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HCA protocol for the administration of inactivated influenza

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					DRAFT




  Protocol for the Administration of Inactivated Influenza Vaccine
                              to adult

                      by Health Care Assistants (HCA)
Purpose of Protocol

To enable suitably trained Health Care Assistants working for Croydon PCT who
have undertaken relevant training (as outlined below), to administer inactivated
influenza vaccine (surface Antigen & Slit Virion) 0.5mls as a single dose, as a duty
delegated by the General Practitioner (GP employee) or a registered nurse (PCT
employee).

Characteristics of staff

Staff group (s)                            Health Care Assistants
Additional Requirements                    Completion of relevant training (as
                                           outlined below)
                                           Knowledge of Croydon PCT policy on
                                           Management of Anaphylaxis in the
                                           Community.
                                           Training and competence in the correct
                                           procedure of administering medication
                                           via intra-muscular injection.
                                           Access to and knowledge of the DH
                                           guidance ‘Immunisation against
                                           infectious disease’
Continuing Training Requirement            Annual updates in Basic Life Support and
                                           2 yearly updates in the treatment of
                                           Anaphylaxis.
                                           Demonstration of competence in relation
                                           to this medication within the PDP and
                                           appraisal process.




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Clinical Condition


Clinical Condition to be treated        All high-risk patients requiring flu vaccination
Criteria for inclusion:                 All patients over the age of 65 years
                                        Any adult (i.e. any person aged 18 years of
                                        over) who has a confirmed diagnosis of one
                                        of the following diseases is considered ‘at
                                        risk’ if the develop flu e.g. asthma, diabetes,
                                        chronic heart/respiratory/renal/ liver disease,
                                        immunosupression; or residing in institutional
                                        settings.
                                        HIV all stages and having a cochlea implant
Criteria for exclusion:                 Patients with one of the following:
                                                      Aged under 18
                                                      Current acute illness
                                                      Hypersensitivity to egg
                                                      Pregnancy
                                                      Guillain Barre syndrome
                                                      Previous severe reaction to flu
                                                       vaccination
                                        Some patients on warfarin, theophylline
                                        phenytoin may occasionally experience an
                                        enhancement of their effects with influenza
                                        vaccine. The benefits of immunisation will out
                                        weigh the effects of the interactions.




Adverse reactions
Health Care Assistants must ensure the availability of an Anaphylactic shock or
Adrenaline 1:1000.

       If a general adverse reaction does occur:
        Record in patients notes
        Inform patients General Practitioner as soon as possible
        Local reactions should be seen by either the general practitioner or practice
           nurse or qualified RN within the district nursing team.

       If a anaphylactic reaction occurs:
        Give treatment in accordance with the PCT policy on the Management of
           Anaphylaxis in the community
        Record in patients notes
        Inform patients General Practitioner as soon as possible.




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Relevant training

1) The Health Care Assistants will attend a training session covering the following
aspects of the administration of inactivated influenza vaccine
       Appropriate anatomy and physiology
       Correct procedure for the administration of the vaccine via intramuscular
         injection
       Vaccine delivery, storage and stock control requirements, maintaining the
         ‘cold chain’
       Cautions and side effects related to the administration of inactivated
         influenza vaccine
       Documentation
       Legal aspects of drug administration

2) The Health Care Assistant will have successfully completed and passed the
Injection Training Course.   This includes an assessment of competence at
performing CPR and underpinning knowledge of consent issues.

3) The HCA will undergo a period of supervised practice and to be directly observed
administering 5 x intramuscular injections of inactivated influenza vaccine either by
the general practitioner or the practice nurse (GP employee) or by a registered nurse
(if employed by Croydon PCT).

Assessment of competence

Assessment of competence will be undertaken following the period of supervised
practice as outlined above. In GP Practice, this will be undertaken by the general
practitioner (or by the practice nurse providing that this duty has been delegated in
writing) in order to comply with the specific requirements of the company providing
medical indemnity. If employed by the Croydon PCT, assessment of competence will
be undertaken by an occupationally competent registered nurse.

Competence will be assessed by direct observation of the HCA’s ability to:
      Prepare the patient for the procedure
      Safe administration of the medication (including choice of site and needle
       technique) and observation of the patient post immunisation
      Correct disposal of clinical waste
      Correct documentation
      Correct procedure followed for delivery, storage and stock control of the
       vaccine

The Health Care Assistant will also be assessed (via oral questioning) on issues
relating to the therapeutics of inactivated influenza vaccine.




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Clinical Aspects

The following will be required:
    1. Patient specific directions – written by the General Practitioner/Prescribing
         Nurse
    2. Patient identification - required prior to the administration of medication (
         confirmed by the patient declaring his or her name date of birth and home
         address)
    3. Consent – informed consent must be obtained from the patient.
    4. Record Keeping – The following should be recorded in the patients notes,
         either according to the GP practice system, or within the district nursing
         documentation drug administration records
            Name of drug, dose route and site of administration
            Date administered
            Batch No and expiry date
            Signature of person administering
            Checklist for influenza immunisation

Significant Events
Any significant event which occurs during or as the result of administration of
medication must be reported to the Practice Manager/General Practitioner (GP
employee) or Registered Nurse / Manager (PCT employee), and the incident
reported via the PCT significant event reporting framework.

The HCA must be familiar with the following documents:

         Croydon PCT Medicines Policy (2004)
         Croydon PCT Consent Policy (2005)
         Croydon PCT Records Management Policy (2005)
         Croydon PCT Adverse Incident/Reporting & Managing Policy (2006)
         Croydon PCT Clinical Guidelines
         NMC Guidelines for the Administration of Medication 2005
         NMC Guidelines for Records & Record Keeping 2005
         Croydon PCT Immunisation Policy




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This protocol has been adapted by Francina Hyatt, Clinical Nurse Trainer/Advisor

Acknowledgement is given to the following people from Salford PCT

Mrs Barbara Jackson
Workforce Modernisation Co-ordinator

Ms Sue Harris
Non-medical Prescribing Lead


Review:
It is the responsibility of the lead of the staff group (s) to whom this protocol applied
to ensure the review process takes place.

This protocol becomes valid on 1st July 2006 and becomes due for review on 1 st July
2008.




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Protocol for inactivated influenza vaccine

Agreement for Croydon PCT Health Care Assistants

This protocol is to be read, agreed and signed by all Health Care
Professionals it applies to

Approved base:      __________________________________


Staff Name:         __________________________________


Designation:        __________________________________


Signature:          __________________________________


Date:               __________________________________


Signature of Team __________________________________
Leader:

Date:               __________________________________



The Health Care Professionals should retain a copy of the document after
signing and the original retained in their personal file.


Expires 1st July 2008




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Protocol for Inactivated Influenza Vaccine

Agreement for Croydon PCT Health Care Assistants

This protocol is to be read, agreed and signed by all Health Care
Professionals it appliesto:

Practice:           __________________________________


Staff Name:         __________________________________


Designation:        __________________________________


Signature:          __________________________________


Date:               __________________________________


Approved by         __________________________________
Lead GP:

Date:               __________________________________



The Health Care Professionals should retain a copy of the document after
signing and the original retained in their personal file.


Expires 1st July 2008




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          General Guidance for the Administration of Vaccines

General

1. The identity of the vaccine must be checked to ensure the right product is
   used in the appropriate way on every occasion.
2. The expiry date must be noted. Vaccines must not be used after the expiry
   date on the label.
3. The date immunisation, title of the vaccine and the batch number must be
   recorded on the recipient’s record. When two vaccines are gives together,
   the relevant sites should be recorded to allow any reaction to be related to
   the causative site. It may be considered good practice to record all sites of
   administration.
4. The recommended storage condition must have been observed.


Reconstitution of Vaccines

1. Freeze dried vaccines must be reconstituted with the diluent supplied and
   used within the recommended period after reconstitution.
2. The diluent must be added slowly to avoid frothing, a sterile 1ml syringe
   with a 21G needle should be used for reconstituting the vaccine and
   smaller gauge for injection, unless only one needle is supplied with a pre-
   filled syringe
3. Vaccines must not be mixed before administration. The only exception is
   Hib and DTP form the same manufacturer.

Cleaning of the Skin
If the skin is to be cleaned, soap and water Are adequate where a HCA skin
cleansing is required.

Route of Administration
Adult Intramuscular injection into the deltoid muscle, patients requiring
subcutaneous injection should be referred to the nurse.

Recommended Choice of Needle Lengths

Women < 90kg        =        25mm needle
Women .>90kg        =        38mm needle
Men 60-118kg        =        25mm needle




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                  CHECKLIST FOR INFLUENZA IMMUNISATION

Name:…………………………………………………………………..

Address: ……………………………………………………………….

Date of Birth:…………………………………………………………...

GP: ……………………………………………………………………...

Have you had Flu injection this year?                                      Yes/No

Are you well today?                                                        Yes/No

Have you had any severe reaction to the flu vaccine or any other           Yes/No
injection before?

Have you had a severe anaphylactic reaction to eggs                        Yes/No
or egg products?

Whilst steroids, chemotherapy or radiotherapy may result in a reduced
antibody response, the benefits of immunisation are such that the patients
should be immunised.

Are you pregnant?                                                          Yes/No

Do you suffer from Guilain Barre Syndrome?                                 Yes/No

Explain the side-effects of the immunisation and keep under observation for 10
                    to 15 minutes for the adverse reactions.


Date:…………………………………………………….

Name of Vaccination: ………………………………………………………………………...

Batch No:……………………………………                        Expiry Date: ……………………………

Site administered:…………………………………………………………..

Signature of Health Care Professional: ………………………………………………

N.B if the patient has answered Yes to any of the above refer to General Practitioner
or Practice Nurse



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