National Minimum Standards and Core Curriculum For

National Minimum Standards and Core Curriculum for

Immunisation Training of

Health Care Support Workers

Acknowledgments

These Standards and Core Curriculum for Immunisation Training of Healthcare Support Workers have been developed by the Vaccine Preventable Disease Programme within the National Public Health Service for Wales (NPHS) in collaboration with the Health Protection Agency (HPA) and Health Protection Scotland

Additional contributions to the development of the document from

-Royal College of Nursing (RCN)

-Department of Health (DH)

-Medicines and Healthcare products Regulatory Agency (MHRA)

-Working in Partnership for Practice (WiPP)

and training providers and immunisation experts from across the UK is gratefully acknowledged.

If you have any comments on this document, please send these to (Wales)

(England)

(Scotland)

Terminology

There is currently a widespread variation in the titles used across the Health Care Support Worker (HCSW) workforce. Numerous titles exist to reflect the many and varied roles they carry out. For the purposes of this document, the term HCSW is used to include titles such as health care assistant, assistant practitioner and other similar titles where the employee has been delegated a role in immunisation by an appropriate registered health professional.

Contents

Page
Introduction / 4
Background to HCSW Training Standards / 4
Initial Considerations / 4
Why do we need Immunisation Training Standards and a Core Curriculum for HCSWs? / 4
Aim and Objectives / 5
Standards for Immunisation Training of HCSWs / 6
Core areas of knowledge for HCSWs / 7
Provision of Training / 8
Updates for HCSWs / 8
Assessment / 8
Trainers / 10
Supervision / 10
Mentorship / 11
Delegation / 11
Evaluation / 11
Good Practice / 12
Administration Issues / 12
Discussion / 13
Summary / 13
References and resources / 15
Appendices / 16

Introduction

Immunisation programmes are one of our most successful public health measures. Ensuring public and professional confidence is critical to the success of these programmes.

The majority of vaccinations in the UK are administered in the primary care setting where there is a move towards a more innovative skill mix of the nursing team.

It is clear that the role of the Health Care Support Worker is being increasingly recognised within health care and in particular, within primary care settings. HCSWs are taking on tasks that were previously carried out by registered nurses. HCSWs job descriptions are varied (as are their titles) and the scope of the role depends largely upon the setting in which they are working, service requirements and which activities the Health Care Professionals choose or are able to delegate.

With the need to deliver very large numbers of influenza and pneumococcal vaccines seasonally each year and the desire for extra capacity to provide these vaccines in a short time period, in some general practices the HCSW role has developed and expanded to include administration of these two vaccines.

This document addresses the minimum standards of training for HCSWs for adult influenza and pneumococcal vaccinations only. It is not current practice for HCSWs to administer childhood, travel or other vaccines.

Background to HCSW Training Standards

The lack of any previous nationally agreed or defined immunisation training programmes for HCSWs means that the delivery and content of immunisation training for this group currently varies across the UK.

The National Minimum Standards for Immunisation Training1 were produced by a multi-professional group led by the Health Protection Agency (HPA) in 2005, endorsed by the National Public Health Service (NPHS) for Wales, Health Protection Scotland, the Royal College of Nursing and other UK health organisations which represent Health Care Professionals who administer vaccinations. The HPA Core Curriculum for Immunisation Training2 supplements the Standards and lists the essential topics which should be incorporated into all immunisation training for Health Care professionals. Both the Minimum Standards and the Core Curriculum have been used as the basis for this guidance for HCSW immunisation training.

In response to the changes in the workforce and the fact that many HCSWs are now taking on a role in immunisation, it was felt that the original Standards1 and Curriculum2 should be reviewed to reflect these changes and ensure that they accommodate the training needs of this developing workforce. It is essential that robust and consistent training is provided for HCSWs undertaking this role, as it is for any one else involved in immunisation.

This guidance has therefore been developed to define the standards that may be considered a minimum for HCSW immunisation training and to provide assistance to those responsible for developing and delivering this training. It is expected that the level of training and assessment for HCSWs who are going to administer influenza and pneumococcal vaccines be at the same level as would be provided to any other new immuniser. However, it is recognised that this group will have different levels of prior knowledge and a different entry level. For this reason, longer time for training and additional clinical assessment and supervision is recommended.essential. KH

Initial considerations

Incorporating immunisation into the role of the HCSW has limitations and implications to clinical care and should therefore be considered carefully by the whole Primary Health Care team. Training in immunisation is essential for HCSWs whose employers wish them to immunise and it is recommended only HCSWs who have achieved care training to National Vocational Qualification/Open College Network/Scottish Vocational Qualification (NVQ/OCN/SVQ) level 3 or equivalent with at least 2 years experience as a HCSW should be considered for immunisation training3.

In June 2009, NHS Education for Scotland (NES) published A Guide to Health Care Support Worker Education and Role Development4, developed in collaboration with the Scottish Government as a result of Scottish wide consultation on this topic. The guide indicates that HCSWs should, as a minimum, have education provided a SCQF level 6, or at SCQF level 7 for those in senior HCSW roles. SCQF levels 6 and 7 correlate with SVQ level 3. Both providers of education and employers in Scotland should take cognisance of the above guidance.

The HCA toolkit on the RCN website (http://www.rcn.org.uk/development/hca_toolkit) provides detailed information for education providers about education and training for HCAs. It is important that those designing and running immunisation training courses for HCSWs read the guidance in the toolkit in conjunction with this immunisation training document.

Why do we need Immunisation Training Standards and a Core Curriculum for HCSWs?

Application of these Training Standards will help to:

·  Ensure high quality practice in immunisation

·  Enable those in charge of designing and running immunisation courses to ensure all core areas of knowledge and competency are covered by providing a curriculum around which to structure the training they offer

·  Define the minimum level of training that should be provided

·  Ensure those who immunise are competent to do so

·  Ensure HCSWs who immunise have adequate training, support, supervision and mentorship

·  Ensure delegating practitioners understand their role and responsibility when mentoring and delegating immunisation to a HCSW

Aims and objectives

The aim of HCSW Standards for Immunisation Training is to ensure that all HCSWs engaging in any aspect of immunisation are trained in order to:

·  Be able to provide accurate and up to date information about the relevant diseases and vaccines to their patients

·  Be able to refer to a health care professional where further information is required for the patient’s needs

·  Ensure that their practice is safe and effective

·  Give a high standard of care

·  Demonstrate competency in administration of influenza and pneumococcal vaccinations

·  Demonstrate competency in recognition and management of anaphylaxis and basic life support

·  Demonstrate an understanding of appropriate management of adverse reactions

·  Demonstrate an understanding of their role and its limitations

Standards for Immunisation Training of HCSWs

Table 1 / Standard
The HCSW / A HCSW who immunises must have completed relevant training and have been assessed as competent.
Mentorship and close supervision are essential and necessary support strategies.
The Health Care Professional (HCP) / Anyone who delegates the role of immunisation should be on a relevant professional register such as the Nursing and Midwifery Council, the General Medical Council or similar. Only prescribers can delegate vaccine administration to HCSWs. This delegating professional has the professional responsibility for ensuring the HCSW has met the necessary standards of competency and undertaken the recommended training.
The requirement to be trained / Any HCSW who immunises should receive specific training in immunisation and should attend annual updates. Those new to immunisation should attend a formal taught course and follow a framework that encourages supervised practice and support and also enables robust assessment of competence.
The training content / The content of the basic training for HCSWs should include, as a minimum, all the core areas of knowledge in Table 2. HCSWs must demonstrate competency, knowledge and practical skills through assessment and practice as well as insight into the limitations of their role.
Duration and frequency of training and updates / The recommended minimum duration of basic immunisation training for HCSWs is 3 days.
Annual updates should be provided and attended by HCSWs who continue to immunise. To include all necessary information these updates should be a minimum of half a day although it is likely that a full day will be required.
Access to national policies and updates / HCSWs with a role in immunisation should have access to the Department of Health’s Immunisation against Infectious Disease5 (the ‘Green Book’) and all updates of national influenza and pneumococcal vaccination policy including CMO/CNO/CPO letters.
Access to supervision and mentorship / HCSWs with input into the clinical practice of immunisation must have an identified supervisor. The supervisor must be appropriately trained and knowledgeable and experienced in immunisation.
The supervisor should ensure the HCSWs immunisation practice meets national standards and reflects current national policy.
A mentor may also be allocated. This would generally be a more experienced HCSW or a HCP.
Evaluation / Those responsible for clinical governance should ensure that staff training (at all levels and all aspects) is included in regular audit of the immunisation service

Core areas of knowledge for HCSWs

Table 2 / Core areas of immunisation knowledge
1 / The aims of immunisation and development of national policy
2 / The immune system and how vaccines work
3 / Vaccine preventable diseases - influenza and pneumococcal disease
4 / The different types of vaccine, their composition and the indications and contraindications for adult influenza and pneumococcal vaccines
5 / Current issues relating to influenza and pneumococcal vaccines
6 / Communicating with patients about vaccines
7 / Legal issues including consent and use of Patient Specific Directions (PSDs)
8 / Storage and handling of vaccines
9 / Correct administration of vaccines
10 / Anaphylaxis, basic life support and adverse reactions
11 / Documentation, record keeping and reporting
12 / Strategies for improving immunisation uptake and effective organisation and running of vaccine sessions
13 / The role of the HCSW as an immuniser (to include, role limitations, the role of others in immunisation)
14 / Support for the HCSW e.g. supervision, mentorship and reflection

All HCSWs involved in immunisation should be able to demonstrate current evidence-based knowledge and understanding of the areas listed in Table 2. S/he must be able to identify the Health Care Professional to whom the patient can be referred if they require more information to enable an informed decision about vaccination to be made.

On completion of immunisation training, the HCSW should only undertake immunisation if they feel competent to do so. This competence should be assessed and each HCSW must be supported and supervised by an experienced Health Care Professional. The Health Care Professional who has delegated the role of immunisation to the HCSW takes professional responsibility for the care delivered by that HCSW and has a professional responsibility to remain up to date in all aspects of immunisation. It is important that they have access to the Department of Health’s Immunisation against Infectious Disease5 (the ‘Green Book’) and all updates of national influenza and pneumococcal vaccination policy including CMO/CNO/CPO letters .BNF and SPCs

Competency assessment and ongoing supervision, support and mentorship is seen as crucial to the application of clinical governance standards to HCSW immunisation.

Trainers should ensure that the content of each session enables the participant to meet the learning objectives specified for each core topic. See Appendix 1 for suggested learning outcomes. These learning outcomes have been adapted from those provided in the Core Curriculum to be specific to pneumococcal and influenza vaccination.

Provision of training

Ideally, training should be provided at local level and be led by local trainers.

Involving local experts in delivering training enables immunisers to raise local issues for further discussion. It also gives immunisers the opportunity to meet those leading on immunisation in their locality so that they know who to contact for support and advice. Certain areas such as clinical governance and record-keeping may have some degree of local area variation and it is therefore beneficial if this can be taught at local level. However, where it is not possible to access training locally, training can be obtained from an experienced training provider elsewhere provided the training comprehensively covers the standards and curriculum detailed in this document.

It is important that there is an identified lead for co-ordinating the training arrangements in a locality, ensuring that appropriate training is being provided and that relevant individuals are given the opportunity to attend.

In many areas, it may be possible to enrol the Local Health Board, NHS or Primary Care Trust educators and training departments to establish and take an organisational lead in immunisation training. Collaboration between educational establishments and LHBs/PCTs should be encouraged to share experience and skills and build upon any currently available courses. Close collaboration with NPHSPHW/HPA/HPS is also recommended.

The people responsible for providing local training and overseeing the local implementation of the immunisation programme in each area have additional professional development needs in order to organise and deliver the broad range of material that is required. Such people are also the leaders in immunisation for their organisation, whether it is a Trust, Health Board or a local unit of the NPHSPHW/HPA, or the Health Protection Team of the NHS Board. They require an in-depth knowledge both of the subject areas they will need to teach and also of more specialist areas such as audit and critical incident management in order to run an effective immunisation service within their area. They also require regular updates on current immunisation issues.