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ENTER NAME OF ORGANISATION Protocol for the administration of 23-valent Pneumococcal Polysaccharide vaccine to adults by Health Care Assistants Purpose of Protocol To enable suitably trained Health Care Assistants working for or on behalf of ENTER ORGANISATION NAME who have undertaken relevant training (as outlined below), to administer pneumococcal vaccine to adults as a single dose, as a duty delegated by the General Practitioner or a registered nurse. Staff characteristics Staff group(s) Additional requirements Health Care Assistants Continuing training requirement Completion of HCA training course on administration of pneumococcal vaccines to adults Completion of period of supervised practice and completion of assessment of competence Training and competence in the correct procedure of administering medication via intra-muscular injection Knowledge of ENTER ORGANISATION NAME policy on management of Anaphylaxis in the community Access to and knowledge of the DH guidance ‘Immunisation against infectious disease’ Annual update in Basic Life Support and treatment of anaphylaxis. Demonstration of competence in relation to this medication within the PDP and appraisal process Annual immunisation update. Consent Refer to organisation’s policy on consent Clinical condition Clinical condition to be treated: All High-risk patients requiring pneumococcal vaccination Criteria for inclusion Please see latest chapter of the Green Book available at: https://www.gov.uk/government/upl oads/system/uploads/attachment_d ata/file/263318/Green-BookChapter-25-v5_2.pdf All patients aged 65 and over Any adult (over the age of 18 years) who has a confirmed diagnosis of one of the following diseases: Chronic heart / renal /liver/ respiratory disease, Diabetes, Asplenia or dysfunction of the spleen, Immunosuppression (after consultation with GP), Cochlear implants, CSF shunts Welders Criteria for exclusion Patients with one of the following: Aged under 18 years Current acute illness Pregnancy/breastfeeding Previous severe reaction to any vaccine or vaccine component Unable to give valid consent Healthy adults under the age of 65 years Previous pneumococcal vaccination with the exception of those with absent or dysfunctional spleen or chronic renal disease Patients with Hodgkins Disease who have received extensive chemotherapy or nodal irradiation Circumstances for further advice/action 1. Consent not given: Counsel with regards to the risks of pneumococcal infections and the protective effect of the vaccine 2. Pregnancy or breast feeding: Refer to GP 3. Acute febrile illness: Re-arrange vaccination at appropriate date Recommended treatment, route and legal status Pneumococcal polysaccharide vaccine to be administered by intramuscular injection into the deltoid muscle If administering influenza immunisation at the same time, use different site of injection Prescription Only Medicine (POM) Dosage & Criteria Adults 0.5ml Frequency of administration & maximum dosage Normally a once only injection Routine booster every 5 years for those with no spleen or splenic dysfunction or chronic renal disease Follow-up & advice Re-immunisation is not normally advised Side effects & their management Local side effects: Redness, swelling, hardness at injection site Systemic side effects: Low grade fever Treat with paracetamol Special considerations/Concurrent medication No drug interactions known The immune response to pneumococcal vaccination is reduced in those who are immunosuppressed or immunodeficient, including HIV patients. Patients should be individually assessed by the GP for the risk vs benefit of immunisation Immunosupressant therapy e.g. Corticosteroids, chemotherapy or radiotherapy may result in reduced antibody response. The benefits are such that immunisation should be considered. Refer to GP for advice. Clinical aspects The following will be required: 1. Patient specific direction – written by the General Practitioner or Independent Nurse Prescriber 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. Health Care Assistants are advised to familiarise themselves with the ENTER ORGANISATION NAME Consent Policy 4. Record Keeping – The following should be recorded in the patients notes or on the computer system according to the GP practice system o Name of drug, dose, route and site of administration o Date administered o Batch number and expiry date o Signature of person administering – written or electronic. o Checklist for influenza and pneumococcal immunisations o Patients assessed as not appropriate for vaccination and any alternative action taken o If the patient has declined the vaccination and any alternative action taken o Any reaction should be recorded in the clinical record Adverse reactions Health Care Assistants must ensure that Adrenaline 1:1000 or an Anaphylactic shock pack is available. 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 If anaphylactic reaction occurs: Give treatment in accordance with the organisation’s policy on the Management of Anaphylaxis in the community Record in patients notes Inform patients General Practitioner as soon as possible Complete Yellow Card if suspected severe reaction. Relevant training 1. Health Care Assistants will undertake training covering the following aspects of the administration of the 23-valent pneumococcal polysaccharide vaccine Appropriate anatomy and physiology Correct procedure for the administration of the vaccine via intra-muscular injection Vaccine delivery, storage and stock control requirements, maintaining the cold chain Cautions and side effects related to the administration of 23-valent pneumococcal vaccine Documentation Legal aspects of drug administration using Patient Specific Directions 2. Health Care Assistants will have successfully completed a relevant course/qualification. This could be NVQ3 or an accredited course (Foundation or Level1) from an academic institution. They should have completed a course in Basic Life Support 3. Health Care Assistants will undergo a period of supervised practice and assessment and will be directly observed administering intramuscular injections of the 23-valent pneumococcal polysaccharide vaccine by the general practitioner or nurse mentor Assessment of competence General practitioner or registered nurse mentor will provide supervised practice and assessment of completion of competency. Health Care Assistants will be assessed by written assessment. Competence will be assessed by direct observation and questioning of the Health Care Assistants ability to: Prepare the patient for the procedure Safely administer the medication (including choice of site, needle size and injection technique) and observation of the patient post procedure Correct disposal of clinical waste Correct documentation Correct procedure followed for delivery, storage and stock control of the vaccine Significant events Any significant event which occurs during or as a result of administration of medication must be reported to the Practice Manager / General Practitioner (GP employee) or the Registered Nurse / Manager (PCT employee), and the incident reported via the PCT significant event reporting framework. Audit: Health Care Assistants will be expected to participate in audit in relation to patient outcomes and the development of this role. Health Care Assistants must be familiar with the following documents: ENTER ORGANISATIONs DOCUMENTS AS APPROPRIATE e.g. Consent Policy Documentation Policy Significant Event Reporting Policy NMC Guidelines for the Administration of Medication NMC Guidelines for Records and Record Keeping References Immunisation against Infectious Disease (Green Book) DH National Minimum Standards and Core Curriculum for Immunisation Training for HealthCare Support Workers 2015 This protocol has been devised by: Signature: Date: Signature: Date: This protocol has been accepted by ENTER ORGANISATION NAME Medicines Management Group: Signature Date: Review: It is the responsibility of the lead of the staff groups to whom this protocol applies to ensure the review process takes place. This protocol becomes valid on ENTER DATE and becomes due for review on ENTER DATE Protocol for 23-valent Pneumococcal Polysaccharide Vaccine Agreement for Health Care Assistants within ENTER ORGANISATION NAME This protocol is to be read, agreed and signed by all Health Care Professionals it applies to: Approved base: ………………………………………………………………….. Staff name: …………………………………………………………………… Designation: …………………………………………………………………… Signature: ……………………………………………………………………. Date: …………………………………………………………………….. Managers signature: ……………………………………………………………… Date: ……………………………………………………………………. The Health Care Professional should retain a copy of the document after signing and the original be retained in their personal file.