The flu season typically coincides with a flurry of advice calls to MDDUS on the various areas of risks in relation to flu vaccines and the management of vaccination programmes generally.
Queries include how to ensure that flu vaccinations are delegated and administered appropriately and how to apply the principles of consent when vaccinating young children and adolescents. Some GPs also encounter the pitfalls that can be associated with vaccination campaigns, such as errors in dosage and equipment failure.
No vaccination programme can guarantee to be 100% safe all the time. However, GPs can work to develop procedures that recognise the common pitfalls and implement steps to avoid them. As part of this effort, all members of the primary care team involved in the vaccination programme should be up-to-date on the relevant NHS guidance.
Here we look at some of the key risk areas and how GPs can avoid common pitfalls in vaccination campaigns.
Patient selection, administration and delegation
Practices should ensure that vaccination invitation systems include all eligible patients and that patients who fall outside the set criteria are not included without clear justification.
In general, named and trained staff should be responsible for the ordering, receipt and care of vaccines.
GPs should ensure that those administering vaccines are legally-entitled and competent to do so. For example, healthcare assistants cannot administer vaccines under a patient group direction (PGD) but they can, in some circumstances, do so under a patient specific direction (PSD).
The distinction between a PGD and a PSD is that the latter is a written instruction that includes the name of the patient as well as name, dose and frequency of the prescription-only medicine to be administered to that named person after the prescriber has assessed the patient on an individual basis.
A doctor is ultimately accountable for any vaccine he or she prescribes, irrespective of who administers it to the patient. GPs must therefore fully satisfy themselves that the person administering the prescribed vaccine is suitably trained and competent to do so.
The issue of consent for treatment in children can, in certain situations, pose difficulties. This is particularly the case when the child is under 16, or their parents disagree on the intended medical treatment.
As each case carries its own unique complexities, MDDUS recommends that GPs seek the support of their colleagues and medical defence organisation when dealing with such matters.
Notwithstanding the above, the principle is that, generally, only a person with parental responsibility can consent to a child’s medical treatment. GPs should therefore take extra care when vaccinating young children to ensure they have obtained the relevant consent.
Equipment and dosage
We have encountered a number of cases involving issues with equipment, storage and patient selection. These include cases in which empty syringes have been inadvertently reused and situations where incorrect patients have been called for vaccination. In some instances, practices have had to recall large numbers of patients following a discovery that their fridges were not at the correct storage temperature for vaccines.
In addition to routine monitoring of fridge temperatures, the expiration date of vaccines should also be regularly checked to avoid expired vaccines being used.
Records are an essential part of the continuing care of a patient and can also provide invaluable evidence in the event of a claim or complaint. Ensure that all vaccines are recorded accurately, including the date, time, vaccine and batch number, as well as site and mode of injection. Finally, the recording should make it clear who prescribed the vaccine and who administered it to the patient.
Accurate records should also be kept of any specific refusals, with an alert system in place to check whether refusals remain valid. As important is accurate documentation regarding invitations and supply of the vaccine stocks.
Practices should display any relevant campaign posters and other written information so that they are easily accessible for patients. Information can be shared verbally, in the form of posters and leaflets and via the practice’s social media channels.
Lead by example
All doctors, nurses and healthcare providers are encouraged to get the flu jab as it sends a strong message to those patients most in need of vaccination.
GMC’s Good Medical Practice states doctors should be: 'immunised against common serious communicable diseases (unless otherwise contraindicated).'