All facilitators will be aware that if students raise issues to which they feel unable to give an adequate response, a member of the NHS Board Health Protection Team is available to consult. Before signing the Certificate of Completion the facilitator should satisfy themselves that the student has: Completed all 12 units of the programme Demonstrated understanding of the unit contents by appropriate discussion during meetings Undertaken all activities, as demonstrated by documents collated in the Folder of Evidence Has demonstrated practical competence to a satisfactory standard. The person who assesses the practical competencies should be an experienced registered practitioner. If the student has no remit for vaccine administration, this section may be omitted. In such cases, facilitators should record on the Certificate of Completion that practical competences have not been assessed. Facilitators may wish to mentor two to four students simultaneously, and arrange to meet as a group. 11
Summary of PEIP Process Students self-register onto PEIP through the NES Turas platform and obtain a Turas account to access the PEIP programme online Facilitator identified Student meets/talks with facilitator Commences programme Meets at agreed intervals with facilitator On completion of theory units by the student they may proceed to assessment of practical competencies supervised by an appropriate experienced registered healthcare practitioner Final discussion of folder or evidence between student and facilitator Successful completion of PEIP programme Facilitator Signs Certificate of Completion-theory only or theory and practice Informs the person in organisation who maintains records of education undertaken that student has completed programme 12
References 1. Public Health England (2018) National Minimum Standards and Core Curriculum for Immunisation Training for Registered Healthcare Practitioners.(revised 2018).London. Public Health England 2. Department of Health (1996) plus later amendments) Immunisation against Infectious Disease. (The Green Book). London. DOH 13
APPENDIX 1 Information resource to support the implementation of Promoting Effective Immunisation Practice This appendix provides a framework to support the implementation of the Promoting effective immunisation practice within NHS Boards. It is designed to inform those who have responsibility for services incorporating the administration of vaccines and associated advice and information giving, such as: Directors of Nursing Immunisation Co-ordinators Health Protection Teams Practice Development Departments General Practitioners/Practice Managers The programme is suitable for all staff whose remit includes immunisation, regardless of the length of time they have been in post. It may be utilised as evidence of continuing professional development. Boards and General Practices may wish to consider eventually incorporating the requirement to undertake the programme into criteria for administration of vaccines against Patient Group Directions. It is advisable that staff who are newly given a remit for immunisation should undertake the programme prior to commencing such duties. NHS Boards may wish to utilise the following template in implementing the programme. 14
Implementation action plan IMPLEMENTATION PLAN (STRATEGY) Action points Lead responsibility Achieve by (date) Achieved by (date) Comment Develop a structure to support implementation Role of Board Immunisation Co-ordinating Group Role of Health Protection Team Role of link immunisation nurses in localities Role of Practice Development/Education & Training Departments Identify links with other governace issues Consider how by implementing the programme it serves e.g. Immunisation Targets Healthcare Improvement Scotland Knowledge and Skills Framework Identify order of roll-out Potential facilitators Articulation with other CPD/mandatory training activities 15
Implementation action plan RESOURCE APPRAISAL Action points Lead responsibility Achieve by (date) Achieved by (date) Comment Identification of learning resources IT access IT support Facilitation arrangements Selection of facilitators Preparation of facilitators On-going support for facilitators Funding Free at the point of use Administration Recording/reporting/verifying arrangements Management of protected student time Estimating the needs of individual students 16
Implementation action plan SUPPORTING STRUCTURES Action points Lead responsibility Achieve by (date) Achieved by (date) Comment Development of a management system to monitor, record and report on and evaluate course effectiveness, learning environments, support services and staff satisfaction. Articulation with current systems e.g. Datix Access to records for relevant service managers Identification of person and or department to lead project Practice Development Department Training and Development Department Named individual Forming a Steering Group Health Protection Team Lines of Communication Lead Nurses Community Health Partnership General Managers Relevant Committees Clinical Governance 17
Implementation action plan MEASURING OUTCOMES Action points Lead responsibility Achieve by (date) Achieved by (date) Comment Develop local measures to assess impact evaluation Use of programme evaluation forms Discussion with audit department/risk Management Team Articulation with current audit systems Student/staff evaluation/datix reporting levels Identification of person and or department to lead project Personal Development Plans Knowledge and Skills Framework Framework for Workforce Education Development for Health Protection in Scotland Clinical competence and arrangements for maintaining competence 18
Appendix 2: Example of a Competency Assessment Tool for Registered Healthcare Practitioners Part 2 Core Skills for immunisation Dates of Assessment Signature of Assessor 2A 2B 2C 2D 2E 2F Is up to date with local requirements for anaphylaxis and CPR training (normally recommended annually). Aware of the whereabouts of anaphylaxis and emergency care equipment, how and when to use it and the follow up care required. Can explain incident response and reporting process in case of a procedural error, needlestick injury, etc. as per local protocol. Demonstrates good practice in hand hygiene and relevant infection prevention techniques. Disposes of sharps, vaccine vials and other vaccine equipment safely in line with local guidance. Demonstrates knowledge and understanding of the rationale for maintaining the vaccine cold chain. Familiar with local protocols for cold chain management and the action to be taken in case of cold chain failure and who to contact. Part 3: Clinical process and procedure 3A 3B Checks patient s identity and patient s records prior to vaccination to ascertain previous immunisation history and which vaccines are required e.g.to bring patient up to date with national schedule, for planned travel, for specific identified risk, post-exposure prophylaxis etc. Can explain which vaccines are to be given and able to answer patient s and/or parents questions, referring to leaflets to aid explanations/discussion as appropriate and using interpreter if necessary to ensure patient/parent informed. Knows who to refer to or who to contact if further detail or advice is required. 19
Appendix 2: Example of a Competency Assessment Tool for Registered Healthcare Practitioners Part 3: Clinical process and procedure 3C 3D 3E 3F 3G 3H 3I 3J 3K 3L Able to clearly and confidently discuss the risks and benefits of vaccination and able to address any concerns patients and/or parents may have. Aware of, and able to discuss, any current issues, controversies or misconceptions surrounding immunisation. Demonstrates knowledge of consent requirements and the particular issues relevant to the area of practice, such as the capacity to consent, Mental Capacity Act and the age of the individual. Ensures consent is obtained prior to vaccination and is appropriately documented. Demonstrates knowledge and understanding of contraindications and is able to assess appropriately for contraindication or, if necessary, the need to postpone vaccination. Checks that the vaccine has been appropriately prescribed via a Patient Specific Direction (PSD) or, is authorised to be supplied and/or administered via a Patient Group Direction (PGD). Checks the presentation of vaccine products, the expiry date, how they have been stored prior to use and prepares them according to the Summary of Product Characteristics (SPC). Positions patient appropriately and chooses appropriate vaccination site(s) i.e. use of anterior lateral aspect of the thigh in babies under one year and/or upper arm in older children and adults for injectable vaccines. Chooses the correct administration route for the vaccine(s) to be delivered. Demonstrates correct subcutaneous technique where recommended e.g. for patients with bleeding disorders Demonstrates correct intradermal technique e.g. for administration of BCG vaccine. 20
Appendix 2: Example of a Competency Assessment Tool for Registered Healthcare Practitioners Part 3: Clinical process and procedure 3M 3N 3O 3P 3Q 3R Demonstrates correct intramuscular technique e.g. for administration of DTaP vaccine. Demonstrates correct intranasal technique e.g. for administration of live influenza vaccine to children. Demonstrates correct oral technique e.g. for administration of live rotavirus vaccine to babies Demonstrates an understanding of practice/clinic procedures for the reporting of vaccine reactions and knows how and when to report using the MHRA s Yellow Card Scheme. Completes all necessary documentation, recording type and product name of vaccine, batch number, expiry date, dose administered, site(s) used, date given and name and signature in personal child health record and clinic notes and reports to Child Health System Advises patient/parent on potential post-vaccination reactions as appropriate (e.g., rash, pyrexia) and management of these. Provides patient/parent with a copy of postimmunisation advice sheets I agree that I am competent in the above aspects of immunisation Date Signed I agree that Date Title, qualifications and relationship to trainee: Signed is competent in the above aspects of immunisation 21
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