Planning and Providing Immunisation Training by ewghwehws


									          Engaging with Staff
        Training and signposting key information
  How to make sure staff are knowledgeable, up to date
          and confident to relay the message.

Helen Donovan              Laura Craig
Immunisation Lead          Immunisation Nurse Specialist
NHS Haringey               Health Protection
                           Centre for Infections
• The main criticism from parents is - LACK OF
• All staff need to be well informed about
  specific issues or know where to get accurate
• DH Wave study 32 2008/9 internet is a
  growing source of information for parents
• However Health care professionals are still
  widely trusted
• Staff should –
   “Nothing had
 prepared me for
the agony of baby
  jabs. How am I
going to face the
   baby abattoir
 Zoe Williams, The
Guardian 11th January
                                     Guardian 16/01/2009

My child’s been unwell?...
                           I haven’t got time?...
                      I want more information…?
The nurse was too busy and so unsympathetic
about my concerns..?
                                Samad et al (2006) Vaccine
National Minimum Standards
Immunisation Training
Why the drive to develop
immunisation training standards?

• Prevention of Serious Untoward Incidents
• Increasing demand for information from parents
• Evidence that Healthcare staff are very influential in
parental decision-making
-high level of knowledge & a positive attitude to immunisation important to
achieve & maintain high vaccine uptake

• Requirements of clinical governance and accountability
• Increasing emphasis on HCWs demonstrating specified
• Patient Group Directions
NHS Re-organisation 2001– impact
on provision of training

Following re-organisation (Shifting the Balance of
Power), formation of PCTs with new Immunisation
      - existing training programmes interrupted
      - those responsible for training new in post
      - local level requests for guidance from national level

10 years on, facing reorganisation again
What are the implications for immunisation training?
PCT survey of immunisation training
                         June 2003
• Questionnaire sent to the “PCT Immunisation Lead” for the 302
PCTs in England
• Revealed variety of different professional backgrounds of Lead
• Responsibility for co-ordinating immunisation training:
             - PCT Imm Lead 17.8%                    - “DIC” 24.2%
             - “others” 30.2%                        - “no-one in particular” 18.7%

• 17% of PCTs were not providing immunisation training
• 79% PCTs responded that they had concerns about training
• 79% PCTs supported the need for national minimum standards in

Cummins A, Lane L, Boccia D, Crowcroft NS. Survey of local immunisation training in England--the case for setting
national standards. Commun Dis Public Health. 2004 Dec;7(4):267-71.
How were the Standards developed?

• Formation of “advisory” group (HPA, DH, ICH,
-variety of professional backgrounds and immunisation experience

•Ascertained what happens in other countries
-Australia, NZ and USA

• 6 Standards, 12 Core Topics + accompanying
Core Curriculum
• Circulated to Professional organisations for
comment and endorsement
National Standards should:

•Help to promote countrywide consistency and high
quality practice in immunisation
•Facilitate an improvement in the proportion of staff
receiving training where this is currently already
•Enable those in charge of designing and running local
immunisation courses to ensure that all core areas of
knowledge and competency are covered by providing a
curriculum around which to structure the training they
•Define the minimum level of training that should be
 Aims of National Standards

To ensure that all immunisers are trained to:
   - provide accurate and up to date information about
   the diseases and vaccines to their patients
   - enable individuals to make informed decisions and
   will promote public confidence in vaccination
   - give a safe, effective and a high standard of care
   - confidently, competently and effectively promote
   and administer vaccinations
   - ensure that JCVI and DH recommendations (as
   detailed in ‘Green Book’) are implemented at local
   level by all involved in immunisation
Who are the Standards for?

Everyone who gives or advises on vaccination as part
of their clinical practice
This includes:
health visitors, practice nurses, school nurses, community
nurses, paediatric nurses
GPs, paediatricians
pharmacists, midwives, occupational health professionals
Public Health Practitioners, CCDCs, Imms Leads/Co-
The Core Topics
1.   The aims of immunisation: national policy and schedules
2.   The immune system and how vaccines work
3.   Vaccine preventable diseases
4.   The different types of vaccines used and their composition
5.   Current issues and controversies regarding immunisation
6.   Communicating with patients and parents
7.   Legal aspects of vaccination
8.   Storage and handling of vaccines
9.   Correct administration of vaccines
10. Anaphylaxis and other adverse events
11. Documentation, record keeping and reporting
12. Strategies for improving immunisation rates
Assessment of Competence

Assessment of Knowledge
Formal courses should be assessed – possibly through a short
multiple-choice answer test
Accreditation of the learner could be linked to this assessment

Supervised Clinical Practice
Recommend that all new vaccinators spend a minimum set amount
of time (e.g. 2 clinic sessions) with an experienced and trained
Assessment should involve observation of new vaccinator during
minimum number of vaccinations/clinic sessions
Competency list such as that contained in Core Curriculum could
be used to demonstrate knowledge and competence
Training Update Days
• As a minimum, recommend yearly updates should be provided for
all immunisers who have completed a basic immunisation course
• Update days should cover any recommended changes to practice
and the most up to date guidelines
• No “core topics” for updates but could include the following
•Current issues in vaccination
•Recent epidemiology of vaccine preventable diseases
•Any relevant/recent changes to the National Immunisation schedule
•Any changes to legislation relevant to vaccination
•Anaphylaxis recognition and management
•Review of current practice and identification of areas for improvement
•Q&A session for commonly-encountered problems in practice
 How should immunisation training
 be delivered?
•Ideally at local level by local trainers/experts
-gives immunisers the opportunity to meet those leading on immunisation at
local level
-local speakers offer good working knowledge of immunisation situation and
issues in the area, thus making training more relevant
-involve variety of ‘expert/specialist’ speakers e.g. pharmacists, Child Health
Computer staff, immunologists etc.

•Collaboration between PCT Training/Education dept, local
educational establishments, lecturer practitioners,etc
•One person should take the lead for co-ordinating training
and ensuring that individuals are being given the
opportunity to attend
Teaching Resources

- ‘Green Book’ is effectively the course manual
- Compliment with wide range of immunisation material
 e.g. DH Immunisation Information resources, journal articles, websites

- Teaching should be interactive – groupwork,
   discussions, scenarios, Q&As, practical sessions,
   DVDs, etc – not just PowerPoint slides!

- HPA Immunisation Training webpage provides
   •   minimum slide sets for teaching
   •   lists of useful references and websites
   •   online assessment facility
   •   details of training courses
Other HPA training work currently in progress:

 •Current issues and specialist slide sets for different
 professional groups
  e.g. midwives, immunisers in custodial settings, OH immunisers, non-

 •National Minimum Standards and Core Curriculum for
 Immunisation Training of Health Care Support Workers
 •UK validated MCQs for assessment of knowledge
 •Immunisation E-learning programme with NHS Core
 •Immunology animation
UK validated MCQs for assessment of

•HPA Training Standards recommend knowledge is
assessed at the end of an immunisation course
•Few London PCTs assess knowledge at end of training
•HPA working with colleagues in Scotland, NI & Wales
to produce a validated knowledge assessment (MCQs)
to enable trainers to assess immunisation knowledge
consistently across UK
•Work in progress – hopefully on HPA website 2011
Immunisation E-
learning programme
with NHS Core
- HPA input to ensure programme
meets the Minimum Standards
Immunology animation
Survey of Provision of Immunisation Training in
London PCTs             London Immunisation Project 2009

•Thanks to 24/31 PCTs who completed the questionnaire
•Overall good provision of immunisation training
•Regular training sessions for HVs, SNs, Community
nurses in most PCTs
•Most provide basic and update courses at least once a
year but frequency varies widely across London
• Basic training: 25% once/year, 40% twice/year, some more than
• Update training: 33% twice/year, 33% more than twice, remainder
  once/year or only when changes to schedule
  How can we ensure relevant staff
    have appropriate skills and
• Survey showed:
• Attendance compulsory for anyone giving
  Immunisations in almost half London PCTs
• But in many PCTs - attendance only compulsory for
  some e.g. directly employed HVs & SNs
• Concerns PNs are not attending?
• Attendance monitored in most PCTs but over 50%
  do not know how many immunisers have attended
  training in last two years?
• Also staff move around
    How can we ensure relevant staff
      have appropriate skills and
•   Make attendance at training compulsory?
•   Competency assessment - Manager sign up
•   PGDs
•   Engaging with GPs and managers
•   Local resources and support
       - Intranet, newsletters, contact numbers, advertising
         courses, training materials available.
       - Sector-wide Training Guidance document.
       - Training available free of charge to staff in the PCT
   How can we make sure training is
      worthwhile and suitable?

• Quality of courses being provided
• Relevant for professional group
• Making the training enjoyable,
     memorable, worthwhile!
• Sharing resources, training, methods that
  work sector-wide
• Train the trainer
• Trust in other PCT’s training?
• Using competency assessment tools.
  How can we make sure training
      stays on the agenda?

• Learning lessons from the past.
• Don’t lose networks and training that has
  been established.
• Securing resources
    • only 20% PCTs have full time imms lead, some
      have less than 6 hours a week for the role
• Acknowledging importance of training
  and specialists to deliver it
     Training subgroup of London
    Immunisation Steering Group?
• To assist in provision of training, respondents to
  the survey asked for:
     • More/protected resources - Facilitating
     sharing of good practice

     • Shared training sessions across sectors or
     groups of PCTs

     • Support for evaluating courses and

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