Ordering Vaccines 2018/19

Following the recent publication of updated guidance for the 2018/19 flu season there have been some changes in recommended vaccines that should be administered to certain age groups.

We are aware that practices are already placing orders for vaccines from their suppliers which will need to be amended. To assist practices with this there are some reports to identify the numbers in each group.


Access these reports at ‘Reporting > Clinical Reporting > Ardens > Vaccinations > 2018 2019 Vaccine Orders’

Read the latest guidance here.

 

Flu Clinics

Follow the steps below to ensure the correct activity is performed and recorded:

  • Step 1. Checking Immunisations Are Still Required
  • Step 2. Care Homes
  • Step 3. Sending Invitations
  • Step 4. Adding PSDs
  • Step 5. Giving The Vaccine
  • Step 6. Refusal recorded prior to 1st September
  • Step 7. Getting Paid


N.B. Read codes are not required for payment. For further information, see here.


Step 1. Checking Immunisations Are Still Required

Some patients may have previously had a 'Needs Influenza Immunisation' or 'Need Pneumococcal Immunisation' read code added to their records as they do not fall in to one of the at risk groups (e.g. Over 65, COPD etc). The reason for adding this read code may be that they are living with someone who is immunosuppressed. Before you send the invitations in Step 3, you can review these patients to see if they still require the immunisation. If not, just add the 'Influenza Immunisation Not Indicated' or 'Pneumococcal Immunisation Not Indicated' read code and this will then remove them from the invitation list.


To find these patients to review, go to Clinical Reporting > Ardens > Vaccinations > For Review



 


N.B. Add these read codes at least 2 days before sending the invitations in Step 3 to ensure that they are included in the invite reports.


Step 2. Care Homes

Care Home Residents are not included in the invitation reports as this avoids sending multiple invitations to the same address. These patient will still however have an alert icon under their name.


To make Care Home Residents appear in the correct reports, please ensure they have been coded with one of the read codes below:

  • Lives in a nursing home - 13F61
  • Lives in a residential home - XaImT 
  • Lives in care home - XaMFG 


To find out how to do this, see here


N.B. Add these read codes at least 2 days before sending the invitations in Step 3 to ensure that they are included in the invite reports.


Step 3. Sending Invitations

Go to Clinical Reporting > Ardens > Vaccinations 


Here you will see reports for 1st, 2nd and 3rd invitations which identify patients who are eligible for:

  • Influenza vaccine only
  • Pneumococcal vaccine only
  • Influenza + Pneumococcal vaccines

Care/nursing home patients are excluded from the invitation reports. Please see this article about coding residential institutes.  



You can send their invite either by email, SMS or post:

  • Email - Has email consent recorded
  • SMS  - Has SMS consent but no email consent recorded
  • Post   - Has no SMS and no email consent recorded

The reports include all eligible age groups so you may wish to breakdown the reports before sending invites. 


To do this, run the specific report then Right Click > Breakdown Results



Under 'Demographics', select 'Age in years' or as in this example 'Age range'. Here we have set the bands to '0-17' and '18 -110'. Click 'Ok' then click 'Refresh'.



This will then display the breakdown of data you have selected. Right click on a row Actions >Print Integrated Word Letters / Send Email / Send SMS Message.


N.B. The reports are set-up so that the preference is always by to send the invite by email if possible. A patient will also only appear in one of the above reports (i.e. not in both the 'Needs Influenza' + 'Needs Influenza + Pneumococcal' report)

         

There is a shingles report here too, but rather than sending separate shingles invites, you may wish to just say something on your Flu invites like ‘If you are eligible for the shingles vaccine, we’ll offer this at the same time’.


Step 4. Adding PSDs

From a Report

The Doctor can add PSDs (Patient Specific Directives) in a batch in advance. As above you could breakdown the report into age groups first. 


  • To do this right click the report > Actions > Add read code > 
  • Click on the Red R read code browser and search for XaZ08 - Has authorisation for medication under PSD 
    • For Adults - In the free text area on the left add “I authorise INACTIVATED INFLUENZA VACCINE (Split Virion) 0.5ml by IM injection to be administered to this patient ONCE. This is valid for ONE year from today.” (or whatever vaccine you’re using see list below).
    • For Children - In the free text area on the left add "I authorise FLUENZ TETRA 0.2ml nasally to be administered to this patient ONCE. This is valid for ONE year from today." (or whatever vaccine you're using see list below).
  • You will need to then go on to page 2 of the report and repeat the above for these patients, then page 3 etc.


NB These reports exclude patients with an influenza or a pneumococcal allergy or contraindication read codes. Another main reason why patients should not have the influenza vaccination is if they have had a severe egg anaphylaxis reaction. There is a drop down box to check this on the templates when giving the vaccine.


From an appointment Rota  

You can also apply a PSD individually or as a batch from an appointment rota. 


  • To do this right click on the appointment rota header > Actions > Add read code >  (to apply to an individual appointment right click on the appointment)
  • If applying to the whole rota, you will then be presented with a list of patients from that rota and at this stage you can deselect certain patients if appropriate 
  • Click on the Red R read code browser and search for XaZ08 - Has authorisation for medication under PSD 
    • For Adults - In the free text area on the left add “I authorise INACTIVATED INFLUENZA VACCINE (Split Virion) 0.5ml by IM injection to be administered to this patient ONCE. This is valid for ONE year from today.” (or whatever vaccine you’re using see list below).
    • For Children - In the free text area on the left add "I authorise FLUENZ TETRA 0.2ml nasally to be administered to this patient ONCE. This is valid for ONE year from today." (or whatever vaccine you're using see list below).


(PSD text copied from the template)

I authorise AGRIPPAL 0.5ml by IM injection to be administered tothis patient ONCE. This is valid for ONE year from today. 

I authorise ENZIRA 0.5ml by IM injection to be administered tothis patient ONCE. This is valid for ONE year from today.

I authorise FLUARIX 0.5ml by IM injection to be administered tothis patient ONCE. This is valid for ONE year from today.

I authorise FLUENZ TETRA 0.2ml nasally to be administered tothis patient ONCE. This is valid for ONE year from today.

I authorise FLUMIST 0.2ml nasally to be administered to thispatient ONCE. This is valid for ONE year from today.

I authorise IMUVAC 0.5ml by IM injection to be administered tothis patient ONCE. This is valid for ONE year from today.

I authorise INACTIVATED INFLUENZA VACCINE (Split Virion) 0.5mlby IM injection to be administered to this patient ONCE. This is valid for ONEyear from today.

I authorise INACTIVATED QUADRIVALENT INFLUENZA VACCINE (SplitVirion) 0.5ml by IM injection to be administered to this patient ONCE. This isvalid for ONE year from today.

I authorise INFLUENZA VACCINATION by IM injection to beadministered to this patient ONCE. This is valid for ONE year from today.

I authorise INFLUVAC by IM injection to be administered to thispatient ONCE. This is valid for ONE year from today.

I authorise INTANZA 0.1ml by IM injection to be administered tothis patient ONCE. This is valid for ONE year from today.



Step 5. Giving The Vaccine 

5.1 Ad Hoc

If you see a patient in your routine surgery and they are due the influenza +/or pneumococcal vaccine, you will see this icon under their name. Click this to open the template. On here should be everything you need to record the vaccination. The templates can also be found under auto consultations > ardens Imms & Injections


There is a separate icon if they are eligible for the shingles vaccine too.



NB The Vaccination node was designed as a ‘container’ for various fields for a vaccination. By adding a vaccination from the built in vaccination screen, its adds more detail in the background including a read code, a consent, batch and expiry date and GMS status which are all searchable. You can see the read codes associated with vaccinations by going to Setup > Vaccinations > Available Vaccinations


5.2 In a Flu Clinic

If you are running a flu clinic, you can either record giving the vaccine on an individual patient basis by following Step 4.1 above or you can record them as a batch. Find our more here.

NB If you plan to record as a batch make sure you check if there has been a mixture of children and adults in the same clinic because you will need to obviously record different vaccinations for each group. 


5.3 Recording Vaccines Given by Pharmacist and Others

If a vaccine is given by a pharmacist, on the template, click the ‘Given by other’ button. This will initially open up 'Record Vaccination' screen and then the 'Event Details' screen. On the 'Record Vaccination' screen check the details are all correct and select 'Other GMS' or 'None' + click ok.


You will then see the 'Event Details' screen where you can record who the event was done by and the location. If you have an Event Details Template setup for the pharmacy etc. you could quickly select and apply this template.



Step 6. Refusals Recorded Prior to 1st September

Practices are increasingly recording refusals for flu vaccinations earlier which does cause a problem if they are recorded before 1st September. This will not appear in the TPP or Ardens reports and you will still see a patient status alert suggesting the patient should be vaccinated.  


So as a tidy up practices will need to run some clinical reports to identify these patients and record the refusal again after 1st September. go to Reporting > Clinical Reporting > Arden's Ltd > Vaccinations > For Review. There are two reports you will need to run and take action. 

  • ?Change date of influenza refusal (read code)....
  • ?Change date of influenza refusal (vaccine content)...


NB It is possible to record a vaccination refusal as a batch from a list of patients. Once you've run it, right click and show patients. Select all patients, right click > Actions > Use Data Entry Template, then search for the 'Influenza Imms' template. You will then be prompted to enter the event details and once you've done this the Imms template will open. From here you can record the 'Influenza Refusal'.


Step 7. Getting Paid

Go to Clinical Reporting > Ardens > Contracts 2017 to 2018 > September > Vaccinations. These reports should hopefully make reconciling CQRS payments quicker & simpler.