Making the Flu Vaccination service work in your pharmacy Martin - - PowerPoint PPT Presentation

Making the Flu Vaccination service work in your pharmacy

Martin Littleton – Implementation Manager

Supporting Community Pharmacy across Avon

Supporting Community Pharmacy across Avon

Outcomes of the Evening

• Why has the service been commissioned?
• Outcomes from 2014
• What the service looks like across BNSSG
• How to run the service
• Self Accreditation – Declaration of Competence
• PharmOutcomes
• How to maximise uptake of the service

–Staff Engagement –How to target the correct patients

• Your commitment

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Why Provide a Community Pharmacy NHS Influenza (‘Flu) Service?

• Vaccinating people against ‘flu can prevent ill-health

and possible death from ‘flu over the winter and reduce hospital admissions

• This is true for the whole population, but especially

important for the clinical at-risk groups

• Primary care is not achieving high enough

vaccination rates for clinical at-risk groups

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The National Picture – ‘Flu vaccine uptake rates 2013/14 – 2014/15

Source: Public Health England: ImmForm reporting website: Data submitted by NHS trusts and area teams.

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The South West Picture Uptake rates 2013-14 vs 2014/15

Bristol North Somerset Somerset South Glouceste rshire Cornwall NEW Devon South Devon & Torbay England 2014/15 75.2 76.3 71.3 78.0 70.4 71.6 68.2 72.8 2013/14 75.7 77.1 72.5 79.4 71.3 72.2 69.1 73.2 Target 75 75 75 75 75 75 75 75 75 10 20 30 40 50 60 70 80 90 100 % Uptake

Seasonal flu vaccine uptake in the over 65s across South West CCGs

2014/15 2013/14

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The South West Picture Uptake rates 2013-14 vs 2014/15

Bristol North Somerse t Somerse t South Gloucest ershire Cornwall NEW Devon South Devon & Torbay England 2014/15 51.3 52.7 48.2 56.9 49.4 45.9 45.0 50.3 2013/14 51.1 54.2 51.3 59.6 52.5 49.2 47.6 52.3 10 20 30 40 50 60 70 80 90 100 % Uptake

Seasonal flu vaccine uptake in the under 65s at clinical risk across South West CCGs

2014/15 2013/14

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How can a Pharmacy Service Make a Difference?

• Increases the overall vaccination rates, especially in

harder to reach groups through:

• Better accessibility
• Many convenient locations
• Long opening hours – open when the patient needs us
• Great patient satisfaction
• We are already vaccinating people who are eligible

for a free NHS flu Jab (via the private service)

• ‘At-risk’ groups could attend a pharmacy up to five

times within the ‘flu season for a prescription presenting opportunities for vaccination

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Service Performance 2014

• 3,643 vaccination delivered through 162

pharmacies

Pharmacies accredited Pharmacies Vaccinated Number

• f

vaccines delivered Average / Pcy N Som 23 23 392

• 17.0

S Glos 28 28 660

• 23.6

Bristol 53 52 1,477

• 27.9

Somerset 61 59 1,114

• 18.3

Total 165 162 3,643

• 22.1

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Service Performance 2014

8% 46% 20% 1% 8% 9% 4% 1% 2% 1%

Risk category?

Main Carer Chronic Respiratory Disease Diabetes Chronic Liver Disease Chronic Heart Disease Pregnant Woman Immunosuppressed Chronic Renal Disease Neurological condi on Asplenia

• r

dysfunc on

• f

the spleen

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Service Performance 2014

59% 41%

Was the pa ent vaccinated in 2013?

Yes No

79% 21%

Has the pa ent ever been vaccinated for flu?

Yes No

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Service Performance 2014

200 400 600 800 1000 1200 1400 1600 1800 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15

For pa ents vaccinated in 2014, were they vaccinated

• n

2013?

Yes No

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Service Performance 2014

62% 3% 3% 13% 5% 12% 1% 0% 0% 1%

Why choose pharmacy?

More convenient No GP Clinic dates available GP unable to provide service Unable to a end GP

• work

commitment Unable to a end GP

• ther

commitments Prefer Pharmacy Unable to a end GP

• transport

problems Other: Unwilling to say Unable to a end GP

• previous

experience

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What has been Commissioned?

• Inclusion criteria for the service
• The service will commence in September 2015 and

terminate on 31st March 2016

• Must have consented to vaccination
• People aged 65 years or over (including those who will

turn 65 by 31st March 2016)

• Patients aged 18 to 64, who must be from one of the

following clinical risk groups:-

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Respiratory Disease

• Asthma that requires continuous or repeated

use of inhaled or systemic steroids or with previous exacerbations requiring hospital admission

• Chronic obstructive pulmonary disease (COPD)

including chronic bronchitis and emphysema;

• bronchiectasis
• cystic fibrosis,
• interstitial lung fibrosis
• pneumoconiosis
• bronchopulmonary dysplasia (BPD)

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What to look out for:

• Anyone with a steroid inhaler
• Anticholiergics (tiotropium, ipratropium…)
• long acting B2 agonist
• Montelukast
• Theophylline
• Nebules
• Steroids (for breathing.)
• For cystic fibrois… Creon capsules

ursodeoxycholic acid, antibiotic nebulisers?

• Not just Ventolin!!!

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Chronic Heart Disease

• Congenital heart disease
• Hypertension with cardiac complications
• Chronic heart failure
• Individuals requiring regular medication and/or

follow-up for ischaemic heart disease

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What to look out for:

• Congenital Heart disease - Patients with stents,

replaced valves, ‘hole in the heart’ – not generally medically treated

• Chronic heart failure
• Symptoms include dyspnoea, especially during and after

exertion (but even at rest if severe), wheeze, cold extremities to name but a few

• Treated with combinations of loop diuretics, ACE-

inhibitors, β-blocker, spironolactone, digoxin

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What to look out for:

• Ischaemic heart disease
• AKA coronary heart disease, coronary artery disease
• angina medication i.e. regular GTN, nitrates, β-blockers,

calcium channel blockers etc.

• Complications of hypertension – retinopathy,

haemorrhage, kidney problems

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Chronic Kidney Disease

• Chronic kidney disease at stage 3, 4 or 5
• Chronic kidney failure
• Nephrotic syndrome
• Kidney transplantation

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What to look out for:

• Drugs including:
• Vitamin D analogues including alfacalcidol
• Phosphate binders (eg. Calcium, lanthanum, sevelamer,

aluminium hydroxide)

• High doses of loop diuretics
• Immunosuppressants (e.g. ciclosporin, tacrolimus,

azathioprine, mycophenolate)

• ACE-inhibitors or angiotensin II receptor antagonists are

used in nephrotic syndrome to address proteinuria as well as furosemide/spironolactone

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Chronic Liver Disease

• Cirrhosis
• Biliary atresia
• Chronic hepatitis

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What to Look Out For:

• Drugs including:-
• Colestyramine
• High dose ursodeoxycholic acid
• Penacillamine
• Spironolactone
• Loop diuretics
• Vitamins i.e. vitamin B, pyridoxine, fat soluble vitamins

(A,D,E,K)

• Disulfram, acamproste, chlordiazepoxide?
• Substance misuse patients?

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Chronic Neurological Disease

• Stroke
• Transient ischaemic attack (TIA)

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What to Look out For:

• Aspirin
• Clopidogrel
• Dipyridamole
• NOT warfarin!!!

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Diabetes

• Type 1 diabetes
• Type 2 diabetes requiring insulin or oral

hypoglycaemic drugs

• Diet controlled diabetes

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Immunosuppression

• Anyone suffering from an immunosuppressive

disorder e.g.:-

• HIV
• Patients undergoing chemotherapy
• Bone marrow transplant
• Myeloma
• Disorders affecting the immune system eg IRAK-4,

NEMO

• Anyone taking the following medication:-
• Azathioprine, mycophenolate, ciclosporin,

cyclophosphamide, tacrolimus, methotrexate, high dose steroids (equivalent to 20mg prednisolone) for more than a month

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Asplenia or Dysfunction of the Spleen

• People with no spleen
• Any dysfunction of the spleen
• Coeliacs – Having coeliac disease can cause the

spleen to work less effectively

• Homozygous sickle cell disease – the spleen can

become enlarged due to misshapen red blood cells

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Pregnant Ladies

• Any stage of pregnancy (1st, 2nd or 3rd trimester)
• Check for exemption status ‘D’ on the back of

prescriptions

• Pregnant ladies coming to the pharmacy for

healthcare advice

• Likely to be unsure of whether to have vaccine
• Is it safe?
• How is my baby affected?
• What are the benefits?

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Pregnant Ladies

• A report found that of all the women who died from

complications of pregnancy or childbirth, 1 in 11 of them died from flu

• Having flu while pregnant could mean the baby is

born prematurely or has a low birth weight, and may even lead to stillbirth or death in the 1st week

• f life
• Some of the immunity from the mother will pass

across the placenta, and protect the baby into their 1st few weeks of life – passive immunity

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Informal (Unpaid) Carers

• Must be the main carer of an elderly or disabled

person

• Must not be paid for this work, however may be in

receipt of carer’s allowance

• If they were to fall ill the welfare of the person they

care for may be at risk

• Could prevent ‘flu from passing to the vulnerable
• Hard to know whether they are a carer or not

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Exclusion Criteria

• People who don’t fall into the above categories
• Professional (i.e. paid) health and social care

workers with no clinical risk conditions

• Have had a flu vaccination since September 2015,
• r are unsure of vaccination
• Suffering a febrile illness or acute infection
• Known hypersensitivity to egg or egg products

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Exclusion Criteria

• Confirmed anaphylactic reaction to a previous dose
• f the vaccine or any component of it
• Bleeding disorder or taking anticoagulant

medication

• Awaiting confirmation on these patients, and

how we may be able to proceed

• Refused consent

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Delivering the service

• Walk through of the service from the perspective of

a pharmacist currently delivering flu vaccinations

• Consent
• Consultation room
• Preparation
• What it feels like to do your 1st vaccination
• Documentation
• Q & A

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Consent

• For consent to be valid the patient must:-
• Have the capacity to give consent
• Be acting voluntarily – they must not be under

any undue pressure from you or anyone else to make a decision

• Have sufficient, balanced information to allow

them to make an informed decision

• Be capable of using and weighing up the

information provided

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Consultation Room

• Furniture – Arrange the furniture in the room so

that both you and the patient are comfortable, and so that you have enough space

• Chair – Choose a chair for the patient which

preferably has arm rests, but does not have wheels

• Equipment – Position your equipment so that it is in

easy reach while you conduct the vaccination

• Sharps bin – Ensure that your sharps bin is

positioned so that you will never have to reach across a patient with an unsheathed needle

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Consultation Room

• Patient's view – Think about what the patient will

be looking at during the vaccination, and consider positioning them in view of a poster or other point

• f interest to distract them from the procedure
• Tidy – Ensure that your consultation room is clean,

tidy and professional looking

• Exit – Make sure that the exit to the room is kept

clear at all times

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Preparation

• Ensure that a member of staff is aware that you are

administering a vaccine

• Wash hands thoroughly and put on latex free gloves
• Review the patient's consent
• Check that the vaccine has been stored correctly
• Check the vaccination label for product name and

expiry date

• Check that the colour and composition of the

vaccine is correct

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Injection Site

• You should administer the injection into the

patient's deltoid muscle

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Documentation

• After you have administered the vaccine, you

should:-

• Record the injection site (left/right deltoid), how

given (IM injection), batch number and expiry date

• Remind the patient that you will be informing

their GP that they have received the vaccination

• Check that the patient has an information leaflet

about the vaccine and the management of side effects

• Complete a service entry on PharmOutcomes

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Self Accreditation

• Declaration of Competence (DOC) – CPPE
• See Easy Guide on our website and sent via email
• www.cppe.ac.uk/services/declaration-of-competence
• You will need to login to your CPPE account,

registering with CPPE first if you have not yet done so

• Then either go to the link above, or scroll down on the

home page to the 'Declaration of Competence’ box

• On this page there is a description of what DOC is all

about, with a list of services down the right hand side

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Self Accreditation

• Choose 'NHS seasonal influenza vaccination

ADVANCED'

• This will then bring up a DOC record for you,

including any appropriate CPPE learning activity already completed

• You must tick the box allowing PharmOutcomes to

access your data, which is the 2nd item on this page

• Go through each step (1 to 5), completing the

necessary information as you go along

• Print and sign the Declaration

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Self Accreditation

• The key elements of this accreditation process are:-
• To meet or be actively working towards to the

Consultation skills for pharmacy practice – practice standards for England

• www.consultationskillsforpharmacy.com
• To meet the competencies expected of all

healthcare professionals with regard to safeguarding children and vulnerable adults

• To have completed full or refresher flu

vaccination training, including PGDs, as appropriate.

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PharmOutcomes

• Where the service is
• Enrolment onto the service
• How to run through and complete the service
• How to print off the GP feedback form

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Workshop

• In your groups think about how each of you is

preparing for the ‘go live’ of the service

• 5 minutes per section then feedback one idea per

group

• LPC will co-ordinate across the four meetings and send out

to all

• Areas to consider
• Enthusiasm
• Preparation
• Teamwork

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Enthusiasm

• Does everyone working in the pharmacy know

about the service?

• Are you talking to your customers?
• Are you creating interest in your customers about

the service?

• Have you spoken to your local GP practice?
• Work out now who will be your first patient?
• Possibly a colleague?

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Preparation

• Be active, not reactive to demand – create

demand!

• Advertise the service alongside your private

service

• Take bookings early
• Make bookings for times of the day in which it

won’t affect your prescription business

• Mark suitable patient’s prescriptions like you

would for MUR/NMS patients

• Have SOP’s been read by the team?

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Preparation

• Do you have facilities for the disposal of sharps?
• Do you have space in your fridge for the vaccines?
• Does your consultation room look clean and

clinical, or like a dumping ground?

• Have you signed the PGD and completed your

Declaration of Competence, with a signed declaration kept in your pharmacy?

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Teamwork

• Engage the WHOLE team, including counter staff to

maximise conversations about the service with patients

• Ensure the WHOLE team know the difference

between the two parallel services to avoid confusion

• Dispensers should know which drugs could indicate

a suitable patient to flag for the service

• Designate a member of staff to lead the team on

this – it shouldn’t just be up to the Pharmacist

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Managing GP Surgeries

• You may have a negative response from your local

GP surgery, who may feel you are taking their business

• Likely to be worse for health centre pharmacies
• The surgery will simply not have the capacity to

vaccinate all their eligible patients

• Work with them to deliver the service to the

maximum number of people possible between you

• Last year 41% of people vaccinated by local

pharmacists did not receive a vaccination in 2013

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Your commitment

• Spend 5 - 10 minutes taking all the best practice

from this evening and commit to the actions you will carry out from tonight onwards

• When will you inject your first patient?
• Aim for this to be on day ONE of the service!

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And finally, don’t forget

We’ve been given the opportunity to demonstrate we can provide this service LET’S GET OUT THERE AND SHOW THEM WE CAN!!!

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Thank you and safe journey