Viewpoint - Should HCAs administer the influenza vaccine?

Dr Paula Varma tested a system where HCAs administer seasonal flu jabs.

Deployment of an HCA allowed one practice to increase vaccinations by 20% (Photograph: AJ Photos/SPL)
Deployment of an HCA allowed one practice to increase vaccinations by 20% (Photograph: AJ Photos/SPL)

The annual influenza vaccination campaign in the UK is time pressured to deliver vaccination to the 'at risk' patient population quickly and efficiently.

Healthcare assistants (HCAs) increasingly form part of the primary healthcare team that administers the vaccine to adults. Local health boards and PCTs have approved this with strict guidance on the training required and the use of directives for prescribing the vaccine.

However, concerns have been raised about this practice, because HCAs have no registering body.

The role of the HCA

The role of the HCA in primary care is approved by the NHS Working in Partnership Programme (WiPP) and is endorsed by the Royal College of Nursing.

In order to protect patients and ensure good practice, HCAs must have specific training in the form of one of the following qualifications: NVQ level 3 (or working towards this); the Primary Care Training Centre health care assistant course; Open University Diploma for HCA in primary care practice Level 3; or a two-year foundation degree programme delivered by an institute of higher education.

They must administer only under patient-specific directives (PSDs).

As registered professionals, doctors are legally accountable for the care provided by delegated, non-registered staff.

The patient must be made aware that the HCA is not a registered professional.

Administering the vaccine

On reviewing the literature, no studies were found that looked at the safety of having non-registered workers administering vaccinations.

This general practice in South Wales had an appropriately trained HCA and, during the autumn of 2011, collected data about who administered the vaccination and whether the patient then attended for an acute appointment to the GP, A&E or out-of-hours provider within 14 days of vaccination. Statistical analysis was performed on the observed and expected frequencies of consultations and there was found to be no difference in rates between the groups.

FREQUENCY OF CONSULTATIONS POST-VACCINATION
  OBSERVED EXPECTED
NURSE (n = 214) 14
14
GP (n = 101)
7
6.75
HCA (n = 65)
4
4.25

With an increase in our elderly population, staffing is an important consideration. According to this study, there is no increase in acute complications following vaccination by doctor, nurse or HCA and it seems to be acceptable to patients. Further studies are needed to ensure this is reproducible.

The HCA had achieved NVQ level 3 and attended a vaccination administration course. The HCA administered the vaccine under PSDs and the patients were made aware of her role at the time of vaccination.

Any queries regarding vaccination were directed to a registered healthcare professional.

Data were collected on the first 380 patients vaccinated against influenza in the autumn of 2011. Their notes were checked for acute attendance at the GP surgery, A&E or out-of-hours provider in the 14 days following vaccination for any acute reason, along with whether they had been vaccinated by a doctor, a nurse or the HCA.

No statistical difference

Chi-square analysis of these values gives a p-value of 0.988, with a CI of 0.94-1.04. There is no statistical difference between the groups. We can therefore accept the null hypothesis of no difference between the groups.

No patients refused vaccination by the HCA. All attendances to GP surgeries, A&E and out-of-hours providers seemed to be unrelated to the vaccination and included UTIs, URTIs, local infections and falls.

The practice was able to vaccinate 20% more patients in the early autumn of 2011 by using the HCA in this role.

Discussion

HCAs are a useful addition to the primary healthcare team and when used in the correct situations with appropriate supervision and training, they can help with the primary prevention of illness in our ageing population.

This small study has shown that in the cohort of patients vaccinated in September and October 2011 there was no statistically significant difference in attendance for acute care after vaccination, irrespective of who had administered the vaccine, and the patients were happy to receive the vaccine from any of the healthcare workers.

The study is limited by the small sample and further research is needed to determine if these results are reliable and reproducible. The strength of the study lies in the computerised records; the vaccinations were all administered within a short timeframe in the same practice, with reliable records for data gathering and analysis.

It is important that those managing HCAs ensure they have appropriate training and maintain their skills. It is also essential that HCAs do not advise on vaccinations but always refer to registered staff regarding any queries, and only administer under PSDs, which is a legal requirement to prescribe the vaccine.

In these times of increasing pressure on NHS resources, it is imperative that we continue to develop and alter our roles and make use of the multi-disciplinary teams within which we work, to ensure patient safety and optimum timing of vaccine administration.

  • Dr Varma is a GP in Pontyclun, Wales.

Resources

DH. Immunisation Against Infectious Disease. Chapter 3, 17-24. London, The Stationery Office, 2006.

HPA. National Minimum Standards for Immunisation Training. London, HPA, 2005.

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