Immunisation Training: Flu Vaccination Service

Patient Group Direction (PGD)

• A PGD is not a substitute for professional judgment and accountability
• You must practise only within the bounds of your own competence
• You must work within the current version of the PGD
• You must sign the PGD and complete the Record of Authorisation
• You must check your professional liability insurance and hepatitis status

Standard Operating Procedures (SOPs)

• Vaccination service
• IM vaccination
• Hand washing
• Actions in the event of a needlestick injury

Record Keeping

• Patient pre-vaccination screening
• Patient post-vaccination check
• Patient record and consent
• Inform patient's GP
• Self audit
• Clinical audit
• Document checklist

The Vaccine

• Quadrivalent Cell-based or Recombinant Influenza Vaccine (QIVc or QIVr)
• Inactivated Egg-grown Quadrivalent Influenza Vaccine (QIVe) may be offered only when every attempt to use QIVc or QIVr has been exhausted
• Vaccine types:
  • A/Victoria/4897/2022 (H1N1)pdm09-like strain
  • A/Darwin/9/2021 (H3N2)-like strain
  • B/Austria/1359417/2021-like strain
  • B/Phuket/3073/2013-like strain
• Storage: 2-8°C (do not freeze) in original packaging
• Intensely monitored, especially black triangle

Influenza Vaccination Service

• Inclusion criteria: 13 years and above, self-identified as at risk, and exclusions
• Consent: must include information that the live vaccine is recommended for 13-17 years and may be available at the GP
• Identification of 'at risk' groups: 65+, chronic respiratory disease, heart disease, kidney disease, liver disease, neurological disease, morbidly obese, learning disabilities, diabetes, immunosuppression, pregnant, people in long-stay residential or homes, carers, Health and Social Care staff

Core Topic: Correct Administration of Vaccines

• Identify correct dose and site of administration for each age group
• List true contraindications and describe common false contraindications
• Position patients of different ages for safe and effective vaccination
• Reconstitute vaccines correctly
• Explain how to prepare and dispose of vaccination equipment

Vaccine Administration

• Reconstitution of vaccine: avoid errors, maintain efficacy and stability
• Check colour and composition of vaccine before administration
• Check vaccine to ensure it is the right product and correct dose for the patient
• Check expiry date
• Route of injection: most vaccines should be given intramuscularly, except for BCG (intradermal), Japanese Encephalitis and Varicella (subcutaneous), and Cholera (oral)
• Needle size: orange (25G, 16mm), blue (23G, 25mm), green (21G, 38mm)
• Injection site: anterolateral aspect of the thigh for infants, deltoid area of the upper arm for older infants and adults
• Avoid major nerves and blood vessels, and do not inject into the buttock

Contraindications and Adverse Reactions

• True contraindications: vaccination in moderately or severely unwell individuals, live vaccines in immunocompromised individuals, anaphylaxis to previous dose of vaccine or vaccine component
• False contraindications: family history of adverse reactions, previous history of pertussis, measles, rubella, or mumps infection, prematurity, stable neurological conditions, contact with infectious disease, asthma, eczema, hay fever, treatment with antibiotics or locally-acting steroids, child's mother is pregnant, child being breastfed, history of jaundice after birth, under a certain weight, over the recommended age

Immunisation Training

• Learning outcomes: critically appraise the flu vaccination service, apply learning from the Green Book and chapter in influenza to clinical cases, explore the influenza vaccination PGD, practise the skills of immunisation using an intramuscular technique
• Learning activity: lecture, workshop, and immunisation training

The Flu Vaccination Service

• Stages: assess individual, consent, and provide advice, vaccine preparation, vaccine administration, record keeping

• Purpose: deliver effective patient care, provide equity in the availability and quality of services, provide a safe legal framework, reduce delays in treatment, maximise the use of skills of health professionals

• Governance: organisational and individual authorisation, procedures, audit, patient journey### Post-Vaccination Procedures

• Observe vaccine recipients for immediate adverse reactions

• Report suspected adverse drug reactions (ADRs) to the Committee on Safety of Medicines using the Yellow Card Scheme

• Specific reporting guidelines for established and newly licensed vaccines

Disposal of Vaccination Equipment

• Dispose of reconstituted vaccines, opened vials, and used needles and syringes in yellow sharps bins
• Dispose of BCG vaccine and equipment in the purple lidded waste container for cytotoxic waste
• Replace sharps bins when 2/3rds full

Recording Vaccination Information

• Record vaccine name, batch number, and expiry date
• Record dose administered, site(s) used, and date of immunisation
• Record name and signature of vaccinator
• Record information in patient-held record, GP record, or other patient record

Contraindications and Exclusions

• Contraindications for influenza vaccination include anaphylactic reactions to previous doses or components
• Exclusions include those who have received a complete dose of the recommended influenza vaccine for the current season
• Exclusions also include individuals suffering from acute severe febrile illness

Administration of Influenza Vaccine

• Administer 0.5ml intramuscular in mid deltoid
• Rotate to 'mix' and allow to come to room temperature before use
• Can give at the same time as other vaccines (separate sites at least 2.5cm apart)

Adverse Effects and Anaphylaxis

• Report adverse effects using the Yellow Card scheme
• Common adverse effects include local reactions, fever, malaise, shivering, and fatigue
• Rare adverse effects include Guillain-Barré syndrome and anaphylactic reactions
• Anaphylaxis onset is within minutes to hours, and patients should remain with the vaccinator for 10 minutes after the procedure