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CHHS16/009

Canberra Hospital and Health ServicesOperational Procedure Immunisation Service Delivery in Schools and Child Health ClinicsContents

Contents...................................................................................................................................1

Purpose.................................................................................................................................... 4

Alerts........................................................................................................................................4

Scope........................................................................................................................................4

Section 1 – Women Youth & Children (WYC)...........................................................................4

1.1 Background.....................................................................................................................4

Section 2 – Child Immunisation Clinics.....................................................................................5

2.1 Eligible Clients................................................................................................................ 5

2.2 Child Immunisation Clinic Appointments.......................................................................5

2.3 Consent.......................................................................................................................... 5

2.3.1 Purpose................................................................................................................... 5

2.3.2 Procedure................................................................................................................5

2.4 Documentation at Child Immunisation Clinics................................................................6

2.4.1 ACT Health Immunisation Record in the Child’s Personal Health Record................6

2.4.2 Computerised Client record on ACTPAS..................................................................7

2.4.3 Australian Childhood Immunisation Register (ACIR)...............................................7

2.4.4 Deceased Child........................................................................................................8

2.5 Vaccination at Child Immunisation Clinics......................................................................8

2.5.1 Child Vaccination Safety..........................................................................................8

2.5.2 Prepare environment..............................................................................................8

2.5.3 Emergency Equipment............................................................................................8

2.5.4 Documentation & Client Information......................................................................8

2.5.5 Vaccination Procedure in Immunisation Clinics.......................................................9

Section 3 – School Immunisation Programs...........................................................................10

3.1 Eligible Clients.............................................................................................................. 10

3.2 Procedure.....................................................................................................................10

3.2.1 Obtaining and Withdrawal of Consent..................................................................10Doc Number Version Issued Review Date Area Responsible PageCHHS16/009 1 01/02/2016 01/02/2021 WY&C –

Community Health Program

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Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register

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3.3 Vaccine Administration for School Immunisation Program..........................................13

3.3.1 Team Leader’s Role...............................................................................................13

3.3.2 The Role of the RN in the post vaccination recovery area.....................................13

3.3.3 Prepare Environment............................................................................................14

3.3.4 Preparing for Vaccine Administration....................................................................14

3.3.5 Administering Multiple Vaccines...........................................................................15

3.3.6 Post Vaccination Administration...........................................................................15

3.4 School Immunisation Records......................................................................................16

3.4.1 Immunisation Record............................................................................................16

3.4.2 National HPV Vaccination Register........................................................................16

Section 4 – Contact Prophylaxis Immunisation Clinics...........................................................16

4.1 Health Protection Services (HPS) will notify:................................................................16

4.2 Clinic site: Belconnen Community Health Centre (BCHC) WiC only..............................16

4.3 Staffing......................................................................................................................... 16

4.4 Equipment....................................................................................................................17

WYCCHP to provide:...........................................................................................................17

Section 5 – Management of Adverse Events following Immunisation...................................17

5.1 Equipment....................................................................................................................17

5.3 Documentation.............................................................................................................18

Section 6 – Competency Assessment for Registered Nurse Immunisers................................18

6.1 Procedure.....................................................................................................................18

Implementation......................................................................................................................19

Related Policies, Procedures, Guidelines and Legislation.......................................................19

References..............................................................................................................................19

Definition of Terms.................................................................................................................20

Search Terms..........................................................................................................................20

Attachments...........................................................................................................................21

Attachment 1 – After Your Child has been Immunised.......................................................22

Attachment 2 – Student Vaccination Record......................................................................24

Attachment 3 – Pre-vaccination Check list for Immunisation Clinic...................................26

Attachment 4 – Pre-vaccination Check list for School Immunisation.................................28

Attachment 5 – Guidelines for safe immunisation in schools.............................................29

Attachment 6 – Basic Life Support Flow Chart...................................................................32

Doc Number Version Issued Review Date Area Responsible PageCHHS16/009 1 01/02/2016 01/02/2021 WY&C –


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Attachment 7 – Adrenaline dose chart for anaphylaxis......................................................33

Attachment 9 – Nursing Management Anaphylaxis Post Immunisation Flow Chart..........35

Attachment 10 – Immunisation Adverse Event Reporting Form........................................36



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Purpose

To provide a clinical procedure for Registered Nurses (RNs) and Midwives who provide immunisation services to infants, children and adolescents within the Women Youth and Children Community Health Programs (WYCCHPs). This procedure document is to be read in conjunction with The Australian Immunisation Handbook, 10th Edition, 2013.

The administration of vaccine from Medication Standing Orders is prohibited for Enrolled Nurses, Undergraduate Registered Nursing and Midwifery (direct entry) students as in accordance with the Medicines, Poisons and Therapeutic Regulation (2008).

The document pertains to infants, children and adolescents who are clients of WYCCHPs.

Vaccines must be administered in accordance with the recommendations of the current edition of The Australian Immunisation Handbook and under the legislative framework of the ACT Medicines, Poisons and Therapeutic Goods Act (2008).

Strict Hand Hygiene should be adhered to at all times when performing all clinical procedures as per Canberra Hospital and Health Services (CHHS) Healthcare associated Infections Procedure CHHS15/072.

Vaccine administration should adhere at all times to standards as per CHHS Clinical Policy Medication Handling CHHS15/086.

For vaccination requirements for Health Care Workers, please refer to CHHS Clinical Procedure, Occupational Assessment, Screening and Vaccination CHHS 15/091

Section 1 – Women Youth & Children (WYC)

1.1 BackgroundThe National Immunisation Program (NIP) for infants, children and adolescents in ACT is provided through the WYC Community Health Programs, Child Immunisation Clinics and School Immunisation Program.

All vaccine and adrenaline administration in WYC Community Health Programs is authorised by a Medication Standing Order and must be given exactly as described.



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This Standard Operating Procedure (SOP) describes for staff the process to

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The following sections detail procedures for service provision pre-vaccination, vaccine administration, post vaccination and management of adverse event following immunisation

Back to Table of Contents

Section 2 – Child Immunisation Clinics

2.1 Eligible ClientsProvide NIP funded vaccines to children from 0 – 5 years. Appointments are made through Community Health Intake (CHI) 6207 9977

NB: Vaccines are only to be administered to children up to their 6th birthday.

For the current NIP schedule refer to link:http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/4CB920F0D49C61F1CA257B2600828523/$File/nips-oct2013.pdf

Standing Medication Orders detail eligibility of vaccines, age given, spacing of vaccines and is to be read in conjunction with The Australian Immunisation Handbook, 10th Edition, 2013

Alert: Nurses and Midwives do not have the authority to give vaccines that have been provided by the client

2.2 Child Immunisation Clinic Appointments Appointments are made through CHI 6207 9977 for: Six to eight week old infant vaccinations - 30 minute appointments Four year old vaccinations – 30 minute appointments All other vaccinations – 15 minute appointment

2.3 Consent2.3.1 PurposeTo ensure the administering RN prior to every immunisation encounter obtains valid consent and it is recorded appropriately (refer to the Australian Immunisation Handbook, 10th Edition, 2013, pp.25-38).

2.3.2 ProcedureParents/legal guardian shall be provided with sufficient information to allow informed consent to be given.



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http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/4CB920F0D49C61F1CA257B2600828523/$File/nips-oct2013.pdf

http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/4CB920F0D49C61F1CA257B2600828523/$File/nips-oct2013.pdf

CHHS16/009

Procedure for Written ConsentThe administering RN will: Provide a written copy of WYCCHP ‘After Your Child Has Been Immunised’ (See

Attachment 1) to the consenting adult and indicate the telephone numbers to contact in the case of a severe adverse reaction

Prior to vaccination the consenting adult to sight or have explained ‘Comparison of Effects of Vaccines and Diseases’ located in the booklet ‘Your Guide to Understanding Childhood Immunisation’

Ensure the ‘Pre-Vaccination Checklist’ (see Attachment 3) is read prior to every Vaccination Inform the consenting adult that the immunised child needs to remain in the clinical area for 15 minutes post-vaccination Ensure the over-arching consent agreeing to the NIP is signed and dated by the

parent/guardian at the first immunisation encounter Document consent at subsequent immunisation encounters by the parent/guardian

signing in the space provided on the immunisation record In the event the child is brought to the clinic by an adult other than the parent/guardian, they must have a signed letter from the parent/guardian stating permission for the immunisation to occur

Procedure for Phone ConsentWhere a child requires vaccination without a parent or legal guardian present, and the carer does not have written permission, phone consent may be obtained by: Verification of the parent/guardian status on the phone by asking the person to state

the child's DOB /address and their full name to confirm they are the parent or legal guardian of the child

Ensuring the parent/guardian has enough information to make an informed verbal consent Two RNs must listen to, corroborate and co-sign that consent has been obtained

2.4 Documentation at Child Immunisation ClinicsThe following 3 areas of documentation and recording are required.

2.4.1 ACT Health Immunisation Record in the Child’s Personal Health Record At first immunisation service the following information is recorded: Parent/guardian consent for the childhood NIP is obtained by the immunising nurse Child’s details include:

o Medicare numbero Surname and given nameo Date of birtho Sex o Addresso Aboriginal and /or Torres Strait Islander



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At first and subsequent immunisation encounters the information related to the immunisation provided is recorded: Initials of the parent/guardian providing consent on the day in the consent column Name of vaccines administered Vaccine batch numbers /by writing or by using stickers provided by vaccine company. Site where the vaccine was administered if multiple vaccinations were given Date the vaccine was administered Signature of the RN administering the vaccine next to each vaccine given ACT Health stamp Date the next immunisation is due

2.4.2 Computerised Client record on ACTPAS Ensure client is registered correctly on ACTPAS, and update details if required Medicare number (if available) recorded against the client details “funding” tab Edit the appointment to record the following Correct clinician Check boxes indicating consent, and risks and benefits Check box indicating whether birth dose Paediatric Hep B given and date Names of vaccines administered For immunisations up to and including 12 months, complete tab ‘CYW Infant Feeding’ reflecting breastfeeding status Record ACIR confirmation number, in ‘comments’ box of ACTPAS tab ‘CYW

Immunisation 1’

2.4.3 Australian Childhood Immunisation Register (ACIR)Each encounter must be entered onto the ACIR website- access link:http://www.medicareaustralia.gov.au/provider/patients/acir/index.jsp

Follow instructions to log onto ACIR, located: G:\CY&W\CY&W_General\Immunisation documents\ACIR FILE. This instruction sheet includes the ACIR code for each immunisation site and the password, which is regularly updated The following information is entered on the ACIR register by the immunisation provider: Medicare Number Medicare reference Number

Note: If Medicare number is unavailable, record name, address, DOB and postcode

Aboriginal/Torres Strait Islander status is indicated ‘Who performed this encounter’ Date Hepatitis B birth dose and date



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http://www.medicareaustralia.gov.au/provider/patients/acir/index.jsp

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Vaccines administered (choose from drop down box) Await confirmation from ACIR and record confirmation number on ACTPAS in

‘comments’ box of the ACTPAS tab ‘CYW Immunisation 1’

2.4.4 Deceased ChildACIR should be notified of a deceased child to prevent a Child History Statement being sent to bereaved parents. Nurses may undertake this task by phoning ACIR on 1800 653 809 and providing details of the child’s name, address, and date of birth, Medicare number and date of death.

2.5 Vaccination at Child Immunisation ClinicsProcedure2.5.1 Child Vaccination SafetyThe attending and ‘recovery’ RN will: Welcome client Ascertain child’s name/identity and relationship to adult Confirm booking against appointment list Ascertain age of child and immunisation status Provide client with pre-vaccination checklist to ascertain wellness and any

contraindications to immunisation Manage the flow of clients into clinics, and monitor the comfort and safety of clients Observe child for 15 minutes post vaccination in nearby vicinity

2.5.2 Prepare environment The RN will ensure that; the vaccine administration area is clean observing infection control principles table, chairs and benches meet Work Health Safety standards there is adequate lighting, heating and cooling

2.5.3 Emergency EquipmentThe RN will ensure equipment is available: Laerdal resuscitator - age appropriate and clean Adrenaline 1:1000 (2 vials) - check expiry date Basic Life Support Flow Chart and Ambulance Information Chart identifying clinic

location (See Attachments 6 & 8) Telephone

2.5.4 Documentation & Client InformationEnsure documentation is available including: Current ACT Health Medication Standing Orders for immunisation are available in Q

drive and in Hard Copy in a designated folder at the clinics Pre-vaccination check list (See Attachment 3) Consent form in Personal Health Record Adverse event form



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Understanding Childhood Immunisation booklets or online at the Immunise Australia Program website http://immunise.health.gov.au

‘After Your Child Has Been Immunised’ information sheet (See Attachment 1) Culture and Linguistic Diversity CALD information – ‘In your language’ immunisation

factsheets http://www.health.vic.gov.au/immunisation/factsheets/language.htm

2.5.5 Vaccination Procedure in Immunisation ClinicsPrior to vaccination 1. Preparation for Vaccination AdministrationThe RN will: Obtain informed consent from client or carer accompanying child Ensure client has read pre-vaccination checklist (See Attachment 3) Provide an explanation of the vaccines to be administered, possible side effects, care

advice and emergency numbers for post vaccination concern Use interpreter services as required to ensure client informed, consult with CNC Provide an explanation of the procedure including sites for administration Inform parent/guardian of 15 minute recovery supervised by RN in a designated

recovery area Complete computerised data entry on the ACTPAS and ACIR

2. Vaccine Administration: The RN will: Remove vaccines from fridge Prepare vaccine according to The Australian Immunisation Handbook 10th Edition 2013,

pp 70-73 Wipe the stopper of vaccines

o Always wipe the outer surface stopper of the rubber stopper with alcohol swabo Allow rubber stopper to dry before inserting needle into vial

The vaccine must be checked by two RNs (includes the drawing up and mixing of all multi component vaccines) to ensure: Right Client Right Vaccine Right Dose Right Route Right Time-frame according to schedule Known allergies and contraindications have been considered

Clinical Procedure for Administration of vaccines: Refer Australian Immunisation Handbook 10th Ed, pp 65-84. The online version of the Australian Immunisation Handbook is to be checked regularly for updates, http://www.health.gov.au/internet/immunise/publishing.nsf/Content/Handbook10-home.



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http://www.health.gov.au/internet/immunise/publishing.nsf/Content/Handbook10-home

http://www.health.vic.gov.au/immunisation/factsheets/language.htm

http://immunise.health.gov.au/

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It will include current recommendations regarding seasonal influenza vaccinations for children aged 6 months and over with underlying medical conditions and changes to the NIP schedule. Medication Standing Orders are updated in accordance with any recommended changes in the Australian Immunisation Handbook.

In addition: Confirm vaccine to be administered by showing vaccine name and expiry date to

consenting parent/guardian, and asking parent/carer to initial Remind parent/guardian of 15 minute recovery time and possible side effects Advise parent/guardian when next scheduled vaccine is due Complete documentation Check the viability of vaccines by close monitoring of the cold chain and record on

Data Logger Temperature sheet - refer to The National Vaccine Storage Guidelines, 2013, Strive for 5, 2nd Edition

Two registered nurses count and record stock at the beginning and at the end of the morning session and at the end of the afternoon immunisation session Ensure all vaccine components tally Report any discrepancies to CNC


Section 3 – School Immunisation Programs

3.1 Eligible ClientsAll students that attend government and private schools are eligible for NIP funded vaccines. International students with valid consent are eligible for vaccination. Immunisation consent and Information forms are distributed to ACT Schools.Medication Standing Orders detail eligibility of vaccines, age given, the spacing of vaccines and is to be read in conjunction with The Australian Immunisation Handbook, 10th Edition, 2013.

3.2 Procedure3.2.1 Obtaining and Withdrawal of ConsentThis can be achieved by the following:1. Written Consent The School Immunisation RNs use specific immunisation consent forms for the school program. These forms are sent to schools in the ACT, both government and non-government, and are distributed to parents/guardians of students (by the school), who are eligible for vaccination under the NIP. The consent forms include information regarding the vaccines, the diseases they prevent, common and rarer side effects and where to access further information. Parents are requested to complete a pre-vaccination checklist to indicate if there are any contraindications or precautions to their child being vaccinated at school.



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Consent is valid if the following elements have been satisfied: parent and/or legal guardian gives consent on the appropriate form full information on risks, benefits and alternatives has been provided consent is signed in ink all required information is filled in on consent form consent is specific to the vaccine being given for all the doses to complete the course in

the school Immunisation program

Completed consent forms are returned and processed by the School Immunisation Team. The team will check that the form has been completed correctly by parent/guardian and note details that require follow up.

The consent forms are divided into three groups; Those giving consent- ‘yes’ Those who may have indicated ‘yes’ but the consent is invalid. Where an invalid

consent is identified the parent/guardian are phoned to obtain ‘phone consent’ (See section 2.3.3)

Those that do not consent o No to all vaccines- a diagonal cross is placed through consent boxes and all

corresponding ‘vaccine given’ tabs.o No consent forms are isolated and filed in separately o No to a single vaccine, is retained with school file

The consent cards are batched, dated and organised into alphabetical order prior to arrival at school.

On the day the nurse administering the vaccine will: ensure the ‘Pre-Vaccination Checklist’(See Attachment 4) has been read & understood

by the student prior to every immunisation occasion of service verify the student's identity; asking their name, date of birth, address and parent/

guardian details checking these correspond to what is written on the consent card and update as required

confirm with the student that the signature on the consent form is indeed their parent or legal guardian’s signature

Note:A student can withdraw consent at anytime. The parents are to be informed and given information on catch up vaccination/s.

2. Phone Consent If a student presents for vaccination on the day but does not have a consent form, or if the consent to hand does not satisfy all the requirements above, phone consent may be obtained in the manner outlined above in Section 2.3.3



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The nurse phones the parent/guardian using the phone numbers listed on the consent form, or the numbers given by the student on the day, to obtain verbal consent. To ensure informed consent the parent/guardian must be given the name of the vaccine, the dose and number required, risks/benefits and post vaccination care. If information & consent card misplaced direct to www.health.act.gov.au/immunisation for immunisation information.

The registered nurse should then ask the parent to state: Their name Their relationship to the student Check the parent has read the consent form Their child’s name and date of birth The name of the vaccine they wish given Contact details as outlined on the consent form

This information will then be repeated by the parent to a second nurse to confirm the details.

In the consent section relating to the discussed vaccine/s the nurse will write: Phone consent obtained from (write parent’s name) and print name, sign, date and

time the entry on the sticker template and attach to consent form The second nurse will also print and sign their name on the sticker to confirm the

information is correct

Any concerns about the ability to obtain valid consent must be discussed with the Clinical Nurse Consultant. Where the health status of the student or validity of consent provided is unable to be determined vaccination must be deferred

3. Withdrawal Consent by Phone Parents/guardians can withdraw consent at any time prior to the vaccinationA ‘Withdrawal of Consent’ should not proceed under any circumstances without the immunisation consent form being to hand.

The registered nurse will: Check the parents name against the consent form Check the students name and date of birth with the parent to ensure the correct

consent form is to hand Ask the parent/guardian to state which vaccine/s they wish to withdraw consent With black pen draw a cross completely through the consent box as well as through the

individual dose record box/s and write clearly on ‘Withdrawn Consent’ sticker the parents name. Print your name, sign, date and time

Ask the parent/guardian to repeat their withdrawal of consent to a second nurse who will also print, sign and date confirming the information given is correct on the ‘Withdraw Consent’ sticker and attach to consent form

If consent for all vaccinations has been withdrawn this card should then be placed with the other ‘no consent’ forms



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http://www.health.act.gov.au/immunisation

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The parent/guardian who signed the consent card must be the same parent/guardian who withdraws consent

3.3 Vaccine Administration for School Immunisation ProgramTo meet the requirements of safe practice one nurse must be available to directly observe clients for 15 minutes following the immunisation procedure. The minimum staffing requirement is three nurses, two performing the immunisation procedure and one performing the recovery role. Staff will rotate roles on the day and/or during the week. All members will work as a team to provide effective services and reduce the risk of injuries with repetitive tasks.

3.3.1 Team Leader’s RoleThe Team Leader role is rotated with the Registered Nurses in the team. The overall responsibility for decision making at the school is the responsibility of RN Level 2/ CNC.

The Team Leader is responsible for being the point of contact on the day for the school staff and will ensure through coordination & delegation of duties that: all consent cards, paperwork, equipment, mobile phone, Immunisation Handbook,

adrenaline and vaccines are ready for transportation to the designated school the paperwork for monitoring the vaccine cold chain has been set up and that the

esky/cooler bag temperatures are monitored and recorded hourly all team members prior to departure from base are informed about the location of the

school and where and when to meet all team members know what their role is for the day according to the staff allocation

list the school office staff know the team has arrived and sign the team in on the school’s

visitors book the immunisation area meets the requirements refer Guidelines for Safe Immunisation

in Schools (See Attachment 5) each immunisation nurse is advised on the number of vaccine doses to be drawn up (to

minimise vaccine wastage) the team have adequate breaks throughout the day the parents of children who refuse immunisations or are unwell/ineligible for

immunisation are notified the daily statistics sheet is completed the vaccine register is completed and the count balances with the statistics sheet all paperwork and equipment is restocked at the end of each day

3.3.2 The Role of the RN in the post vaccination recovery areaA RN is to be present at all times in a ‘recovery’ area post vaccination.

The registered nurse in ‘recovery’ area will inspect the student recovery area and ensure that it: Meets the minimum standard for safe Immunisation in schools Guidelines for Safe

Immunisation in Schools (See Attachment 3)Doc Number Version Issued Review Date Area Responsible PageCHHS16/009 1 01/02/2016 01/02/2021 WY&C –


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is large enough to accommodate the number of students being immunised has adequate room for resuscitation should it be necessary adjoins or is screened off from the immunisation area is the same level as immunisation area e.g. not on the stage or in an upstairs room has carpet on the floor or gym mats for the students to sit or lie on Check resuscitation equipment and set up in the recovery area prior to Immunisation Remove adrenaline from esky and take to the recovery area and recheck expiry date Complete the Emergency Chart with the school address, post code and location of the immunisation area (See Attachment 9) Inform team of emergency evacuation points

3.3.3 Prepare EnvironmentThe RNs will; check tables and chairs to meet Workplace Safety Standards (In the event that the

school is unable to meet the Safe Immunisation in Schools the Team Leader will contact the Manager/CNC immediately)

clean area observing infection control principles set up own work area with vaccines, syringes, needles, kidney dishes, cotton balls,

gloves/hand hygiene solutions, pens, stamps, stapler, clock, plastics/contaminated waste bags, sharps container , cooler bags / eskies, Ice sheets / blocks and thermometers to manage the cold chain monitoring

adrenaline 1:1000 resuscitation equipment relevant standing orders, pre and post vaccination information, generic forms

3.3.4 Preparing for Vaccine Administration Two RNs will check the following before drawing up and giving vaccine; cold chain integrity correct vaccine batch number expiry date of vaccine and diluents correct dose patency of vaccine (colour, sealed or intact ampoule/syringe) the mixing of the Varicella vaccine ampoule with the pre filled diluents syringe

RNs are encouraged to use an ‘underarm’ technique for mass vaccination to minimise the risk of workplace injury.

Varicella Vaccination Preparation The maximum number of doses to be prepared at one time is 15 per nurse Any reconstituted Varicella vaccine must be used within 90 minutes and protected from

light Always wipe the outer surface of the rubber stopper with alcohol swabDoc Number Version Issued Review Date Area Responsible PageCHHS16/009 1 01/02/2016 01/02/2021 WY&C –


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Allow rubber stopper to dry before inserting needle into vial

3.3.5 Administering Multiple Vaccines RN ‘A’ will: explain this process to the student Check the student has read and understood the pre-vaccination check

list and discuss any concerns with the student Check for valid parent /guardian consent Give first vaccine in the left deltoid

RN ‘B’ will: Listen to the Nurse A check details for consent Give the 2nd vaccine in the right deltoid The vaccine will be administered in the following order Human Papillomavirus (HPV) vaccine will be given in the left arm Varicella or Diphtheria, Tetanus & Pertussis vaccine will be given in the right arm Document vaccines given on Student Vaccination Record (See Attachment 2) indicating

vaccine given, site, nurse signature and designation.

Both RNs to sign, print name and designation (stamp) on Immunisation Record and Student Vaccination Record. The Student Vaccination record is given to the student to take home to parent / guardian. The Immunisation Record is retained by the Immunisation team, until the end of the school year. 3.3.6 Post Vaccination AdministrationThe RN in recovery will: Ensure school staff member are present to manage student behaviour Observe all students for at least 15 minutes post immunisation for unexpected and

adverse events and provide care as required Contact CNC or manager for support and advise following any unexpected and adverse

events Ensure the students have a record of immunisation and aftercare information when

leaving the recovery area Ensure any student who remains unwell after observation period is taken to the

school’s sickbay. The student is escorted by at least one nurse and one other person and is left in the care of a designated person from education.

Report adverse events as per management of Adverse Events following Immunisation (See Section 9)

3.4 School Immunisation Records3.4.1 Immunisation Record At the end of the school year, students that have missed vaccines will be sent a letter

advising parent/guardian of the vaccine missed and it’s availability from GP (in the ACT) free of charge for the next 12months.



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All student immunisation records will have URN added to the record Immunisation record at completion of program will be boxed to be scanned onto

student medical record

3.4.2 National HPV Vaccination Register All students given the Human Papillomavirus vaccine (HPV) by the school immunisation

nurses will have their data entered onto the National HPV Vaccination Program Register via excel spreadsheets. Nurses will be instructed on use of the HPV Vaccination Register as part of their orientation to the team and before given access to the Register.

Prior to commencing the CNC will set up on–line access. It is the responsibility of the team member completing the data entry of the school to

convert and upload the file onto the National HPV Vaccination Register.


Section 4 – Contact Prophylaxis Immunisation Clinics

Contact Prophylaxis Immunisation clinics are organised at short notice in order to manage contacts following exposure to a vaccine preventable disease e.g. Measles Contact Prophylaxis Immunisation clinics will be managed between the Walk- in Centre (WiC) Belconnen Community Health and WYCCHP.

4.1 Health Protection Services (HPS) will notify: Assistant Director of Nursing (ADON) WiC for management of the contact clinic

processes ADON, WYCCHP who will organise staff to vaccinate children under 2 years of age, if

required

4.2 Clinic site: Belconnen Community Health Centre (BCHC) WiC only

This facility utilised for appropriate reception area with reception staff, on duty seven days a week from 7:30 am to 10pm with suitable areas for post vaccination observation.

4.3 Staffing Nursing staff from WiC to administer vaccines Credentialed immunising staff from WYCCHP to administer vaccines to children less

than 2 years of age WiC staff to organise access to BCHC level 3 through IAM for vaccines supplied by HPS

as the WiC vaccine fridge has limited storage capacity

4.4 EquipmentWYCCHP to provide: needles, syringes (Need 19g, 23 g and 25g and 2 ml syringes) eskies for vaccine decanting thermometers to manage the cold chain monitoring



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Resuscitation equipment i.e. Laerdal resuscitator for children under 2 years adrenaline in case of adverse event

WiC to provide: Resuscitation equipment i.e. bag and mask for clients ˃ age 2

HPS to provide: vaccines (delivered to WYCCHP MACH fridge, level 3 BCHC) Pre and post vaccination information, generic consent forms Medication standing orders Prospective client names and DOB prior to client arrival by phoning WiC BCHC

Reception on (02) 6205 443


Section 5 – Management of Adverse Events following Immunisation

To be read in conjunction with Australian Immunisation Handbook 10th Ed, pp 85-97

5.1 EquipmentEnsure that emergency equipment is available as follows: Phone, fully functioning Laerdal resuscitator age appropriate Adrenaline 1:1000 (2 vials and 1ml syringes, 23g needles) Basic Life Support Flow Chart (See Attachment 6) Ambulance Information Chart (See Attachment 8) Nursing Management of Anaphylaxis flow chart (See Attachment 9)

5.2 ProcedureTo minimise the risk of an adverse event following immunisation all persons prior to vaccination are screened using the pre-vaccination checklist (Attachment 4)

All nurses must be able to distinguish between anaphylaxis; convulsions and a vasovagal episode refer to Australian Immunisation Handbook 10th Ed, 87-88

Recipients of vaccines to remain under direct observation of a Nurse for at least 15 minutes following immunisation.

Adverse Events that include anaphylaxis, prolonged loss of consciousness, severe asthma Phone Ambulance-000 Notify Parents/Guardian Inform CNC as soon as practical School Immunisation to notify School Staff Member



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5.3 DocumentationAll adverse events are reported on Report of Adverse Event Following Immunisation (AEFI) form (See Attachment 10). This is faxed within 48 hours to Health Protection Service on 6205 1738.

A RiskMan report is also made via the Health Intranet (https://acthrisk/) or by phone when computer access is not available: Phone the Help desk on 6205 4000.


Section 6 – Competency Assessment for Registered Nurse Immunisers

6.1 ProcedureAll RNs that work within the Child and/or School Immunisation Clinics are required to complete WYCCHP Self Directed Learning Immunisation package within 6 weeks of commencing employment to Immunisation Clinics.

To maintain immunisation competency the RN will: be assessed as competent in Basic Life Support every twelve months by a credentialed

assessor have an annual immunisation competency assessment attended by CDN/CNC or

Immunisation RN with Certificate IV in Workplace Training and Assessment The assessment is completed using:

o the WYCCHP Immunisation Competency Assessment form (See Q:\CH\CY&W\CY&W_General\CDN\Competency Assessment)

o WYCCHP Competency Assessment- Administration of Adrenaline in Immunisation Adverse Event

o (See Q:\CH\CY&W\CY&W_General\CDN\Competency Assessment)

Evidence of competency will be recorded by CDN/CNC/School Immunisation Coordinator on Capabiliti and a copy retained by the RN for her own records.




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Implementation

This Clinical Procedure document will be implemented and communicated to RNs who are credentialed to immunise. The document will be incorporated into the clinical pathway for MACH nurses and the orientation package for Immunisation Nurses. The document will be available in hardcopy where computer access is not available.


Related Policies, Procedures, Guidelines and Legislation

Policies ACT Health, Consent to Treatment Policy ACT Health, Work Health and Safety Policy CHHS Clinical Policy Medication Handling CHHS Patient Identification and Procedure Matching Policy

Procedures ACT Health Consent for a Child or Young Person SOP ACT Health Consent to Treatment SOP ACT Health Management of Severe Allergic Reactions and Anaphylaxis in Adults and

Children ACT Health Vaccine Cold Chain Management CHHS Patient Identification and Procedure Matching Procedure ACT Health Standing Medication Orders for current year CHHS Medication Standing Orders for current year

Guidelines The Australian Immunisation Handbook, 10th Edition, 2013 National Vaccine Storage Guidelines, 2013-Strive for 5, 2nd Edition

Legislation Medicines, Poisons and Therapeutic Goods Regulation, 2008


References

Australian Government Department of Health and Ageing, 2013, the Australian Immunisation Handbook, 10th Edition, Commonwealth of Australia

Australian Government Department of Health and Ageing, 2013, National Vaccine Storage Guidelines – Strive for 5, 2nd Edition, Commonwealth of Australia

Health Industry Commission ACIR Website (Medicare Australia)



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Australian Government Department of Health & Ageing, 2011, Understanding Childhood Immunisation, Australian Government.

Therapeutic Goods Administration, 2014, Infection Prevention and Control – Bug BustersNewsletter, October


Definition of Terms

ADON Assistant Director of NursingAEFI Adverse Event Following Immunisation that is an unwanted or unexpected event

following immunisationCALD Culturally & Linguistically Diverse CHHS Canberra Hospital and Health ServicesCNC Clinical Nurse ConsultantHPS Health Protection Service, in the Population Health Division of ACT HealthHPV Human Papillomavirus vaccineMACH Maternal & Child HealthNIP National Immunisation ProgramNHIG Normal Human ImmunoglobulinRN Registered NurseWiC Walk in CentreWHS Workplace Health and SafetyWYCCHP Women Youth & Children Community Health Program


Search Terms

Chicken Pox, Diphtheria, HPV, Human Papillomavirus, Immunisation, InoculationPertussis, School Health, School Immunisation, Tetanus, Vaccination, Varicella, Whooping cough




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Attachments

Attachment 1 – After Your Child has been ImmunisedAttachment 2 – Student Vaccination RecordAttachment 3 – Pre-vaccination Check list for Immunisation ClinicAttachment 4 – Pre-vaccination Check list for School ImmunisationAttachment 5 – Guidelines for safe immunisation in schoolsAttachment 6 – Basic Life Support Flow ChartAttachment 7 – Adrenaline dose chart for anaphylaxisAttachment 8 – Ambulance templateAttachment 9 – Nursing Management Anaphylaxis Post Immunisation Flow ChartAttachment 10 – Immunisation Adverse Event Reporting Form

Disclaimer: This document has been developed by ACT Health, Canberra Hospital and Health Service specifically for its own use. Use of this document and any reliance on the information contained therein by any third party is at his or her own risk and Health Directorate assumes no responsibility whatsoever.

Date Amended Section Amended Approved ByEg: 17 August 2014 Section 1 ED/CHHSPC Chair



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Attachment 1 – After Your Child has been Immunised



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Attachment 2 – Student Vaccination Record



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Attachment 3 – Pre-vaccination Check list for Immunisation Clinic

PRE VACCINATION SCREENING CHECKLISTFOR CHILDREN AGED 0-5 YEARS

PLEASE READ THIS INFORMATIONASK IF YOU NEED MORE INFORMATION BEFORE DECIDING TO PROCEED

The following information is needed to assess whether your child can be vaccinated and which vaccines they may require. Before any vaccination takes place please tell the immunisation provider if any of the following apply to your child:

Is unwell today e.g. High temperature, not drinking adequate fluids/breast milk, or is lethargic

Has had a severe reaction following any vaccine e. g. Breathing difficulties, skin weals or itchiness, facial swelling

Had any severe allergies (to anything) e. g. Anaphylaxis, collapse, breathing difficulties

Has received immunoglobulin, blood products or whole blood transfusion in the past year e.g. Following exposure to chickenpox, measles, or due to injury or chronic illness.

Has a chronic illness. This may require additional vaccines e.g. Cystic Fibrosis, Down Syndrome, Cardiac Disease, Insulin Dependent Diabetes, Intracranial shunts, Cochlear implants

Has received a vaccine in the past month Includes travel vaccines and other childhood vaccines

Identifies as Aboriginal or Torres Strait Islander This may alter the vaccination schedule

Has a disease which lowers immunity or is receiving treatment which lowers immunity e.g. Cancer, HIV, receiving chemotherapy, radiotherapy, having high doses of steroids or has a non functioning spleen

Has a past history of Intersusseption If yes Rotavirus vaccine should not be given

Lives with someone who has a disease which lowers immunity or lives with someone receiving treatment that lowers immunity This does not contraindicate vaccination but may give rise to further considerations



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Was born preterm Born before 32 weeks

Has a bleeding disorder This may require a different injection technique

Has a past history of Guillain-Barre Syndrome This is rarely seen in children

PLEASE WAIT FOR 15 MINUTES AFTER YOUR CHILD IS IMMUNISED

NOTE: IF YOU HAVE ANY QUESTIONS ABOUT THIS INFORMATION OR ANY OTHER MATTER RELATING TO VACCINATION, PLEASE ASK THE NURSE BEFORE THE VACCINES ARE GIVEN

REFERENCE: The Australian Immunisation Handbook 10th edition 2013



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Attachment 4 – Pre-vaccination Check list for School Immunisation

PRE VACCINATION CHECKLIST FOR IMMUNISATION PROGRAMS

This checklist helps the nurse decide about vaccinating you today

Please tell the nurse if you: Are unwell today e. g. high temperature, fever Have fainted following vaccination or any injection Have had a severe reaction following any vaccine e. g. breathing difficulties, skin weals

or itchiness, facial swelling, Guillain-Barré Syndrome Have had any severe allergies (to anything) e. g. Anaphylaxis, collapse, breathing

difficulties

Have received a vaccine in the past month

Have a medical condition e. g. epilepsy, asthma, diabetes, including previous Guillian-Barré syndrome

Have a bleeding disorder Have received an injection of immunoglobulin, or received any blood products within

the past year

Are pregnant or could be pregnant Have a disease or treatment that lowers immunity e.g. cancer, HIV, receiving

chemotherapy, radiotherapy, high doses of steroids Live with someone who has lowered immunity

If you have asthma please ensure you have your inhaler with you and if you have gum please dispose of this before you see the nurse.

You will be required to wait for 15 minutes after your immunisation in the recovery area, you are asked NOT to eat anything during this time.

The nurse will tell you when it is time to leave to return to leave.

If you have any questions about this information or any other matter relating to vaccination, please ask the nurse before the vaccine is given.

THANK YOU FOR YOUR COOPERATION

REFERENCE: the Australian Immunisation Handbook 10th edition 2013



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Attachment 5 – Guidelines for safe immunisation in schools

The School Health Program nurses are committed to evidence base nursing practice when they carry out school based immunisation programs. In keeping with these protocols and Occupational Health and Safety Legislation this is a minimum standard required to provide an immunisation service in your school.

When confirming the dates for the immunisation at your school can you please book the venue that meets these standards for the day/days of immunisation

This is a check list to help you decide if the room and equipment is appropriate for immunisation

Date Checked Requirements Requirements MeetYes No

Parking to be as close as possible to the room the nurses will be using for vaccinating, as there is a large amount of equipment to be carried.Emergency Procedures including location of fire extinguishers, nearest exits and assembly points.2 members of staff, 1 to help organise the front another to remain in the recovery area –see notes below

Room/s size will depend on the size of the schoolThe room should be large enough to accommodate 4 to 6 nurses sitting at table/s to administer vaccinesA post vaccination recovery area/room needs to be adjoining, or partitioned from the vaccinating area/room.Recover area will depend on student numbers, as they will be seated on the floor that is carpeted or has gym mats.

The nurses will be observing these students for at least 15 minutes after immunisation.This requirement is mandatory due to the risk of students either fainting or suffering an adverse reaction. If school staffs remove the students prior to 15 minutes they take on responsibility for the student’s wellbeing.Exclusive use of the room while at the school to carry out immunisations and be able to secure the room when unattended.The room should have two doors to allow for a smooth flow of students in and out.



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Date Checked Requirements Requirements MeetYes No

Room/s size will depend on the size of the school (cont)The room will need to meet infection control requirements by being as clean as possible and have adequate lighting and heating/cooling as appropriate with hand washing facilities nearby2 - 4 school desks or 2 large tables of a good working height for adults and 1 additional large table.

Equipment will be dependent on school size4-6 adjustable office chairs on wheels, without arms on for the nurses. This is a Work Safety requirement to reduce the risk of injury. There is a lot of twisting and turning when giving vaccinations that can lead to neck and back problems.3-6 normal adult sized chairs for the students.2 – 3 large floor length screens or similar, if the immunisation and recovery areas are in the same room. The National Guidelines for immunisation states that the client needs to have privacy when being vaccinated.Paper Recycle Bin and general waste bin.

What will happen on the day of immunisation? In most cases the nurses will arrive at your school between 9.00 to 9.15am. The School Health Team will require the venue for a Full School Day due to the

increased number of vaccines to be given. In a small number of cases there will be two small schools that are visited on the same

day. The first school’s times will be as above. The second school will be given and expected time of arrival closer to the day of immunisation.

It would be appreciated if all the furniture/equipment is in the designated room/s. The nurses will set up their equipment and prepare their vaccines ready to begin

vaccinating between 9.15-9.30am.

What the school can do to provide the best outcomes for the students on the day of immunisation?

We require the students to be supervised during the immunisation program as the nurses do not have duty of care and are not trained in managing student behaviour. Therefore we ask that students are supervised by a teacher in the recovery area.

It is preferable that students waiting for vaccinations are supervised separately from post vaccination students to assist in reducing possible distress.

Therefore we would request that: A teacher or designated person is required to supervise the students prior to

vaccination. They will be responsible for marshalling the students and ushering



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students in to the immunisation area/room. They can provide reassurance to the students and identify the students who would benefit by having their vaccinations without a wait; this would include students with medical, physical or emotional conditions (e.g. asthma, anxiety, fear of immunisation etc).

A second teacher/designated person will be required to supervise the students while in the recovery area. The school could provide some quiet activities for the 15 minute post immunisation period, such as DVDs, books etc.

The students should be encouraged to eat prior to vaccination, as low blood sugar levels can be a predisposing factor to fainting and to bring their water bottles with them during hot weather.

Where possible the children should be allowed to wear their sports uniform on the day of immunising to allow easier access to the upper arm and to assist with the student’s privacy.

Thank You for your assistance in meeting these guidelines for the School Health Team Should you have any enquiries please contact us on following phone numbers: School Health Office: 62052086 School Immunisation Coordinator: 62050747



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Attachment 6 – Basic Life Support Flow Chart



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Attachment 7 – Adrenaline dose chart for anaphylaxis

ADRENALINE

The recommended dose of 1:1000 ADRENALINE is 0.01mg/kg body weight given by deep intramuscular injection.

The following table lists the doses of 1:1000 Adrenaline to be used if the exact weight of the individual is not known.

DOSE OF 1:1000 (one in one thousand)ADRENALINE FOR ANAPHYLAXIS

Less than 1 year 0.05 – 0.1ml1 – 2 years (approx 10kg) 0.1ml2 – 3 years (approx 15kg) 0.15ml4 – 6 years (approx 20kg) 0.2ml7 – 10years (approx 30kg) 0.3ml11 – 12 years (approx 40kg) 0.4ml> 12 years and adult (over 50kg) 0.4 – 0.5ml

Australian Government. 2013. The Australian Immunisation Handbook, 10th Edition, Commonwealth Department of Health and Aging. Australian Government Printing Service, Canberra, pp 90



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Attachment 8 – Ambulance template

AMBULANCE – Police or FireDial 0 wait for dial tone then 000

If using a mobile dial 000State you are in the ACT

The Address of this Clinic/School

It is located in the Suburb of _______________________

Nearest Main Road _______________ Postcode____________

The Telephone Number _____________________________

It calling an Ambulance state – You are a Registered Nurse The age and condition of the client Have someone meet the ambulance to provide directions to the room

where assistance is require

If in a Regional Health Centre phone the reception staff on ____________ so they can provide direction

Your Nearest Emergency EXIT is located ___________________________________



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Attachment 9 – Nursing Management Anaphylaxis Post Immunisation Flow Chart



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Attachment 10 – Immunisation Adverse Event Reporting Form



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Doc Number Version Issued Review Date Area Responsible Page<xxxxx/xxx> X <XX/XX/XXXX> <XX/XX/XXXX

(> or = 3 yrs)XXXX 37 of 37

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