MODULE Influenza vaccination - Prevention - Brisbane South PHN
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Prevention
Influenza
vaccination
MODULE
Version 2
QUALITY IMPROVEMENT TOOLKIT
ADULT VACCINATION - INFLUENZA
Introduction
The Quality Improvement Toolkit
This Quality Improvement (QI) Toolkit is made up of modules that are designed to support your practice to make
easy, measurable and sustainable improvements to provide best practice care for your patients. The Toolkit will
help your practice complete Quality Improvement (QI) activities using the Model for Improvement.
Throughout the modules you will be guided to explore your data to understand more about your patient
population and the pathways of care being provided in your practice. Reflections from the module activities and
the related data will inform improvement ideas for you to action using the Model for Improvement.
The Model for Improvement uses the Plan-Do-Study-Act (PDSA) cycle, a tried and tested approach to achieving
successful change. It offers the following benefits:
• it is a simple approach that anyone can apply
• it reduces risk by starting small
• it can be used to help plan, develop and implement change that is highly effective.
The Model for Improvement helps you break down your change into manageable pieces, which are then tested to
ensure that the change results in measurable improvements, and that minimal effort is wasted.
There is an Influenza example using the Model for Improvement and a blank template for you to complete at the
end of this module.
If you would like additional support in relation to quality improvement in your practice please contact Brisbane
South PHN on optimalcare@bsphn.org.au
Due to constant developments in research and health guidelines, the information in this document will need to be
updated regularly. Please contact Brisbane South PHN if you have any feedback regarding the content of this
document.
This icon indicates that the information relates to the ten Practice Incentive Program (PIP) Quality
Improvement (QI) measures.
Acknowledgements
We would like to acknowledge that some material contained in this Toolkit has been extracted from organisations
including the Institute for Healthcare Improvement, the Royal Australian College of General Practitioners (RACGP);
the Australian Government Department of Health; Best Practice; Medical Director, CAT4 and Train IT. These
organisations retain copyright over their original work and we have abided by licence terms. Referencing of
material is provided throughout.
While the Australian Government Department of Health has contributed to the funding of this material, the
information contained in it does not necessarily reflect the views of the Australian Government and is not advice
that is provided, or information that is endorsed, by the Australian Government. The Australian Government is not
responsible in negligence or otherwise for any injury, loss or damage however arising from the use of or reliance
on the information provided herein.
Brisbane South PHN 2 INFLUENZA VACCINATION
QUALITY IMPROVEMENT TOOLKIT The information in this Toolkit does not constitute medical advice and Brisbane South PHN accept no responsibility for information in this toolkit is interpreted or used. Unless otherwise indicated, material in this booklet is owned by Brisbane South PHN. You are free to copy and communicate the work in its current form, as long as you attribute Brisbane South PHN as the source of the copyright material. Brisbane South PHN, 2020 Brisbane South PHN 3 INFLUENZA VACCINATION
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Contents
ADULT VACCINATION - INFLUENZA ........................................................................................................................... 2
Introduction ....................................................................................................................................................... 2
The Quality Improvement Toolkit ......................................................................................................................... 2
VACCINATIONS - ADULT - INFLUENZA ....................................................................................................................... 6
2020 seasonal flu vaccine overview ...................................................................................................................... 6
Overview of key points and updates for 2020 .................................................................................................. 6
Table 1. Seasonal influenza vaccines registered and available for use in Australia in 2020, by age ................. 6
Influenza virus strains included in the 2020 southern hemisphere seasonal influenza vaccines: .................... 7
Highlights for 2020 influenza vaccine formulations .......................................................................................... 7
Timing of vaccination......................................................................................................................................... 7
Influenza vaccination for pregnant women....................................................................................................... 7
Eligibility for influenza vaccines funded by the National Immunisation Program (NIP) ................................... 8
Table 2. Medical conditions associated with an increased risk of influenza disease complications and for which
individuals are eligible for free vaccination under the NIP* ............................................................................. 8
Queensland health immunisation schedule ...................................................................................................... 9
Activity 1.1 – Data collection from CAT4 ............................................................................................................... 10
Activity 1.2 – Identifying the number of flu vaccines given in previous year/s ..................................................... 11
Best Practice search – Identify the number of flu vaccines administered at your practice in previous year/s. ... 12
Medical Director Search – Identify the number of flu vaccines administered at your practice in previous year/s.
............................................................................................................................................................................... 13
Activity 2.1 – Data collection from CAT4 ............................................................................................................... 16
National immunisation program eligibility ........................................................................................................ 17
State immunisation program eligibility ............................................................................................................. 18
Activity 2.2 – Review previous flu vaccine administration and current eligibility ................................................. 19
SETTING UP DEDICATED FLU CLINICS IN YOUR PRACTICE ..................................................................................... 21
1. Leadership roles............................................................................................................................................. 21
2. Human resource needs .................................................................................................................................. 21
3. Practice lay-out and specifications ................................................................................................................ 22
4. Booking systems ............................................................................................................................................ 22
5. Room set up ................................................................................................................................................... 23
6. Vaccine policy and procedures ...................................................................................................................... 23
7. Non English speaking patients ....................................................................................................................... 23
Activity 3.1 Pracsoft – Set up flu clinic appointment book ................................................................................... 24
Activity 3.2 Best Practice – Set up flu clinic appointment book .......................................................................... 26
Activity 3.3 – Review practice policies and procedures ........................................................................................ 28
Activity 3.4 – Identifying process for setting up flu vaccine clinic ......................................................................... 29
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RUNNING THE VACCINATION SESSIONS .................................................................................................................... 32
1. Patient management (meet and greet, injection areas, observation area) .............................................. 32
Activity 4.1 – Preparing the practice team ............................................................................................................ 32
2. Cold chain management ............................................................................................................................ 33
3. Vaccine administration .............................................................................................................................. 33
4. Post vaccination ......................................................................................................................................... 34
5. Vaccine documentation ............................................................................................................................. 34
Entering immunisation details in Medical Director ............................................................................................... 35
To maintain adult (patient >=18 years of age) immunisations in Medical Director .......................................... 36
Entering immunisation details in Best Practice ..................................................................................................... 36
Adding immunisations in Best Practice ............................................................................................................. 37
Entering immunisation batch numbers in Best Practice ................................................................................... 37
Creating progress notes shortcuts in clinical software.......................................................................................... 38
To create a progress note short cut in Medical Director....................................................................................... 38
To create a progress note short cut in Best Practice ............................................................................................. 39
6. Managing an adverse event ...................................................................................................................... 40
Report an AEFI ................................................................................................................................................... 40
Activity 4.2 – Complete vaccine clinic checklist..................................................................................................... 40
ADVERTISING STRATEGIES ......................................................................................................................................... 43
1. Patient reminder letters ............................................................................................................................ 43
2. Online reminders ....................................................................................................................................... 43
3. Using online booking software .................................................................................................................. 43
4. Information on practice website and other social media ......................................................................... 44
RACGP publication - Guide for the use of social media in general practice ...................................................... 44
5. Display table in the practice ...................................................................................................................... 44
6. Inclusion in your practice newsletter ........................................................................................................ 44
7. Signage outside the practice ..................................................................................................................... 44
8. Newspaper article ...................................................................................................................................... 45
Activity 5.1 - Review practice advertising strategies ............................................................................................. 45
Model for improvement and PDSA worksheet EXAMPLE ..................................................................................... 48
Step 1: The thinking part - The 3 fundamental questions ................................................................................. 48
Model for improvement and PDSA worksheet EXAMPLE ..................................................................................... 49
Step 2: The doing part - Plan, do, study, act ...................................................................................................... 49
Model for improvement and PDSA worksheet template ...................................................................................... 50
Step 1: The thinking part - The 3 fundamental questions ................................................................................. 50
Model for improvement and PDSA worksheet template ...................................................................................... 51
Step 2: The doing part - plan, do, study, act cycle............................................................................................. 51
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VACCINATIONS - ADULT - INFLUENZA
Influenza (flu) is a highly contagious viral infection that spreads easily from person to person through coughing,
sneezing and close contact.
Unlike a cold, symptoms such as fever, sore throat and muscle aches develop suddenly with flu and last about a
week. In some cases, severe illness and complications such as pneumonia and bronchitis can develop, which can
result in hospitalisation and even death. The flu can also make some existing medical conditions worse.
The flu virus can be especially dangerous for elderly people, pregnant women, Aboriginal and Torres Strait Islander
people and very young children, as well as for people with underlying medical conditions and some chronic
diseases.1
2020 seasonal flu vaccine overview
Important: Please read this statement in conjunction with The Australian Immunisation Handbook available here.
Overview of key points and updates for 2020
• Annual vaccination is the most important measure to prevent influenza and its complications.
• Annual influenza vaccination is recommended for all people ≥6 months of age.
• All vaccines available in 2020 are quadrivalent influenza vaccines (QIVs).
• All children aged 6 months to less than 5 years are now eligible to receive free annual influenza vaccines
under the National Immunisation Program (NIP).
• The dose of influenza vaccines for all ages is 0.5mL. The 0.25mL dose for young children is no longer
available.
• For adults aged ≥65 years the adjuvanted QIV, Fluad® Quad, is preferentially recommended over standard
QIVs.
Table 1. Seasonal influenza vaccines registered and available for use in Australia in 2020,
by age
Vaccine FluQuadri Vaxigrip Tetra Fluarix Tetra Afluria Quad Influvac Tetra Fluad Quad
0.50 mL 0.50 mL 0.50 mL 0.50 mL 0.50 mL 0.50 mL
(Sanofi) (Sanofi) (GSK) (Seqirus) (Mylan) (Seqirus)
Registered
age group
6 to 35 months
✓ * x x x
(
QUALITY IMPROVEMENT TOOLKIT
* Funding only for Aboriginal and Torres Strait Islander people, pregnant women and people who have certain medical conditions.
† Adjuvanted QIV preferred over standard QIVs.
Influenza virus strains included in the 2020 southern hemisphere seasonal influenza
vaccines:
• A (H1N1): an A/Brisbane/02/2018 (H1N1)pdm09-like virus;
• A (H3N2): an A/South Australia/34/2019 (H3N2)-like virus;
• B: a B/Washington/02/2019-like (B/Victoria lineage) virus;
• B: a B/Phuket/3073/2013-like (B/Yamagata lineage) virus.
Highlights for 2020 influenza vaccine formulations
• Vaxigrip Tetra® is a QIV, newly registered for use in adults and children from 6 months of age.
• Fluad® Quad is an adjuvanted QIV, newly registered for use in adults ≥65 years of age.
• FluQuadri® is a QIV, previously registered for adults and children from 3 years of age. The age indication for
this vaccine has now been extended to include children from 6 months of age. The FluQuadri Junior
formulation is no longer available.
• Influvac Tetra® is a QIV, previously registered for adults from 18 years of age. The age indication for this
vaccine has now been extended to include children from 3 years of age.
Timing of vaccination
• Annual vaccination should occur before the onset of each influenza season. The period of peak influenza
circulation is typically June to September in most parts of Australia.
• While protection is generally expected to last for the whole season, optimal protection against influenza
occurs within the first 3 to 4 months following vaccination.
• Vaccination should continue to be offered as long as influenza viruses are circulating and a valid vaccine
(before expiration date) is available. Some vaccine brands now have an expiry date of February 2021.
• Revaccination later in the same year is not routinely recommended, but may benefit some individuals due
to personal circumstances, such as travel or pregnancy.
• Only one government-funded influenza vaccine is available for eligible people each year, with the
exception of eligible children up to 9 years of age receiving an influenza vaccine for the first time. These
children require and are funded for 2 doses, 4 weeks apart.
Influenza vaccination for pregnant women
• Influenza vaccine is recommended in every pregnancy and at any stage of pregnancy.
• Influenza vaccine can safely be given at the same time as pertussis vaccine.
• For women who received an influenza vaccine in 2019, revaccinate if the 2020 influenza vaccine becomes
available before the end of pregnancy.
• For women who receive an influenza vaccine before becoming pregnant, revaccinate during pregnancy to
protect the unborn infant.
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Eligibility for influenza vaccines funded by the National Immunisation Program (NIP)
• Annual influenza vaccination is recommended and NIP-funded for all children 6 months to
QUALITY IMPROVEMENT TOOLKIT Queensland health immunisation schedule View a summary of the Queensland government's 2020 influenza immunisation program advice which provides important information specific to Queensland including: • which vaccines to give for specific age groups • information regarding people with medical conditions who are eligible for funded influenza vaccine Brisbane South PHN 9 INFLUENZA VACCINATION
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Activity 1.1 – Data collection from CAT4
Complete the below table by collecting data from your CAT4 Data Extraction Tool.
Note - Instructions on how to extract the data are available from PenCS website: Identifying patients at risk
for Influenza or from your clinical software package. Instructions are available for Best Practice and Medical
Director.
The aim of this activity is to collect data to determine the number of influenza vaccines that were administered at
your practice in the previous year/s. This activity will assist in planning for the upcoming flu season. It will provide
an estimate of the number of vaccines to order, number of patients to expect and assist with GP and staff coverage.
Description Number Number Number
completed completed completed
two years last year this year
ago
1.1a Identify total number of influenza vaccines given
1.1b Identify the number of patients diagnosed with coronary heart
disease (CHD) who received a flu vaccine
1.1c Identify the number of patients diagnosed with heart failure
who received a flu vaccine
1.1d Identify the number of patients diagnosed with chronic
obstructive pulmonary disease (COPD) who received a flu
vaccine
1.1e Identify the number of patients diagnosed with asthma who
received a flu vaccine
1.1f Identify the number of patients diagnosed with diabetes who
received a flu vaccine
1.1g Identify the number of patients diagnosed with renal failure
who received a flu vaccine
1.1h Active eligible Aboriginal and Torres Strait Islander patients six
months and over
1.1i Active eligible patients six months - < five years
1.1j Active eligible patients 65 years of age and over
Please note: when completing the above searches, you may have the same patient appear in multiple searches. For
e.g. if you have a 67-year-old Aboriginal and Torres Strait Islander patient with diabetes, they will appear in 1.1f,
1.1h and 1.1j. The searches are set like this to ensure that you capture all of your eligible patients, a 35-year-old
patient with diabetes will only appear in 1.1f.
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Reflection comments as a result of completing Activity 1.1:
Practice name: Date:
Team member:
Activity 1.2 – Identifying the number of flu vaccines given in
previous year/s
The aim of this activity is to review the number of flu vaccines given in previous year/s
Description Action to be taken
After completing Activity 1.1
note how many patients were Number of flu vaccines administered last year: ____________________________
provided with a flu vaccine at
your practice previously? Number of flu vaccines administered previous years: _______________________
Was there a significant Provide details if there was a significant increase or decrease:
difference of flu vaccines
administered between last
year and previous years? Is there an explanation as to the difference? (for e.g. change in practice size,
changes in flu vaccine promotion):
Reflection comments as a result of completing Activity 1.2:
Practice name: Date:
Team member:
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Best Practice search – Identify the number of flu vaccines
administered at your practice in previous year/s.
To conduct a search of administered immunisations in Best Practice:
1. From the Best Practice screen, select Utilities and Search
2. Select Immunisations
3. The search for immunisations screen appears
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4. Change the date range to last year’s dates (1/1/2019 to 31/12/2019)
5. To identify all the flu vaccine brands, scroll through the vaccine list and highlight it, make sure the
AND button is on for the first vaccine and then change to OR for the rest of the vaccines selected
and then click Add. Go through the entire list and make sure all have been selected
6. Given by: All doctors
7. Select OK
8. Click Run query.
Medical Director Search – Identify the number of flu vaccines
administered at your practice in previous year/s.
To conduct a search of administered immunisations in Medical Director:
1. From the Medical Director Clinical front screen, select Search and Immunisations
2. The immunisation window appears
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3. For the date range: Select Interval as Other and then change the date range to last year
(1/01/2019 to 31/12/2019)
4. Select All Vaccinators
5. To ensure that you identify all flu vaccines given, you will
need to go through the select immunisations list and
highlight every brand name
Tip: hold down the ctrl key on your keyboard while you
are selecting the vaccines
6. You will also need to make sure that all the other tick
boxes are appropriately selected. The only two that you
might want to have selected is Include inactive and
deleted and also exclude if not given here
7. Click OK – this will then generate the list of flu vaccines
given last year
Follow the above steps to also do a search for date range 1/01/2018 to 31/12/201.
The following search criteria options are available
Allows you to specify the time interval you wish to view immunisations for. If the
interval you want is not available or you wish to specify a special time interval, click the
Select interval
Other option in the list. The list is replaced with From and To date boxes and allows you
to enter the dates required. To return to the list click the See list button.
Allows you to specify a specific Vaccinator's name. Select the All vaccinators option to
view the immunisations for all Vaccinators in the practice, including practitioners that
you have deleted from Medical Director Clinical or those that have been marked
Vaccinator
inactive
Note: indicates that the vaccinator is active
indicates that the vaccinator has been flagged inactive or deleted
Select the immunisations to view. Multiple immunisations can be selected by clicking
Select immunisations on the various immunisation names
Note: Only immunisations that you have administered will appear in this list
Include inactive and Tick this checkbox to display practitioners that you have deleted from Medical Director
deleted checkbox Clinical or those that have been marked inactive
Only show vaccinators Tick this checkbox to display only those users that have administered a vaccination
Tick this box to perform a search for immunisations performed on behalf of the
On behalf of checkbox selected practitioner. For example, a nurse may perform the immunisation for the
practitioner, or one practitioner may perform the immunisation whilst another is away
Exclude if previously If this option is selected, any immunisation records that have been printed in the past
printed are ignored
Selecting this option highlights all items in the list. You can remove the highlight from
Select all
individual items (by clicking them) that you do not wish to appear on the printouts
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The following search criteria options are available
Exclude if not given If the immunisation was not given at this surgery it is excluded from the list
here
Selecting this option only searches for immunisation of patient's over 65 years of age,
Over 65/ATSI 50 and
or 50 and over if they have been marked as being Aboriginal or Torres Strait Islander.
over
Results show only those immunisations for this age range
Selecting this option modifies the immunisation list so that only childhood
immunisation is selected. You can then select extra items or clear items you do not wish
Childhood to appear on the printouts. Results show only those patients 18 years of age or younger
immunisations only
Note: When selecting Childhood Immunisation, any highlighted items are cleared
before the childhood immunisations are highlighted
Tick this check box to display only those immunisations where the patient was flagged
Show only declined
as being eligible for or due for, where the patient has subsequently declined the
immunisations
immunisation
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Activity 2.1 – Data collection from CAT4
Complete the below table by collecting data from your CAT4 Data Extraction Tool to gather information on
your current patient population who are eligible for the funded influenza vaccine.
Note - Instructions on how to extract the data are available on PenCS website at: Identify patient at risk for
influenza with predisposing condition and Identify patient at risk for Influenza based on age, ethnicity or pregnancy
For eligibility criteria the National Immunisation Program eligibility and State Immunisation Program eligibility.
The aim of this activity is to collect data to determine the number of at-risk patients eligible for a funded influenza
vaccine and to create various lists of patients to target for flu clinic promotion.
Count - Count -
Description pre-flu post flu
clinic clinic
2.1a Active eligible patients who are pregnant
2.1b Active eligible patients diagnosed with CHD
2.1c Active eligible patients diagnosed with heart failure
2.1d Active eligible patients diagnosed with COPD
2.1e Active eligible patients diagnosed with asthma (N.B only patients with severe
asthma are eligible for the government funded vaccine). Refer to Asthma Goal 1
Activity 2 to ensure your practice has determined the terms for consistent coding
for your Asthma patients
2.1f Active eligible patients diagnosed with diabetes
2.1g Active eligible patients diagnosed with renal failure
2.1h Active eligible Aboriginal and Torres Strait Islander patients - six months and over
2.1i Active eligible patients six months - < five years
2.1j Active eligible patients 65 years of age and over
2.1k Total number of active patients eligible for influenza vaccine
(Add numbers for above searches 2a-2j)
Please note: You may wish to change the search criteria from active (3 visits in 2 years), if you have patients that
may not fit these criteria but are eligible for a flu vaccine.
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Reflection comments as a result of completing Activity 2.1:
Practice name: Date:
Team member:
National immunisation program eligibility
Patients eligible for the national funded influenza vaccine:
• All children aged ≥ 6 months and ≤ 5 years
• everyone 65 years of age and over
• all pregnant women at any time during pregnancy
• Aboriginal and Torres Strait Islander people aged six months and over
• persons aged six months and older with medical conditions as outlined below are predisposed to severe
influenza and are eligible for funded influenza vaccination.
Vaccination strongly recommended for individuals with the following clinical
Medical condition
conditions
Cardiac disease Cyanotic congenital heart disease
Congestive heart failure
Coronary artery disease
Chronic respiratory Severe asthma (including frequent hospitalisation and use of multiple
conditions1 medications)
Cystic fibrosis
Bronchiectasis
Suppurative lung disease
Chronic obstructive pulmonary disease (COPD)
Chronic emphysema
Chronic neurological Hereditary and degenerative CNS disease
conditions Seizure disorders
Spinal cord injuries
Neuromuscular disorders
Immunocompromising Immunocompromised due to disease or treatment
conditions2 (e.g. malignancy, transplantation and/or chronic steroid use)
Asplenia or splenic dysfunction
HIV infection
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Vaccination strongly recommended for individuals with the following clinical
Medical condition
conditions
Diabetes and other metabolic Type 1 or 2 diabetes
disorders Chronic metabolic disorders
Renal disease Chronic renal failure
Haematological disorders Haemoglobinopathies
Long-term aspirin therapy in These children are at increased risk of Reyes syndrome following influenza
children aged six months to infection
10 years
1. Persons who have any condition that compromises the management of respiratory secretions or is
associated with an increased risk of aspiration should be vaccinated.
2. Persons with certain immunocompromising conditions (i.e. haematopoietic stem cell transplant, solid
organ transplant) receiving influenza vaccine for the first-time post-transplant are recommended to receive
two vaccine doses at least four weeks apart (irrespective of age) and one dose annually thereafter. 2
State immunisation program eligibility
Annual vaccination is the most important measure to prevent influenza and its complications and is recommended
for all people aged 6 months and over.
Free vaccines will be available to eligible Queenslanders from mid-April.
More information is available from Queensland Health website.
Practice decision point
It is recommended that you meet either in your established micro-team or at a practice meeting
to create a process for Identifying eligible patients for the coming year. This will ensure the
maximum number of patients receive the flu vaccine.
Please utilise the below table to guide you through this process.
2
https://immunisationhandbook.health.gov.au/vaccine-preventable-diseases/influenza-flu
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Activity 2.2 – Review previous flu vaccine administration and current
eligibility
Based on the review of the number of patients administered with a flu vaccine in previous years and
number of eligible patients for the upcoming year, complete the following table.
Questions to consider Status Action to be taken
After reviewing the Yes, see action Please explain:
number of flu vaccines to be taken.
administered over the
past couple of years, No, continue What action will you take?
are there unexpected with activity.
results?
How will you use this information to inform your activities this flu
season?
After reviewing the Yes, see action Please explain:
number of eligible to be taken
patients for flu vaccine
for the upcoming flu What action will you take?
season, are there any
unexpected results?
No, continue
with activity How will you use this information to inform your activities this flu
season?
Are there any other Yes, see action (for example: workers, patients with other health conditions, other
patients within your to be taken ethnicities)
practice you will target *Please note they may need to purchase the vaccine privately
to offer flu vaccine to?
No, continue Please explain:
with activity
After reviewing the Yes, see actions Refer to the Model for Improvement (MFI) and the Thinking part
number of influenza to be taken” to at the end of this document
vaccines given, are help set you
there any changes you goals
would like to
implement in the No, you have Refer to the Doing part - PDSA of the Model for Improvement
practice, to help completed the (MFI) to test and measure your ideas for success
manage patients, over activity
the next 12 months?
Brisbane South PHN 19 INFLUENZA VACCINATIONQUALITY IMPROVEMENT TOOLKIT Reflection comments as a result of completing Activity 2.2: Practice name: Date: Team member: Brisbane South PHN 20 INFLUENZA VACCINATION
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SETTING UP DEDICATED FLU CLINICS IN YOUR PRACTICE
The aim of this activity is to assist you and your practice to identify the best way of ensuring the maximum number
of eligible/at risk patients receive their annual flu injection. The easiest and most efficient way to run a flu clinic is to
allocate a specific day, or time of day, for vaccinations. This way all of your staff are prepared to manage the
additional influx of patients.
To facilitate the most efficient and safe delivery of available vaccine via large community clinics, these
recommendations and guidelines have been developed to assist with planning large-scale influenza vaccination
clinics.
Please note: multiple role can be done by one person – use this document for ideas, but scale to suit your
practice.3
This activity provides general guidance in areas relating to practice logistics to help ensure smooth operations at
large-scale vaccination clinics under six major headings:
1. Leadership roles
2. Human resource needs
3. Practice lay-out and specifications
4. Booking systems
5. Room set up
6. Vaccine policy and procedures.
1. Leadership roles
• Designate clinic leaders for overall vaccination campaign operations, and leaders for communications
systems.
• Designate a clinic manager and a team leader each for supplies, logistics, medical personnel, support
functions and their respective backups.
• Designate a leader to oversee infection control at the clinic, which includes ensuring that healthcare
personnel who are preparing and administering the vaccinations are appropriately trained on safe injection
practices.
2. Human resource needs
To ensure everything runs smoothly, the team will need:
• defined roles and responsibilities for staff working in the clinic/s
• secure staff to fill the positions of greeters-educators, registration personnel, medical screeners,
form/payment collectors, clinic flow controllers, vaccination assistants, vaccination administrators, and
emergency medical personnel, please note that for smaller practices one person may be responsible for
multiple roles
• prepare staff members to know and execute their responsibilities and be able to correctly answer
questions from patients
3
https://www.cdc.gov/flu/professionals/vaccination/vax_clinic.htm
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• staff member/s as per roster to supervise the patient in the recovery area on the day. Patients need to
remain seated in the recovery area for 15 minutes after their vaccination. This staff member will need to
know the procedure to alert clinicians if the patient is unwell
• signage providing patients and staff with directions (multi-lingual may be necessary)
• ensure practice staff are trained and have demonstrated knowledge in the proper vaccine storage,
handling and administration of vaccines
• cross-train staff members, if possible, to enable flexibility in meeting needs at various stations as demands
fluctuate
• ensure staff well-being by scheduling times for rests and snacks in a designated area.
All immunisation service providers are familiar with and adhere to the national vaccine storage guidelines - Strive
for 5 and Australian Immunisation Handbook 10th Edition.
3. Practice lay-out and specifications
• Set up for patient flow from an external gathering area
o eligibility screening area
o facility waiting area(s)
o registration/question and answer/form completion area (multiple stations)
o medical screening/treatment area (as needed)
o Medicare and other payment area (multiple stations)
o vaccination area (multiple stations).
• Provide seating for patients and the person administering the vaccine at each vaccination station and have
one or more vaccination stations with surrounding screens where over-clothed patients can discreetly bare
their arms for vaccination. Each station must also have adequate administration supplies.
• Section off private area(s) where patients who experience acute adverse events after vaccination or who
have medical problems can be evaluated and treated.
• Adequate number of computers and internet access to determine immunisation history from the
Australian Immunisation Register (AIR) of patients presenting for vaccination.
• Ensure the presence of an onsite emergency medical kit and a designated trained clinician who can
administer treatment for allergic reactions and address urgent medical problems.
4. Booking systems
To ensure the clinics run smoothly, it is helpful to have an appointment system to be able to manage the times
patients arrive at the clinic and also the waiting times for the patients. This can be done either by the patient
contacting the receptionist or the patient can book online (if this option is available at your practice).
Admin entered appointments:
Most practice management software has some limitations with setup needing to be consistent for all the GPs. If
you would like to set up an appointment book with five-minute appointments, instructions are available for Best
Practice and Pracsoft. For other systems contact your software support team for assistance.
Brisbane South PHN 22 INFLUENZA VACCINATIONQUALITY IMPROVEMENT TOOLKIT
5. Room set up
Room set up checklist:
• a well-lit, well-ventilated room with a separate entry and exits if applicable
• the room should be quiet, spacious and free of clutter with adequate cooling and heating
• access to patient records
• telephone for internal communications with GP’s and external communication with patients, other health
professionals and support organisations
• hand washing facilities
• ensure the trolley is adequately stocked with:
o disposable gloves
o sharps container
o syringes
o distraction item for children such as toys
o band-aids
o vaccines
o temperature controlled environment for vaccine storage (or dedicated vaccine fridge)
o adrenaline 1 in 1000.
6. Vaccine policy and procedures
It is important that the practice reviews their policy and procedure manual, to ensure relevant documentation is in
place and up-to-date. At a minimum the following policies and procedures need to be available:
• preparing an anaphylaxis response kit
• infection control
• needle stick injury
• waste management
• cold chain management
• stock management
• staff immunisations
• hand hygiene
• cough etiquette and social distancing.
Complete the checklist in Activity 3.3 to review the practice’s policies and procedures.
7. Non English speaking patients
For patients who don’t speak English use the Appointment Reminder Translation Tool
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Activity 3.1 Pracsoft – Set up flu clinic appointment book
1. In the appointment book, click on Set up and Manage Appointment Books
2. Click on Add and then in Description type Flu Clinic and click OK
3. To switch between the ordinary appointment book and Flu Clinic appointment book
4. To change the appointment times to five minutes, you go into Set up and Options and change the
slots per hour to 12. Whilst you are in the screen adjust the first time slot and last time slot to suit.
Click Save
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5. You will then need to setup your standard sessions. To do this select Set up, Availability and
Standard Sessions
6. In your ordinary appointment book, block out your GP time with a note saying see flu clinic
appointment book. This way it saves double up in two appointment books.
Brisbane South PHN 25 INFLUENZA VACCINATIONQUALITY IMPROVEMENT TOOLKIT
Activity 3.2 Best Practice – Set up flu clinic appointment book
Please follow the steps below. Go to:
1. Main screen > Set up > Configuration > Appointments
2. From the drop-down menu Appointment length: select five minutes
3. Click Save
4. It will prompt you if you want to set up this length for each user session
5. Click No
6. Now go to: Main screen > Set up > Sessions
7. Select the provider you want allocate five minutes appointments to
8. Double-click on the session you want to edit
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9. From the Appointment length drop-down menu select five minutes
You can customise the
session however you
would like. You can
change the colour so it is
easier to see and do the
five-minute sessions as
one off or a recurring
session.
10. Click Save. Open up the appointment book. This is how the appointment book can look in Best Practice.
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Activity 3.3 – Review practice policies and procedures
Complete the below table to gather information on your current policies and procedures relating to
immunisations and vaccine management.
Does the practice have a policy Policy up to Policy needs Who will review or Date
and procedure for the date * reviewing update? completed
following?
Preparing an anaphylaxis Policy is up to Policy needs
response kit date updating
Policy is up to Policy needs
Infection control
date updating
Policy is up to Policy needs
Needle stick injury
date updating
Policy is up to Policy needs
Waste management
date updating
Policy is up to Policy needs
Cold chain management
date updating
Policy is up to Policy needs
Stock management
date updating
Policy is up to Policy needs
Staff immunisations
date updating
Policy is up to Policy needs
Hand hygiene
date updating
Cough etiquette and social Policy is up to Policy needs
distancing date updating
* Ensure that the practice policy is up to date with the current guidelines and that relevant practice staff are
following the practice policy.
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Reflection comments as a result of completing Activity 3.3:
Practice name: Date:
Team member:
Activity 3.4 – Identifying process for setting up flu vaccine clinic
The aim of this activity is to identify the process for setting up your practices flu vaccine clinic
Description Status Details
After completing Yes, provide
Activities 1.1 and details and
continue with Number of eligible patients for the year: ________________________
2.1, do you know
how many patients activity
are expected at Number the practice is aiming to immunise: _____________________
your flu clinic? No, Refer to
Activity 1 and 2
instructions
To achieve the Yes, provide How and when will the clinics be held: __________________________
number of patients details and How many doctors and nurses will be involved?
in the practice to continue with
receive their flu activity
injection, have you
thought about how
and when the clinics No, Review
will be held? The Activity 3 –
number of staff Human resource
required? needs
Have leadership Yes, provide Clinical leader: _____________________________________________
roles been details and
Infection control leader: _____________________________________
appointed and continue with
communicated to activity Administration leader: _______________________________________
the practice team in Clinic manager: ____________________________________________
relation to flu
clinics? No, Review
Activity 3 –
Leadership roles
Brisbane South PHN 29 INFLUENZA VACCINATIONQUALITY IMPROVEMENT TOOLKIT
Description Status Details
Do all the leaders Yes, continue Create a list of roles and responsibilities for each person involved
understand their with activity Communicate this information to the whole team via team meeting on
appointed roles? date:
Has this information
No, consider
been shared
amongst the team? allocating
leaders. Review
Activity 3 –
leadership roles
Do you need any Yes, provide List anything that you will need to source prior to commencing flu
more resources to details clinic: (think about medical supplies, staff rostering, consent forms
conduct the flu etc.)
clinics?
(You may refer back
to Activity 3 – room No, continue with
setup description of activity
what is required to
set up a dedicated
flu clinic
Do you know how Yes, provide List all marketing strategies that the practice will use:
you will details
communicate the
availability of the flu
No, refer to
clinic/s to your
patients? (see Activity 5 of the
Activity 5 of this workbook
workbook for
assistance)
After identifying Yes, see actions Refer to the Model for Improvement (MFI) and the Thinking part at
your practices to be taken” to the end of this document
process for flu help set you
vaccines, are there goals
any changes you
would like to Refer to the Doing part - PDSA of the Model for Improvement (MFI) to
implement in the test and measure your ideas for success
practice, to help No, you have
manage patients, completed the
over the next 12 activity
months?
Brisbane South PHN 30 INFLUENZA VACCINATIONQUALITY IMPROVEMENT TOOLKIT Reflection comments as a result of completing Activity 3.4: Practice name: Date: Team member: Brisbane South PHN 31 INFLUENZA VACCINATION
QUALITY IMPROVEMENT TOOLKIT
RUNNING THE VACCINATION SESSIONS
The aim of this activity is to assist your practice to ensure you are prepared for the influenza vaccination clinics.
This activity will cover the following:
1. Patient management (meet and greet, injection areas, observation area)
2. Cold chain management
3. Vaccine administration
4. Post vaccination
5. Vaccination documentation
6. Managing an adverse event.
1. Patient management (meet and greet, injection areas, observation area)
Provide staff with frequently asked questions (FAQs) on vaccinations so they are able to confidently answer general
vaccination questions from patients.
Activity 4.1 – Preparing the practice team
The aim of this activity is to identify if your practice team is prepared for influenza season
Description Status Action to be taken
Do all staff know what a flu Yes, continue with activity • Influenza fact sheet
shot is?
• Flu (influenza) immunisation
No, see action to be taken service
Can all staff answer “how Yes, continue with activity • Flu vaccine won’t definitely stop
long does the flu vaccine you from getting the flu, but it’s
protect me?” No, see action to be taken more important than you think
Do all the staff know the Yes, continue with activity • Medical myth: the flu vaccine will
answer to “Can I still get the give you influenza
flu after getting a flu shot?” No, see action to be taken
Can all staff provide patients Yes, continue with activity • Influenza frequently asked
with the answer to “Can I get questions
a flu shot if I have a cold?” No, see action to be taken
Can all staff explain the costs Yes, continue with activity Outline practice fees associated with flu
associated with having a flu injection. Is there a cost for the vaccine?
injection No, see action to be taken Is there a cost for the GP/nurse time?
(Ensure the practice communicates to
patients about any out-of-pocket
expenses)
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Description Status Action to be taken
Do all staff know which Yes, continue with activity
patients are eligible for the
Government funded flu No, refer to national and
injection? state immunisation eligibility
After reviewing your staff Yes, see actions to be taken” Refer to the Model for Improvement
preparedness, are there any to help set you goals (MFI) and the Thinking part at the end of
changes you would like to this document
implement in the practice, to
help manage patients, over No, you have completed the
the next 12 months? activity
Refer to the Doing part - PDSA of the
Model for Improvement (MFI) to test and
measure your ideas for success
Reflection comments as a result of completing Activity 4.1:
Practice name: Date:
Team member:
2. Cold chain management
The Vaccine Storage Guidelines, Strive for 5 3rd Edition, provides information and advice for vaccine storage
management. It has been written to assist all Australian immunisation service providers, from medical practices to
large hospitals, clinics and outreach providers.
The publication’s title refers to Strive for 5 degrees Celsius (°C) – that is, the point midway between +2°C and +8°C
which is the temperature range recommended for vaccine storage. Many vaccines are damaged or destroyed at
temperatures outside this range.
These guidelines:
• describe the best approach to ensure that patients receive effective and potent vaccines
• describe the ‘cold chain’ and provide advice on what should be done in the event of a cold chain breach
• include resources such as checklists, charts, posters and stickers
• apply to both purpose-built vaccine refrigerators and domestic refrigerators.
3. Vaccine administration
• adequate supplies should be available including as per room setup checklist in Activity 3.5
• hand hygiene should be performed before vaccine preparation, between patients, and any time hands
become soiled
• vaccine recipients should always be seated during vaccine administration
• an appropriate gauged needle should be used for each patient.
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4. Post vaccination
Immediately after vaccine administration:
• dispose of clinical waste, including sharps and vaccine vials, at the point of use. (See RACGP Infection
prevention and control standards)
• cover the injection site quickly with a dry cotton ball and tape as needed
• gently apply pressure for one or two minutes – do not rub the site as this will encourage the vaccine to leak
back up the needle track, which can cause pain and may lead to local irritation
• to distract the vaccinated person and reduce distress, immediately change the position of the child/person
after completing the vaccination, for example, ask the parent/carer to put the infant over his/her shoulder
and move around with the infant
• remove the cotton wool after a few minutes and leave the injection site exposed to the air
• record the relevant details of the vaccines given.
The vaccinated person and/or parent/carer should be advised to remain in the vicinity for a minimum of 15
minutes after the vaccination. The area should be close enough to the immunisation service provider so that the
vaccinated person can be observed and medical treatment provided rapidly if needed.
Source: Australian Immunisation Handbook 10th edition
5. Vaccine documentation
It is essential that immunisation service providers ensure there is appropriate documentation of all vaccinations
given to persons of any age. There are a number of ways in which this should be done.
All vaccines administered to children should be documented in the child’s clinical file and the individual child health
record that is established for all newborn infants. This record should be kept by the parent/carer and presented
every time the child is seen by a health professional. For information on how to enter details in Medical Director
and Best Practice, please refer to pages 43-45.
Vaccines administered to adolescents and adults should be recorded in both the vaccinated person’s clinical file
and the personal health record, or individual record, of vaccination. For information on how to enter details in
Medical Director and Best Practice, please refer to pages 43-45.
More information can be found here.
Practices should submit information on vaccinations administered to the Australian Immunisation Register (AIR) via
the practices clinical software or the usual portal for reporting immunisations.
It is important when doing immunisations that you upload a Shared Health Summary to the patients My Health
Record to ensure up-to-date information on individuals immunisation status at all times. More information is
available here.
To save time at every consultation you can set up a progress note shortcut in Best Practice and Medical Director.
Brisbane South PHN 34 INFLUENZA VACCINATIONQUALITY IMPROVEMENT TOOLKIT Entering immunisation details in Medical Director To maintain childhood (patient
QUALITY IMPROVEMENT TOOLKIT
Make sure that the following information is
entered:
• vaccinator
• consent provided by
• date
• vaccine type
• vaccination site
• sequence
• batch number.
You can also mark the patient for a reminder
by clicking on the Mark for recall button.
To maintain adult (patient >=18 years of age) immunisations in Medical Director
1. From the patient's Clinical Window, select the Imm. tab.
2. Then, to add an immunisation record, either
o click + on the toolbar, or
o press the F3 key, or
o right-click in the list of immunisations (even
if list is empty) and select New Item from
the pop-up menu.
3. The Vaccination Window appears
4. Enter all the information using the drop-down
menus included and then click save. Make sure
you add a reminder for 12 months in the patients
record.
Entering immunisation details in Best Practice
Best Practice Software records immunisations within the Patient Record. To enter or
view a patient’s immunisation record, click on the Immunisations icon in the tree
view located on the left-hand side of the screen. The Vaccines given list will be
displayed.
If the patient is an adult, the Date given, Vaccine, Sequence number, Batch number,
Ordered by, Given by, Site, Route and comment will be displayed.
When the patient is a child (under eight), the screen will change to show the
Childhood Immunisation schedule and the Vaccines given.
Brisbane South PHN 36 INFLUENZA VACCINATIONYou can also read
