2018/19 Flu Season

Guidance from the National Flu Immunisation Programme (Public Health England) and the Green Book Chapter 19 have been amended for the 2018/19 flu season. This year there is an extension to the additional cohort of children so that those aged two to nine but not yet ten are now eligible.  


NHS England has issued instructions based on advice from the Joint Committee on Vaccination and Immunisation that the following vaccines should be administered:


Target Group

Vaccine    

6 months to less than 2 years -  in a risk group
Quadrivalent Vaccine (QIV)      
2 years to 18 years - in a risk group
* Live Attenuated Influenza Vaccine (LAIV) 
2 years but not yet 9 years - in a risk group and not received an influenza vaccination before
Should be offered a second dose 4 weeks after first 
2 years but not yet 10 years - not in a risk group
* Live Attenuated Influenza Vaccine (LAIV) - Single dose irrespective of whether influenza vaccine had been received before
18 years to under 65 years - in a risk group
Quadrivalent Vaccine (QIV)      
65 years and over
Adjuvanted Trivalent Vaccine (aTIV) 

* If LAIV contraindicated or unsuitable then a suitable inactivated vaccine should be offered

 

Reports

All of the influenza reports have been reorganised so that everything you need is accessible on one screen.  These can be found by going to 'Reporting > Clinical Reporting > Ardens > Vaccinations > Influenza Vaccination 2018 2019'


Vaccine Orders

Three of the above reports are for the main target groups to show the numbers of patients and give practices an indication of how many vaccines of each type they should consider to order. 

Flu Clinics

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

  • Step 1. Check the 'Review' reports (labelled 'before 1/09/18')
  • Step 2. Care Homes
  • Step 3. Sending Invitations
  • Step 4. Adding PSDs
  • Step 5. Giving The Vaccine
  • Step 6. Check the 'Review' reports (labelled 'after 1/09/18)
  • Step 7. Getting Paid


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


Step 1. Check The Review Reports (before clinics)

Go to 'Reporting > Clinical Reporting > Ardens > Vaccinations > Influenza Vaccination 2018 2019 > For Review Before Clinics'

Before Clinics - before sending invitations:


Step 1.1 Change date of influenza refusal read code

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.  Any coded refusals added prior to 1st September should be added again after 1st September.


N.B. 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 1.2 Change date of influenza refusal vaccine content

As above, should be recorded after 1st September.


N.B. Ensure that you add these read codes at least 2 days before sending the invitations to ensure that they are included in the invite reports.


Step 1.3 Allergies or contraindications

Review records of patients identified to check if the record is up to date and whether the allergy or contraindication is still relevant and if not potentially end it or mark in error.

Step 1.4 Still needs influenza 

Review records of patients identified who are not in an at risk group but previously read coded (after 1st September 2017) as required to check if they need to be vaccinated again this year and add 9OX4 to make the vaccination eligible for payment.


Step 2. Care Homes

There are 2 reports available in the same folder 'Reporting > Clinical Reporting > Ardens > Vaccinations > Influenza Vaccination 2018 2019'

Care Home Residents are not included in the main 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 to ensure that they are included in the invite reports.


Step 3. Sending Invitations

Go to 'Reporting > Clinical Reporting > Ardens > Vaccinations > Influenza Vaccination 2018 2019'


Here you will see reports for 1st, 2nd and 3rd invitations which identify patients who are eligible by age and vaccine type. 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



N.B. The reports are set-up so that the preference is always to send the invite by email if possible. 

         

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


Step 4. Adding PSDs

PSDs can be applied individually or as a batch but it is recommended that these are recorded individually after reviewing the patient record. 


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.


N.B. 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 FLUAD ADJUVANTED TRIVALENT INFLUENZA VACCINE (aTIV) by IM injection to be administered to this patient ONCE. This is valid for ONE year from today.

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

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

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

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

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

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

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

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.

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

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

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


Step 5. Giving The Vaccine 

Please note: you do not need to add read codes when recording vaccinations

5.1 Ad Hoc

If you see a patient in your routine surgery and they are due the influenza 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.


N.B. The vaccination buttons will only be active if the patient is eligible, however if you need to administer a different vaccine you can tick the 'Override...eligibility' which will then make the vaccination buttons available for use.  


And in the same way the two links to the 'Pneumococcal Imms' and 'Shingles Imms' template will only be active if the patient is eligible.



There is a separate icon if they are eligible for the shingles or pneumococcal vaccine which have their own templates too.


N.B. 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.

N.B. Because of the variety of vaccines being administered this year it will be more complicated to record as a batch. Consideration will need to be made for clinics / rotas and how you book patients in 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. Check The Review Reports (after clinics)

Go to 'Reporting > Clinical Reporting > Ardens > Vaccinations > Influenza Vaccination 2018 2019 > For Review After Clinics'

After Clinics - after vaccinations have been recorded:


Step 6.1 Vaccination given but not eligible

Each year you will find a number of patients who receive the vaccination but are not coded in anyway to indicate that they were eligible and therefore don't qualify for payment. Review records of patients identified in the report to check if there was a valid reason. This may need to be reviewed by the GP and once agreed consider adding backdated 'Needs influenza immunisation 9OX4'.


Step 6.2 Vaccination given but recorded as a read code not a vaccination
Occasionally vaccinations are not recorded correctly as a vaccination but instead only as a read code. Staff should be encouraged to record vaccinations correctly in the vaccination node. Review records of patients identified and add a backdated entry as a vaccination and to avoid any possible confusion with duplication mark in error the read coded entry. 


Step 6.3 Vaccination given elsewhere 

There is risk that practices could claim inappropriately for vaccinations given elsewhere. So it is important to review records of patients identified in these two reports and ensure that the correct event details have been recorded as described in 5.3. 


Step 6.4 No response to 3rd invite 

If after sending three invites there has been no response add 'No response to influenza vaccination invitation XaQxM'.


Step 7. Getting Paid

Go to Clinical Reporting > Ardens > Contracts 2018 to 2019 CQRS > k   Monthly Sep 2018 > 2018-19 Q2 SEP | Vaccination Given SFLU001.....  

These reports should hopefully make reconciling CQRS payments quicker and simpler.