DEDICA TIO N - Immunise - The National Immunisation … Guidelines for Immunisation Education for Registered Nurses & Midwives A GUIDE FOR COURSE ASSESSORS, EDUCATORS & TRAINING ORGANISATIONS

i i

i O N

M

M U

N

S A T

immmunisation

National Guidelines for Immunisation Education for

Registered Nurses & Midwives

A GUIDE FOR COURSE ASSESSORS, EDUCATORS & TRAINING ORGANISATIONS

A project of the South Australian Immunisation Coordination Unit (South Australian Department of Human Services) and the Commonwealth Department of Health and Aged Care in collaboration with members of the National Immunisation Education Course Committee, a former working party of the National Immunisation Committee.

Project Leaders Ms Ann Kempe MSc (Hons), BA, DipApplSc, RM, RN South Australian Department of Human Services

Ms Maggi Osbourn RN, RM, BN, Grad Dip Legal Studies, DipApplSc (Community Health Nursing) South Australian Department of Human Services

© Commonwealth of Australia 2000

ISBN 0 644 35539 5

This work is copyright. It may be reproduced in whole or in part for study or training purposes subject to the inclusion of an acknowledgment of the source and no commercial usage or sale. Reproduction for purposes other than those indicated above requires the written permission of the Commonwealth Department of Health and Aged Care GPO Box 9848, Canberra ACT 2601.

First published in November 2000 Designed By: Swell Design

D E D I C A T I O N

These guidelines are dedicated

to the memory of Ms Leeanne

Norton. Her professionalism

and commitment ensured a

quality outcome to the project.

NATIONAL GUIDELINES FOR IMMUNISATION EDUCATION FOR REGISTERED NURSES & MIDW IVES i i i

v i v I M M U N I S A T I O N NATIONAL GUIDELINES FOR IMMUNISATION EDUCATION FOR REGISTERED NURSES & MIDW IVES

Foreword

The aim of these National Guidelines for Immunisation Education for Registered Nurses and Midwives is to ensure that registered nurse and midwife vaccinators are trained as safe and effective immunisation providers. The Guidelines outline the core areas of knowledge and competencies, which the members of the National Immunisation Committee believe a registered nurse or midwife should demonstrate to achieve this aim. In some states and territories existing legislation also supports registered nurses/midwives in their role of immunisation providers.

The Guidelines can be used as a resource by those involved in immunisation program management and education to assist with the planning and implementation of immunisation education strategies for registered nurses/midwives at undergraduate or post-graduate level, or through in-service modes of education.

However, institutions/organisations developing immunisation courses or other training strategies for immunisation providers, should also seek endorsement of these courses/strategies from the appropriate professional nursing organisation.

I am sure that this publication will support the highest possible standards of education and encourage consistency in immunisation knowledge and skills throughout Australia.

John Mathews Head National Centre for Disease Control

Contents

Foreword iv

Acknowledgments vii

Background 1

Introduction to the use of these Guidelines 3 Core areas of knowledge and skills recommended for registered

nurse and midwife vaccinators 7 Theoretical foundations of immunisation 8

Topic 1.1 Immunisation: a public health perspective 9

Topic 1.2 The immune system and vaccine and vaccine action 11

Topic 1.3 Epidemiology of vaccine preventable diseases 12

Topic 1.4 Immunisation myths and realities 13 Summary 14 Clinical theory and practice 15

Topic 2.1 Legal aspects of immunisation: legislative and common 16 law issues

Topic 2.2 Recognition and management of adverse events following 18 immunisation

Topic 2.3 Vaccines used in the current Australian Standard Vaccination 20 Schedule (NHMRC)

v i i v i I M M U N I S A T I O N NATIONAL GUIDELINES FOR IMMUNISATION EDUCATION FOR REGISTERED NURSES & MIDW IVES

Topic 2.4 Management, handling, storage and transporting 22 vaccines (the cold chain)

Topic 2.5 Administration of vaccines 24

Topic 2.6 Health promotion resources for immunisation 25

Summary 27

Abbreviations and acronyms 28

Endorsees of these Guidelines 29

Contact details for Commonwealth, State and Territory

Government Health Authorities 30

References and resource material 31

Standards for childhood vaccination 33

Acknowledgments

This document was written in collaboration with members of the National Immunisation Education Course Committee (NIECC) which was a sub-committee of the National Immunisation Committee (NIC) in 1997/1998. Members of the National Immunisation Education Course Committee *Ms Leeanne Norton (Chair), Business Manager, Faculty of Nursing, University of SA. Ms Ann Kempe (Deputy Chair), SA Immunisation Coordinator, SA Immunisation Coordination Unit SA Department of Human Services. Ms Yvonne Epping, Immunisation Coordinator, ACT Department of Health and Community Care.

Ms Sue Campbell-Lloyd, Manager, Immunisation, NSW Department of Health. Ms Nan Miller, Senior Project Officer, Territory Health Services, NT. Ms Maggi Osbourn, Clinical Nurse Consultant, SA Immunisation Coordination Unit, SA Department of Human Services. Ms Kathy Bell, Project Officer, National Aboriginal Community Controlled Health Organisation. Ms Yvette Roe, Project Officer, National Aboriginal Community Controlled Health Organisation. Ms Karen Peterson, Immunisation Coordinator, Queensland Health Department. Ms Gill Bricher, Lecturer, School of Nursing, University of SA.

i x v i i i I M M U N I S A T I O N NATIONAL GUIDELINES FOR IMMUNISATION EDUCATION FOR REGISTERED NURSES & MIDW IVES

Ms Carole Traylor, Professional Officer - Projects, Royal College of Nursing, Australia.

Ms Liz Foley, Professional Officer - Projects, Royal College of Nursing, Australia.

Mr Geoff Clark, Executive Officer (Nursing Board of Tasmania), representing the Australian Nursing Council Inc.

Dr Rosemary Lester, Manager, Prevention and National Health Priorities Section, Department of Human Services, VIC.

Dr John Litt, Royal Australian College of General Practitioners.

The members of the National Immunisation Committee were also consulted throughout the development of this document.

*The committee members were saddened by the death of Ms Norton in mid-1998. Ms Norton contributed a great deal to ensure the academic rigour of this document.

Members of the National Immunisation Committee (at time of endorsement) Mr Greg Sam (Chair), Director, Immunisation and Vaccine Preventable Diseases Section, Commonwealth Department of Health and Aged Care. Dr Rosemary Lester (Deputy Chair), Manager, Prevention and National Health Priorities Section, Department of Human Services, VIC. Ms Ann Kempe, SA Immunisation Coordinator, SA Department of Human Services. Dr Jag Gill, Director, Disease Control, Health Department of WA. Ms Yvonne Epping, Immunisation Coordinator, ACT Department of Health and Community Care. Ms Sue Campbell-Lloyd, Manager, Immunisation, NSW Department of Health. Dr Avner Misrachi, Senior Medical Officer, Public and Environmental Health, Department of Health and Human Services, Tasmania.

Ms Karen Peterson, Immunisation Coordinator, Queensland Health Department. Dr John Aloizos, Royal Australian College of General Practitioners. Ms Diana Terry, National General Practice Immunisation Coordinator, Australian Divisions of General Practice. Dr Sophia Couzos, Public Health Officer, National Aboriginal Community Controlled Health Organisation. Dr Peter Eizenberg, Australian Divisions of General Practice. Dr Christine Selvey, Head, Immunisation, Centre for Disease Control, Territory Health Services, NT. Ms Helen McFarlane, Director, Sexual Health and Immunisation Section, Office of Aboriginal and Torres Strait Islander Health, Department of Health and Aged Care.

(NB Dr Cathy Mead, Executive Officer, National Public Health Partnership, Chaired the National Immunisation Committee in 1997 and part of 1998). Ms Nan Miller, Senior Project Officer, Territory Health Services, NT was a member of the NIC during the development of these guidelines in 1997–98.

Background

In 1993, the National Health and Medical Research Council (NHMRC) identified the improvement of education programs for health professionals as a major priority in its National Immunisation Strategy. The Strategy recommended that regular updates or advice on current practices be used to maintain the professional education of immunisation providers.

In addition, the 1994, Standards for Childhood Immunisation state that:

Vaccines (should be) administered by properly trained individuals who receive ongoing education and training on current immunisation recommendations. (Refer to page 33–34 for a summary of standards for childhood immunisation).

Only properly trained individuals should administer vaccine. The adoption by all States and Territories of a standardised training curriculum would ensure consistency in the

implementation and application of immunisation procedures throughout Australia for all staff involved in providing such services. Training and education should include current guidelines and recommendations of the NHMRC, as specified in the NHMRC Australian Immunisation Handbook, as well as the Standards for Childhood Immunisation (Commonwealth Department of Human Services and Health) and other immunisation information sources.

In November 1996, members of the National Immunisation Committee (NIC) decided that a working party should be set up to develop national education guidelines for registered nurses/midwives involved as immunisation service providers. In this way the Commonwealth Department of Health and Aged Care could assist with implementation of Standard 13 of the 1994, Standards for Childhood Immunisation.

NATIONAL GUIDELINES FOR IMMUNIS ATIO N EDUCATION FOR REGISTERED NURSES & MIDW IVES 1

3 2 I M M U N I S A T I O N K E E P I T C O O L : T H E V A C C I N E C O L D C H A I N NATIONAL GUIDELINES FOR IMMUNISATION EDUCATION FOR REGISTERED NURSES & MIDW IVES

In early 1997, the Department of Health and Aged Care funded the South Australian Immunisation Coordination Unit (South Australian Department of Human Services) to provide the Secretariat for the National Immunisation Education Course Committee (NIECC) and between 1997 and 1998, the NIECC developed these National Guidelines for Immunisation Education for Registered Nurses and Midwives.

While the original intent of the NIECC was to develop national guidelines for all professionals involved in immunisation, it was later decided that the final guidelines should be directed at registered nurses/midwives only. The National Immunisation Committee felt there were already existing mechanisms to coordinate training for general practitioners and Aboriginal Health Workers across Australia, however, the Guidelines could be used as a supplement to the education and training of these health service providers if appropriate.

The principal authors reviewed these Guidelines in 2000 to take account of recent revisions of source documents

Handbook. This publication received final endorsement from of the National Immunisation Committee in November 2000.

Educational organisations may wish to contact their State/Territory

such as The Australian Immunisation

immunisation coordinators to discuss this document (refer to page 30 for contact details).

Introduction to the use of these Guidelines

The aim of the National Immunisation Education Course Committee (NIECC) was to develop national guidelines for the development of immunisation courses and other education strategies for registered nurses/midwives. This document has been developed to encourage a consistent approach to immunisation education. The information is based on already published national documents on immunisation including: 1. National Health and Medical

Research Council (NHMRC) current (2000–2002) Australian Standard Vaccination Schedules.

2. NHMRC Australian Immunisation Handbook 7th edition 2000.

3. Commonwealth Department of Human Services and Health (1994), Standards for Childhood Immunisation.

4. Commonwealth Department of Health and Aged Care (2000), Keep it cool: the vaccine cold chain; Guidelines for immunisation

providers on maintaining the cold chain.

5. Commonwealth Department of Health and Aged Care, 2000, Immunisation Myths & Realities: Responding to Arguments against Immunisation – A guide for providers, 3rd Edition.

These Guidelines are reviewed on a regular basis. Persons using this publication as a reference should ensure that they have the latest edition. Broad Learning Outcomes A broad set of learning outcomes should be stated at the beginning of any curriculum that is developed using these education guidelines. The statement of the general learning outcomes of a course that has been developed using these guidelines could include the following: At the end of the course (developed using these guidelines) the participant should have:

5 4 I M M U N I S A T I O N K E E P I T C O O L : T H E V A C C I N E C O L D C H A I N G U I D E L I N E S F O R I M M U N I S A T I O N P RO V I D E R S O N M A I N T A I N I N G T H E C O L D C H A I N

• the knowledge, skills, attitudes

and experience to competently deliver a quality immunisation service to the community;

• the knowledge, attitudes and skills to actively promote, communicate and educate the community and other health professionals, about the diverse range of issues related to immunisation; and

• a commitment to continuous self- education to ensure they are professionally competent to practice as an immunisation service provider.

Specific learning outcomes, which meet the broad learning outcomes stated above, have been developed for each of the core subject areas in these course guidelines. Please refer to pages 7 to 27 for details.

Recommended subject areas and topics

These education guidelines are presented under two broad subject headings that could be delivered either internally or externally. Each subject area includes a list of recommended topics with suggested learning outcomes for each topic. These recommended subject areas and topics are listed below.

1. Theoretical foundations

of immunisation 1.1 Immunisation: a public

health perspective 1.2 The immune system

and vaccine action 1.3 Epidemiology of vaccine

preventable diseases 1.4 Immunisation: myths

and realities 2. Clinical theory and practice

of immunisation 2.1 Legal aspects of

immunisation: legislative and common law issues

2.2 Recognition and management of adverse events following immunisation

2.3 Vaccines used in the current NHMRC Australian Standard Vaccination Schedule

2.4 Management, handling, storage and transporting vaccines (the cold chain)

2.5 Administration of vaccines 2.6 Health promotion resources

for immunisation

Integration of knowledge Each topic should contain the relevant readings from current journals, NHMRC and Commonwealth Department of Health and Aged Care publications, other national documents, audio- visual presentations and appropriate learning exercises. This material should help the student to integrate the theoretical knowledge to their clinical practice. Clinical practice and assessment Supervised clinical practice is recommended to be included in any education strategy for immunisation. It is an essential component to ensure the integration of the theoretical knowledge with clinical practice. The clinical assessment process should have the ability to assess the knowledge, skills and attitude of the learner and a competency approach to this integration is also recommended. The use of a preceptor is one recommended strategy that could assist the student to integrate theory with clinical practice.

For more information on nursing competency please refer to: • Australian Nursing Council Inc.,

(2000) National Nursing Competencies for the Registered Nurse and within this publication:

Australian Nursing Council Inc., (2000) National Competency Standards for the Registered Nurse and Enrolled Nurse; and

• Australian Nursing Federation (1997) Competencies for the Advanced Practitioner.

Role of the preceptor/mentor A preceptor can assist the student to become a competent nurse/midwife vaccinator by acting as a teacher or role model while the student integrates immunisation theory with his or her clinical practice. The preceptor can also review the student’s clinical competency in the field. The role of a preceptor is a complex one that includes being: • a professional role model • a teacher • a resource person • a reviewer of progress

and assessor • responsible for direct client care.

7 6 I M M U N I S A T I O N K E E P I T C O O L : T H E V A C C I N E C O L D C H A I N NATIONAL GUIDELINES FOR IMMUNISATION EDUCATION FOR REGISTERED NURSES & MIDW IVES

Theoretical assessment

A method of theoretical assessment is recommended for inclusion in any immunisation education strategy. A method of assessing the theoretical knowledge and understanding of the subject serves two purposes:

• to assess the learner’s knowledge

base and understanding of the theoretical foundations and clinical practice of immunisation; and

• to familiarise the learner with the major texts which are a major resource for clinical practice, particularly the current NHMRC Australian Immunisation Handbook.

Once a student has satisfactorily completed both theoretical and clinical assessments, they should be competent to proceed as an autonomous immunisation provider. Formal recognition by the institution or organisation of completion of an accredited course is also recommended because it promotes professional recognition of the student’s achievement.

Core areas of knowledge and skills recommended for registered nurses and midwife vaccinators

9 8 I M M U N I S A T I O N NATIONAL GUIDELINES FOR IMMUNISATION EDUCATION FOR REGISTERED NURSES & MIDW IVES

Subject area one: Theoretical foundations of immunisation

Aim

The aim of this subject is to provide a strong theoretical foundation to immunisation practice.

Practitioners will also be able to use this information to better inform their clients, colleagues and the community.

Practitioners will be able to make improved clinical decisions in relation to immunisation because of a deeper understanding of the theoretical base of immunisation practice.

Recommended topics 1.1 Immunisation: a public health

perspective 1.2 The immune system and

vaccine action 1.3 Epidemiology of vaccine

preventable diseases 1.4 Immunisation: myths and

realities

Topic 1.1 Immunisation: a public health perspective

Suggested learning outcomes At the completion of this topic learners will be able to: • describe the aims of an

immunisation program • outline international and national

population health perspectives of immunisation

• describe the importance of the public health perspective to individual practice

• state the concept of population/community immunity as compared to individual immunity.

Recommended content for this topic: • Concepts of control, elimination and

eradication of vaccine preventable diseases and their impact on global and national immunisation programs, and practical strategies which demonstrate these concepts.

• Information on the signs and symptoms, occurrence, mode of transmission and control, of vaccine preventable diseases.

• Current information on the epidemiology of vaccine preventable diseases using national and state/territory data sources, including data from the Australian Childhood Immunisation Register (ACIR) and surveys conducted by the Australian Bureau of Statistics (ABS), and the importance of surveillance for immunisation providers in terms of program management.

1 1 1 0 I M M U N I S A T I O N NATIONAL GUIDELINES FOR IMMUNISATION EDUCATION FOR REGISTERED NURSES & MIDW IVES

• The distribution of the health dollar

for preventative health (including immunisation) in Australia in comparison to supporting those with a health problem.

• Definition of immunisation terminology including immunogenicity, reactogenicity efficacy, protection, herd immunity etc, and application of terminology to immunisation practice.

• Current national/state/regional strategy documents and other quality management tools underpinning immunisation programs as a benchmark for program evaluation. For example NHMRC National Immunisation Strategy (1993), Standards for Childhood Immunisation (1994), Keep it cool: the vaccine cold chain (2000).

• Global perspective and Australia’s relationship with the World Health Organisation’s (WHO) Expanded Program on Immunisation (EPI).

Topic 1.2 The immune system and vaccine and Vaccine action

Suggested learning outcomes At the completion of this topic learners will be able to: • have a basic knowledge of the

immune system • describe the relationship between

the immune system and vaccine action

• relate this information to practice with regard to maintaining the NHMRC Australian Standard Vaccination Schedule.

Recommended content for this topic: • Revision of the immune system for

example, active and passive immunity, acquired immunity, antigens, antibodies etc.

• The normal physiological immune function interaction with specific vaccines for example live attenuated vaccines and implications for the NHMRC Australian Standard Vaccination Schedule.

• Knowledge of the immune system and its influence on the construction of the NHMRC Australian Standard Vaccination Schedule (for example number of doses, timing, spacing of booster doses etc).

• The role of vaccine providers in encouraging the community to maintain the recommended NHMRC Australian Standard Vaccination Schedule to maximise individual and community protection.


Topic 1.3 Epidemiology of vaccine preventable diseases

Suggested learning outcomes

At the completion of this topic learners will:

• have knowledge of the

epidemiology of vaccine preventable diseases and vaccine coverage at a national and state/territory levels, including coverage of different populations within Australia

• have an awareness of the comparison of Australian vaccine coverage with international coverage in both developing and developed countries

• understand the necessity to apply this knowledge to immunisation service provision

• understand the application of epidemiology to immunisation practice.

Recommended content for this topic: • The epidemiology of vaccine

preventable diseases and vaccine preventable disease rates at national and state/territory levels in Australia.

• Comparison of disease rates and vaccine coverage in Australia with specific countries.

• Discuss the national perspective of past and current vaccine preventable disease rates. Introduce Communicable Diseases Intelligence and other data sources.

• State/territory vaccine coverage data using data from ACIR, ABS surveys, etc.

• Discussion on mechanisms that could be used to feedback coverage and disease surveillance data to vaccine providers.

Topic 1.4 Immunisation: myths and realities

Suggested learning outcomes At the completion of this topic learners will be able to: • state some of the common

arguments against, or myths about, immunisation

• respond to these arguments against immunisation from a basis of current scientific knowledge

• explore their personal beliefs regarding immunisation and relate these to the scientific evidence

• discuss these issues with client/patients with confidence.

Recommended content for this topic • Differences in the interpretation

of knowledge, for example scientific compared with alternative ‘knowledge’.

• The common arguments or myths against immunisation.

• The current scientific evidence which refute the most common arguments.

• The role of the media in presenting immunisation to the public and how to discuss this with clients/patients.

• The issue of individual rights in relation to choosing not to immunise.

• The role of valid consent procedures in dealing with the anti- immunisation perspective.

• The importance of a practitioner’s communication skills when discussing this issue with community members.


Summary of Theoretical foundations of immunisation

A summary of this subject area should be included which clarifies the expected learning outcomes and allows students to assess whether they have achieved them. This subject area should demonstrate the foundations of immunisation and prepare the learner for clinical experience.

Recommended content for a summary on Theoretical Foundations of Immunisation.

• a public health perspective

expands the focus beyond clinical practice.

• a public health perspective informs practitioners with regard to improving and maintaining immunisation coverage in Australia.

• knowledge of epidemiology focuses client care beyond individual care to include the broader community.

• immunisation is a global preventative population health activity.

• the importance of the ability to present scientific evidence in responding to arguments/myths of immunisation without prejudice.

The summary should make a link to the following section or subject area, Clinical Theory and Practice.

Subject area two: Clinical theory and practice

Aim The aim of this subject area is to provide students with a mechanism to put the theoretical knowledge about immunisation into clinical practice as an immunisation provider.

Recommended topics 2.1 Legal aspects of immunisation:

legislative and common law issues

2.2 Recognition and management

of adverse events following immunisation

2.3 Vaccines used in the NHMRC

Australian Standard Vaccination Schedule

2.4 Management, handling, storage

and transporting vaccines (the cold chain)

2.5 Administration of vaccines 2.6 Health promotion resources

for immunisation

1 7 1 6 I M M U N I S A T I O N G U I D E L I N E S F O R I M M U N I S A T I O N P RO V I D E R S O N M A I N T A I N I N G T H E C O L D C H A I N

Topic 2.1 Legal aspects of immunisation


At the completion of this topic learners will be able to:

• outline the relevant state/territory

acts and/or regulations which relate to vaccines as prescription only drugs and their impact on clinical practice as an immunisation provider

• outline the relevant state/territory acts and/or regulations relating to professional practice and their impact on clinical practice as an immunisation provider

• outline the relevant state/territory acts and/or regulations relating to consent to medical procedures and their impact on clinical practice as an immunisation provider

• recognise the impact of specific aspects of common law decisions on immunisation practice (particularly Rogers v. Whitaker 1993 and subsequent cases)

• state the common components of valid consent procedures

• apply the components of valid consent to practice

• recognise the need for professional accountability

• apply all of the above to clinical practice.

Recommended content for this topic • Relevant state/territory acts and/or

regulations which cover vaccines as prescription only drugs.

• Documents required for practice arising from the acts, and/or regulations for example standing drug orders, and implementation of these documents to immunisation service provision.

• Relevant state/territory acts and/or regulations relating to professional practice, for example, nurses act and their impact on, and relevance to immunisation service provision.

• Relevant state/territory acts and/or regulations relating to consent to medical procedures and their implementation in immunisation service provision.

• The history of informed consent (Bolam principle) and the impact of the Rogers v. Whitaker decision for consent procedures.

• The current legal requirements for consent for immunisation and their implementation in immunisation practice.

• The components of valid consent (for example comparison of effects of diseases and vaccines) and the developed resources for obtaining valid consent in the specific state/territory.

• Supervised clinical practice should occur which applies all aspects of this topic.


Topic 2.2 Recognition and management of adverse events following immunisation


At the completion of this topic learners will be able to:

• describe possible common, mild, moderate and severe adverse events following immunisation and the statistical likelihood of their occurrence

• recognise an adverse event following vaccination

• appropriately treat a client/patient with a mild, moderate or severe adverse event

• describe the relevant state/territory and national adverse event reporting system and report an adverse event to vaccines to the appropriate authority


Recommended content for this topic • Description of common, mild,

moderate and severe adverse events which can occur with specific vaccines on the current Australian Standard Vaccination Schedule and their statistical likelihood of occurrence.

• The signs, symptoms and clinical management of anaphylaxis.

• Requirements in the clinical setting for treatment of adverse events after immunisation (particularly anaphylaxis).

• Future management of patients/clients who have had a previous adverse event to vaccines.

• Current information for recipients of vaccines regarding the incidence of common/ moderate/severe adverse events and their management, including take home advice.

• Information about reporting adverse events following immunisation vaccines to the appropriate state/territory authority or the Adverse Drug Reactions Advisory Committee (ADRAC).

• Risk and benefit information about adverse events following vaccines.

• Possible future directions of immunisation (for example new vaccines).


NOTE: Health professionals providing an immunisation service need to maintain their CPR skills.


Topic 2.3 Vaccines used in the current Australian Standard Vaccination Schedule Suggested learning outcomes

At the completion of the topic learners will:

• have knowledge of the uses,

contraindications and precautions of vaccines in the current recommended Australian Standard Vaccination Schedule

• be familiar with vaccines used in the current Australian Standard Vaccination Schedule and for special groups

• have knowledge of how to complete a client/patient immunisation using catch-up immunisation and other variations to the recommended schedule

• have basic knowledge of travel vaccines and where clients can access these vaccines

• have basic knowledge of special vaccines (eg. rabies) and where to access these vaccines.

• apply all of the above to clinical

practice Recommended content for this topic • Pharmacological information about

vaccines in the recommended schedule including indications for use, dosage and frequency, contraindications.

• Revision of epidemiology of certain diseases and the need to apply this information to the schedule for special groups, for example, Hepatitis B use for at risk groups, pneumococcal infection and recommendations for Aboriginal adults.

• Revision of immunology, vaccine efficacy and reactogenicity and the spacing of vaccines, particularly in relation to catch up schedules.

• Interchangeability of vaccines

• State/territory variations to the Australian Standard Vaccination Schedule.

• How to deal with clients with inadequate or no written immunisation records.

• Information regarding the differences between live attenuated and inactivated vaccines and special precautions.

• Vaccines for special purposes, for example Hepatitis A, BCG.

• Passive immunisation with immunoglobulin and its uses.

• The use of vaccines in outbreaks of vaccine preventable diseases, for example measles, mumps, rubella.

• Professional responsibility to maintain pharmacological knowledge about vaccines.

• State/territory resources for travel vaccine information and international schedules.



Topic 2.4 Management, handling, storage and transportation of vaccines (the cold chain)


At the completion of this topic students will be able to:

• describe the current NHMRC

recommendations for the storage, transportation and temperature monitoring of vaccines used in the national immunisation program in Australia

• identify vaccines which are affected by extremes of cold and heat

• identify vaccines affected by exposure to light

• describe the state/territory system for managing "cold chain" failure through faults in the storage, transportation or temperature monitoring of vaccines

• describe the state/territory system in relation to auditing of vaccine wastage and the cold chain monitoring


Recommended content for this topic • Professional responsibility for

administering effective (potent) vaccines.

• The cost of individual vaccines, acceptable levels of wastage and mechanisms to improve efficacy.

• WHO formula for calculating doses needed in order to reduce wastage.

• The state/territory procedure for supplying free child and (where applicable) free/subsidised adult vaccines.

• WHO cold chain recommendations and guidelines and their role in the national immunisation program in Australia.

• The relationship between efficacy of vaccines and maintaining recommended temperature range for storage and transportation of vaccines.

• Procedures and equipment required for managing cold chain.

• Responsibility for management of vaccines at clinic level.

• Interpretation of monitors used in transporting and storage of vaccines and recording of temperatures.

• State/territory vaccine audit protocols for wastage and cold chain management.

• State/territory protocols for management of cold chain breakdowns.


Topic 2.5 Administration of vaccines


At the completion of this topic students will:

• have knowledge of all aspects of

the recommendations relating to administration of vaccines, for example, sites, route needle gauge/length and angle of insertion

• consider the occupational health, safety and welfare issues relating to immunisation

• be aware of the documentation requirements with regard to immunisation

• be able to apply all of the above to clinical practice.

Recommended content for this topic

• National recommendations re sites,

route, needle gauge/length and angle of insertion and speed of administration.

• Revision of physics (angles, depths and fluid under pressure), anatomy and physiology (muscle fibres and absorption).

• Research which justifies the change to injection technique (The Australian Immunisation Handbook 7th edition 7–13).

• Best practice medication management (eg. the ‘6 drug rights’ or the ‘6 Rs’).

• Reiterate consent process prior to administering vaccines.

• Documentation requirements for immunisation.

• Concept of opportunistic immunisation and health professional’s role should reflect Standard 4 of the Standards for Childhood Immunisation (Commonwealth of Human Services and Health).

• Disposal of syringes, needles etc. • Safety of provider/clients/patients. • Post-immunisation waiting time. • Take home information for parents. • Provider attitude and its influence

on patients/clients continuing with immunisation.


Topic 2.6 Health promotion and resources for immunisation

Suggested learning outcomes At the completion of this topic students will be able to • describe how to access their local

and national promotional resources • recognise the need to form and

maintain networks, particularly with other vaccine providers

• utilise national and local databases to develop strategies for improving immunisation uptake, for example ACIR

• initiate strategies to promote immunisation locally for example working with service groups, meeting with key community people

• realise the importance of updating theoretical knowledge regularly to maintain national standards

• understand the need to target

immunisation to certain groups, for example; people from non English speaking backgrounds, Aboriginal and Torres Strait Islander people, working parents, remote and isolated families

• understand the need to recognise cultural differences of communities, through appropriate community consultation, as related to immunisation and apply this to health promotion strategies


2 4 I M M U N I S A T I O N NATIONAL GUIDELINES FOR IMMUNISATION EDUCATION FOR REGISTERED NURSES & MIDW IVES 2 5

2 7 2 6 I M M U N I S A T I O N K E E P I T C O O L : T H E V A C C I N E C O L D C H A I N NATIONAL GUIDELINES FOR IMMUNISATION EDUCATION FOR REGISTERED NURSES & MIDW IVES

Summary of the Clinical Theory and Practice

Recommended content for this topic

• Relate to Standard 2 of Standards

for Childhood Immunisation which advocates the removal of barriers to immunisation.

• Provide information on how to access NHMRC publications and resources for professionals and the community.

• Discuss the Ottawa Charter and its application to immunisation service delivery, health promotion and education to different communities.

• Discuss community promotional opportunities and working with other health and non health professionals.

• Promote the importance of respect of cultural differences and the need to work with key community representatives.

• The importance of professional networking at local and regional level.

• The importance of maintaining resources current and in line with organisational policy.

• Cross cultural awareness.

A summary of this subject area should be included which clarifies the expected learning outcomes and allows students to assess as to whether they have achieved them. This section should demonstrate the clinical theory and practice required ensuring the nurse/midwife is safe and competent to practice as a vaccine service provider. This aspect of training should incorporate a clinical placement, which may or may not include a preceptor relationship. The focus should be on competency assessment, which aims to integrate immunisation theory and practice. Recommended content for the summary on Clinical Theory and Practice: • reiterate NHMRC

recommendations as best practice. • stress professional responsibility

to know the law which governs immunisation practice.

• stress professional responsibility to administer effective vaccines by maintaining the cold chain.

• the importance of a professional and caring approach in clinical practice which encourages open discussion about immunisation with clients/patients.

• the professional’s responsibility to upgrade knowledge re immunisation regularly as per Standard 13 Standards for Childhood Immunisation.

• stress the importance of the benefits of liaison and professional networking that best meets the needs of the community, as defined by the community.

• the need to use the clinical setting to integrate the knowledge.


Abbreviations and acronyms

Proudly endorsed as an educational resource by:

ABS Australian Bureau of Statistics

ACIR Australian Childhood Immunisation Register

NHMRC National Health and Medical Research Council

NIC National Immunisation Committee

NIECC National Immunisation Education Course Committee

WHO World Health Organisation

Association for Australian Rural Nurses Inc Australian Association of Maternal Child and Family Health Nurses Australian College of Midwives Inc Australian Confederation of Paediatric and Child Health Nurses Australian Council of Community Nursing Services Australian Infection Control Association

Australian Nursing Council Inc

Australian Nursing Federation

Council of Remote Area Nurses of Australia Inc Royal College of Nursing Australia

Nurses Board of the Northern Territory Nurses Board of the ACT

Nurses Board of Tasmania

Nurses Board of Western Australia

Nurses Board of South Australia

Nurses Board of Queensland

Nurses Registration Board – NSW

Nurses Board of Victoria


Contact details for Commonwealth, State and Territory Government Health Authorities

Commonwealth (02)6289 1555

Australian Capital Territory (02) 6205 2300

New South Wales Public Health Unit (look under 'Health' in the white pages)

Northern Territory (08) 8922 8044

Queensland (07) 3234 1500

South Australia (08) 8226 7177

Tasmania (03) 6233 3762 or 1800 671 738 (Tasmania only)

Victoria (03) 9637 4144

Western Australia (08) 9321 1312

References and resources

The following references may also be used by lecturers to assist in the compilation of correct course content: National Health and Medical Research Council (NHMRC) (2000–2002) Australian Standard Vaccination Schedule. NHMRC (2000) The Australian Immunisation Handbook 7th edition, Commonwealth Department of Health and Aged Care. Australian Government Publishing Service, Canberra. Commonwealth Department of Human Services and Health (1994), Standards for Childhood Immunisation. Australian Government Publishing Service, Canberra.

Commonwealth Department Health and Aged Care (2000), Keep it cool: the vaccine cold chain; Guidelines for immunisation providers on maintaining the cold chain. Australian Government Publishing Service, Canberra. Commonwealth Department of Health and Aged Care (2000), Immunisation Myths & Realities: Responding to Arguments against Immunisation – A guide for providers (3rd Ed). Australian Government Publishing Service, Canberra. NHMRC (1993) National Immunisation Strategy. Australian Nursing Council Inc., (2000) National Nursing Competencies for the Registered Nurse. Australian Nursing Council Inc., (2000) National Competency Standards for the Registered Nurse and Enrolled Nurse.


Australian Nursing Federation (1997) Competencies for the Advanced Practitioner.

High Court of Australia judgement (1992) in Rogers v. Whitaker.

Staunton, PJ and Whyburn B (1993), Nursing and the Law, Harcourt Brace and Co Australia.

WHO (1986) Ottawa Charter for Health Promotion.

The following websites also provide useful information:

http://www1.hic.gov.au/general/acircirghome

http://www.abs.gov.au/

http://www.health.gov.au/pubhlth/cdi/cdihtml.htm

http://www.ncirs.usyd.edu.au/

http://www/pubhlth/immunise/index.htm

http://www.who.int/

Standards for childhood vaccination

The following is a summary of the standards for childhood vaccination which were developed by the National Immumsation Committee in consultation ith the National Immunisation Education sub- committee which consists of representatives from professional organisations. They are intended as a guide rather than a legalistic

imposition on providers, and can provide the basis for quality assurance at all levels in the health system. As such they have been endorsed by the Australian Medical Association, the Royal Australian College of General Practitioners and the Australian College of Paediatsics and have been welcomed by a variety of other professional bodies.

Standard 1 Vaccination services are readily available. Standard 2 There are no barriers or prerequisites to vaccination services. Standard 3 NHMRC recommended childhood vaccines are offered free,

without cost to parent or guardian. Standard 4 Vaccination providers utilise all clinical encounters to assess

vaccination status and, when indicated, vaccinate children. Standard 5 Providers educate parents and guardians about vaccination. Standard 6 Providers question parents or guardians about contraindications

and, before vaccinating a child, inform them in specific terms about the benefits and risks of the vaccines their child is about to receive.

Standard 7 Providers withhold vaccination only for true contraindications.

http://www1.hic.gov.au/general/acircirghome

http://www.abs.gov.au/







http://www.who.int/

3 4 I M M U N I S A T I O N

Standard 8 Providers offer and administer, where possible, all vaccines for which a child is due at the one visit.

Standard 9 Providers use accurate and complete recording procedures.

Standard 10 Providers report adverse events following immunisation promptly, accurately and completely as set out in section 1.6.

Standard 11 Providers adhere to appropriate procedures for vaccine cold- chain management.

Standard 12 Vaccination providers maintain current and easilv retrievable vaccination guidelines at all locations where the vaccines are administered.

Standard 13 Vaccines are administered by properly trained individuals who receive ongoing education and training on current vaccination recommendations.