Primary Care Childhood Vaccination Policy (COR/PBH.03/V1.00)

Transcription

1 Primary Care Childhood Vaccination Policy (COR/PBH.03/V1.00) BACKGROUND This policy is based on NICE Public Health Guidance 21 and outlines the minimum standard of care that must be in place in all practices commissioned by NHS Hampshire to provide childhood s; it is integral to the Child Health Surveillance programme. The role of the Health Visitor, Practice Nurse and General Practitioner is vital in this agenda if children are to be protected against vaccine-preventable diseases. The flowchart explains the minimum actions that all practices and their teams must implement within NHS Hampshire. The aim of this procedure is to clarify the process for inviting children for and the steps to take when the child does not attend that initial appointment. AIM The aim is to ensure that every opportunity is used to encourage the uptake of childhood vaccines to reduce the transmission and incidence of vaccine-preventable communicable diseases. STANDARDS At every appropriate opportunity with a child the professional should ascertain the immunisation status of the child and offer as necessary. This should also be integral to each child health review (NICE, 2009). All vaccinators involved in childhood s, should be trained to vaccinate prior to taking on this extended role, as recommended by the Health Protection Agency (HPA, 2005a). Initial courses are provided by the Learning and ganisational Development (LOD) team at Hampshire Community Health Care (HCHC). However, any course which meets the standards set by the Health Protection Agency can be accessed (HPA, 2005b). A record of training should be maintained by the GP surgery in addition to that kept by the individual for professional registration purposes. All vaccinators should undertake an update study day every 3 years, at least, after their initial training course. Suitable training modules can be diverse and may include cascade or web based training. These updates are also provided by LOD team at HCHC. Regular information will be provided from the Hampshire and Isle of Wight Health Protection Unit (HPU) and the Immunisation Co-ordinator at NHS Hampshire via a cascade system. This has been established through the Professional Development Leads, and it is the responsibility of all vaccinators to ensure the Professional Development Lead for their area is informed of their address. When a parent refuses to get their child vaccinated an opt-out form must be completed and a record must be made in the child s notes. The appropriate Child Health Information System (CHIS) manager must also be informed. The Department of Health guidance Immunisation against infectious disease, colloquially known as The Green Book, should be available to all vaccinators during each clinic.

2 Each practice should identify an Immunisation Lead who will be responsible for promoting and monitoring uptake rates in their practice (NICE, 2009). The immunisation lead should ensure there is a local written policy for delivery and work towards achieving the World Health ganisation (WHO) target of 95%. Flexible appointments for s should be offered when possible, especially for persistent non-attenders. Longer appointment times should be considered for those parents with anxieties and concerns about the scheduled, allowing time for discussion. Staff should ensure that there is parental information available before and during the process. This should specifically concern the vaccine due to be administered. Leaflets on all vaccines can be ordered directly from Clinics should be manned by a minimum of two staff, one of which is required to be a qualified immuniser, as per national guidelines. This improves parental experience, reduces the likelihood of return visits and minimises the possibility of administration or clerical errors. Each practice must ensure and be able to demonstrate that vaccines have been stored correctly according to national guidelines (DH, 2006 Chapter 3). Each practice must ensure that a record of all s is recorded in the Personal Child Health Records and the practice s primary care information system. Agreed Read codes must be used at all times for electronic recording of s. See pages 5-10 of this policy. All s must be reported to the appropriate CHIS, which will be used by the Practitioner and Patient Services Agency (PPSA) for Hampshire and the Isle of Wight to calculate payment. REFERENCES Butler JR. (1997) Child Health Surveillance in England and Wales: the good news. Child: Care, Health Dev;23: Department of Health (2006) Immunisation against Infectious Disease The Green Book. Department of Health. Available at: Department of Health (2008) The Child Health Promotion Programme. Pregnancy and the first five years of life. London; Department of Health. Department of Health (2009) Healthy Child Programme from 5-19 years old. London; Department of Health. Hall D, Elliman D. (2003) Health for all children. 4th ed. Oxford: Oxford University Press. Health Protection Agency (2005a) Core Curriculum for Immunisation Training. Available at: Health Protection Agency (2005b) National Minimum Standards for Immunisation Training. Available at: National Institute for Health and Clinical Excellence (2009) Reducing differences in the uptake of immunisations (including targeted vaccines) among children and young people aged under 19 years. London; NICE. Available at: Date Written: March 2010 Author: N McFarland, Immunisation Co-ordinator, NHS Hampshire Date Agreed: Review Date: March

3 Childhood Vaccination Policy Letter will be sent by CHIS or the practice. Parent/carer sent letter requesting attendance of child for as per national schedule. At new birth visit health visitor discusses s and provides leaflet. Declines. Attends Opt out form to be signed Yes No Document in notes, PCHR and inform CHIS. A second reminder letter to be sent Practice to check contact details are correct. Liaise with HV. Attends Yes No Presents at practice- Opportunistic considered Surgery to contact parents directly and invite to attend. GP to vaccinate Yes Attends Opt out form to be signed No Declines. Health visitor informed and to make contact with the family and facilitate opportunistic. Document in PCHR and inform CHIS. PCHR = Personal Child Health Records 3

4 NATIONAL VACCINATION SCHEDULE When to immunise Diseases protected against Vaccine given Two months old Diphtheria, tetanus, pertussis (whooping cough), polio and Haemophilus influenzae type b (Hib) Pneumococcal infection DTaP/IPV/Hib + Pneumococcal conjugate vaccine, (PCV) Three months old Diphtheria, tetanus, pertussis, polio and Haemophilus influenzae type b (Hib) Meningitis C DTaP/IPV/Hib + MenC Four months old Diphtheria, tetanus, pertussis, polio and Haemophilus influenzae type b (Hib) Meningitis C Pneumococcal infection DTaP/IPV/Hib + MenC + PCV Around 54 weeks Haemophilus influenza type b (Hib) / Meningitis C Measles, mumps and rubella Pneumococcal infection Hib/MenC MMR + PCV Three years and four months or soon after Diphtheria, tetanus, pertussis and polio Measles, mumps and rubella DTaP/IPV or dtap/ipv +MMR Girls aged 12 to 13 years Cervical cancer caused by human papillomavirus types 16 and 18. HPV 13 to 18 years old Diphtheria, tetanus, polio Td/IPV FOR AT RISK NEONATES ONLY When to immunise Disease protected against Vaccine Birth Tuberculosis Bacillus Calmette-Guèrin (BCG) Birth 1 month 2 months 12 months Pre-school Hepatitis B Hepatitis B 4

5 Childhood Vaccinations - Suggested Read Codes - V2 (for all users except HealthySoft & TPP SystmOne users) It is advisable to always use the templates on your clinical systems for recording s, to ensure accurate and consistent coding. InPS Vision users: 1. For combined vaccines Vision records separate Read codes for each of the individual vaccine component parts, rather than the combination Read codes shown below. 2. It is advisable to avoid using the "Advised" option under the "Status" button, as this will record the Read code even though you haven't actually given the vaccine. Age Vaccination Read Code Term Read code for Refusal Term 1st DTaP/IPV/Hib 65a0. 2 months 1st Pneumococcal 657L. First diphtheria tetanus and five component acellular pertussis, HIB, inactivated polio First pneumococcal conjugated 68NX. No consent pneumococcal immunisation 2nd DTaP/IPV/Hib 65a1. Second diphtheria tetanus and five component acellular pertussis, HIB, inactivated polio 3 months 1st Men C 657E. First meningitis C 68Nf. 68Nh. No consent for meningitis C immunisation Meningitis C immunisation refused 4 months 3rd DTaP/IPV/Hib 65a2. Third diphtheria tetanus and five component acellular pertussis, HIB, inactivated polio

6 2nd Men C 657F. Second meningitis C 2nd Pneumococcal 657M. 1 year Hib/MenC 65b.. 68Nf. 68Nh. No consent for meningitis C immunisation Meningitis C immunisation refused Second pneumococcal conjugated 68NX. No consent pneumococcal immunisation Haemophilus influenzae type B and meningitis C And/ 68Nf. And/ No consent for meningitis C immunisation 1st MMR 65M1. Measles/mumps/rubella vaccn. 68Na. No consent for MMR1 13 months 3rd Pneumococcal 657N. Third pneumococcal conjugated 68NX. No consent pneumococcal immunisation DTaP/IPV 65I8. Low dose diphtheria, tetanus, five component acellular pertussis and inactivated polio 68NR. No consent pre-school vaccs. OR 65I9. Booster diphtheria, tetanus, acellular pertussis and inactivated polio as above as above MMR booster 65MB. MMR pre-school booster 68Nb. No consent for MMR2 Pre-school Booster OR 65MA. Measles mumps and rubella booster as above as above Girls aged years old HPV 65FS. 65FT. 65FV. First human papillomavirus Second human papillomavirus Third human papillomavirus 68Np. No consent for human papillomavirus vacci School leaver Td/IPV 65K5. Low dose diphtheria, tetanus and inactivated polio 68NS. No consent school exit vaccs. 6

7 Other Useful Codes 8I23. Immunisation contraindicated 9O51. Child imm.- 1st call 9O52. Child imm.- 2nd call 9O53. Child imm.- 3rd call 14OI. Missed childhood immunisations 9N4b. DNA - DTP, Hib and polio 9N4c. DNA - DTaP, polio and MMR booster 9N4d. DNA - 2nd DTP, Hib and polio 9N4e. DNA - 3rd DTP, Hib and polio Tuberculosis (BCG) 68ND. No consent BCG 65F1. 1st hepatitis B 65F2. 2nd hepatitis B 65F3. 3rd hepatitis B 65F4. Boost hepatitis B 65F6. 4th hepatitis B 65F7. 5th hepatitis B 65FM. Sixth hepatitis B 68Nm. Hepatitis B refused 7

8 Childhood Vaccinations - Suggested Read Codes - CTV3 (for TPP SystmOne and HealthySoft users) It is advisable to always use the templates on your clinical systems for recording s, to ensure accurate and consistent coding. TPP SystmOne Users: SystmOne does not use Read codes to record s. You may find the Refusal codes useful however. Also see "Other Useful Codes" below the table. Age Vaccination Read Code Term Read code for Refusal Term 1st DTaP/IPV/Hib XaK4t 2 months 1st Pneumococcal XaLqs First diphtheria tetanus and five component acellular pertussis, haemophilus influenzae type b, inactivated polio First pneumococcal conjugated 68NX. No consent pneumococcal immu 2nd DTaP/IPV/Hib XaK4u Second diphtheria tetanus and five component acellular pertussis, haemophilus influenzae type b, inactivated polio 3 months 1st Men C XaF1x First meningitis C XaFqp No consent for meningitis C imm 4 months 3rd DTaP/IPV/Hib XaK4v Third diphtheria tetanus and five component acellular pertussis, haemophilus influenzae type b, inactivated polio 8

9 2nd Men C XaF1y Second meningitis C XaFqp No consent for meningitis C imm Second pneumococcal conjugated 2nd Pneumococcal XaLqt 68NX. No consent pneumococcal immu 1 year Hib/MenC XaMKL Haemophilus influenzae type B and meningitis C And/ XaFqp And/ No consent for meningitis C imm 1st MMR 65M1. Measles/mumps/rubella XaClD No consent for MMR1 13 months 3rd Pneumococcal XaLqu Third pneumococcal conjugated 68NX. No consent pneumococcal immu DTaP/IPV XaK4w Low dose diphtheria, tetanus, five component acellular pertussis and inactivated polio 68NR. No consent - pre-school vaccina MMR booster 65MB. MMR pre-school booster XaClE No consent for MMR2 Measles mumps and rubella booster Pre-school Booster OR 65MA. as above as above XaNNI XaNNJ First human papillomavirus Second human papillomavirus Third human papillomavirus No consent for human papilloma Girls aged years old HPV XaNNK XaPlr School leaver Td/IPV XaK4x Low dose diphtheria, tetanus and inactivated polio 68NS. No consent - school exit vaccina 9

10 Other Useful Codes XE0iZ Immunisation contraindicated 9O51. Child imm.- 1st call 9O52. Child imm.- 2nd call 9O53. Child imm.- 3rd call XaInY Missed childhood immunisations XaLLK Did not attend child immunisation XaJh0 DNA - DTP, Hib and polio XaJh1 DNA - DTaP, polio and MMR booster XaJh2 DNA - 2nd DTP, Hib and polio XaJh3 DNA - 3rd DTP, Hib and polio Tuberculosis (BCG) XaLK7 Booster tuberculosis (BCG) 68ND. No consent BCG X74VC Hepatitis B immunisation 65F1. First hepatitis B 65F2. Second hepatitis B 65F3. Third hepatitis B 65F6. Fourth hepatitis B 65F7. Fifth hepatitis B XaKXg Sixth hepatitis B 65F4. Booster hepatitis B 10