Guidelines for Immunisation practice in local governments

Background

In Victoria, local councils deliver a significant proportion of vaccines under the National Immunisation Program (NIP) Schedule, to people at all ages and stages of life.

All vaccines listed in the NIP Schedule are free. Eligibility for free vaccines under the NIP is linked to eligibility for Medicare benefits.

Within their municipal districts, local council immunisation services may provide NIP-funded vaccinations to babies and children; young people in secondary schools; refugee and asylum seeker communities; and those eligible for free influenza immunisation. These services may be delivered in the community, secondary schools and workplaces.

Purpose of these guidelines

The purpose of these guidelines is to provide a single reference document that provides or links to legislation, regulations, standards, policies and procedures relevant for local government immunisation services. The intent is that local government can refer to the guidance provided or referenced in this document when developing their own policies, procedures and practice for the delivery of a safe and effective immunisation service.

These guidelines provide an overview of the following areas in the context of the provision of local government immunisation services:

• Clinical governance framework
• Legislative and regulatory framework
• Provision of immunisation services
• Provision of the secondary school immunisation program
• Vaccine and stock logistics
• Vaccine procedures
• Monitoring and evaluation of services.

Clinical governance framework

Safer Care Victoria has published Victoria’s clinical governance framework that outlines expectations regarding clinical governance and provides best practice guidance to inform good clinical governance.

The five domains of the framework, underpinned by continuous monitoring, evaluation and improvement are:

• leadership and culture
• consumer partnerships
• workforce
• risk management
• clinical practice

The framework is designed so that your local council can adapt and implement the components to best meet the needs of your consumers and your organisation.

The framework sets out the systems, processes and protocols that should be in place:

• Contribution to a culture of safety, transparency, multidisciplinary teamwork and collaboration and ensuring high-quality care for every consumer in a way that is seamless and integrated;
• Effective monitoring and improved clinical performance, including clinical processes, equipment and technology that are designed to minimise error and support clear communication and accurate reporting of care provision;
• Comprehensive strategies and plans for recruiting, allocating, developing, engaging and retaining high-performing staff and includes supporting staff to work within their scope, provide supervision where required and manage performance;
• New procedures and vaccines to be introduced in a way that ensures quality and safety issues have been identified; and the staff involved in immunisation services actively identify, monitor and manage areas of key risk and lead appropriate escalation, response and mitigation where safety may be compromised.

Leadership and culture

• All staff have a shared responsibility for building a positive workplace culture
• Organisational culture – a ‘just’ culture exists whereby staff are supported, and their wellbeing prioritised
• Clinical leadership – strong, transparent, supportive and accessible leadership fosters a culture of learning, accountability and openness, with strong clinical engagement
• Teamwork – staff are supported at all levels of the organisation by skilled management
• Ownership and accountability by all staff.

Consumer partnerships

The consumer is at the centre of care and viewed as a critical partner in the design and delivery of the immunisation service.

• Consumer engagement and input is actively sought and facilitated
• Using and improving systems to support organisational and community priorities
• Partnering with consumers and management to ensure clients receive appropriate information and care
• Commitment to providing a positive consumer experience every time.

Workforce

Local councils are responsible for a safe environment for both consumers and staff.

• All immunisation staff have the required knowledge and skills, technology and equipment to provide the best care possible, and are accountable for the care they provide
• Credentialing - the formal process of checking that Nurse immunisers are appropriately qualified, registered and experienced to deliver safe, high-quality care within their scope of practice
• All staff undertake appropriate professional development annually.

Risk management

Safeguarding against clinical risk requires a structured approach to safety that is both proactive and reactive.

• Active participation in local council processes that support client safety and identify and act on opportunities for quality improvement
• Reporting incidents and near misses
• Following through with open disclosure to clients & families
• Analysing and addressing adverse events
• Appropriately escalating safety issues to managers.

Risk management - Nurse immunisers

• The local council must ensure that any Nurse immuniser meets and maintains the requirements for professional registration for the full period of their engagement.
• It’s strongly recommended that the local council develops and institutes policies/procedures to confirm a Nurse immuniser’s registration status on initial engagement and at annual renewal.

Clinical practice

Good clinical practice requires systems that provide safe and appropriate care for each consumer with the best possible outcome.

• Shared responsibility for protocols, equipment, and resources.

The framework is underpinned by continuous monitoring, evaluation and improvement.

Legislative and regulatory framework

Local government immunisation services should be familiar with the legal and legislative framework within which they operate. This section provides information in relation to the legislative and regulatory framework governing:

• the responsibility of local government in co-ordinating and providing immunisation services
• possession, supply and administration of vaccines
• obtaining consent for vaccination
• keeping and accessing records related to vaccination
• the requirement to report suspected child abuse.

The information provided in this section is not intended to serve as legal advice. Local Government immunisation providers are advised to seek independent advice from legal professionals.

The responsibility of local government in co-ordinating and providing immunisation services

Delivery of services

In Victoria, immunisation services are a function of local government according to the Public Health and Wellbeing Act 2008 (PHWA), Part 3, Division 3, s.24.

This section states:

‘the function of every council under this Act is to seek to protect, improve and promote public health and wellbeing within the municipal district by-

(f) co-ordinating and providing immunisation services to children living or being educated within the municipal district;’

Under the current legislation local governments may provide a variety of services and utilise various models of delivery in fulfilling the public health responsibility of the immunisation of children within their municipality. Examples of models currently utilised for the delivery of immunisation services include:

• immunisation programs managed, staffed and resourced by individual local governments for their local government area
• immunisation services contracted to other immunisation providers.

Victorian legislation impacting on delivery of services to children living or being educated in the municipal district

Enrolling in kindergarten or childcare

'No Jab, No Play' is the name of legislation that requires all children to be fully vaccinated to be enrolled in childcare or kindergarten in Victoria (unless they have a medical exemption).

The Public Health and Wellbeing Act 2008 Part 8, Division 7s143B requires parents to provide an immunisation status certificate pertaining to their child to the early childhood service in which they wish to enrol their child. The certificate must show that the child is up to date with immunisations. Some children may be eligible to enrol under the grace period.

Relevant resources

Printed resources supporting No Jab, No Play can be ordered via the Immunisation Unit resource order form.

The immunisation website provides further information regarding the role of immunisation service providers in regard to the No Jab No Play legislation.

Enrolling in primary school

Part 8, Division 7, of the Public Health and Wellbeing Act 2008 s124 requires parents to provide a school entry immunisation status certificate pertaining to their child to the primary school in which they wish to enrol their child.

Relevant resources

The immunisation website provides further information regarding school entry immunisation documentation requirements.

The resource Starting Primary School: immunisation information of parents enrolling a child in primary school in Victoria can be ordered via the Immunisation Unit resource order form.

Sharing contact details for delivering the secondary school immunisation program

The Public Health and Wellbeing Regulations 2019 regulation 112 authorises secondary schools to provide their local council with student and parent/guardian contact information for any student scheduled to receive a vaccination. This information assists local councils to follow-up parents/guardians of students with incomplete or missing consent cards.

Contact details must be used strictly for the purposes of delivering the secondary school vaccine program.

Parents/guardians and the school should be given ‘a collection statement’ of the use and purpose of any school class lists provided to local government. This requirement is in accordance with the Health Records Act 2001. (Health Privacy Principle 1.4)

Relevant resources

An example collection statement, from school principals to parents/guardians of Year 7 and Year 10 students to let them know that their contact information is shared with the relevant local council for the purposes of delivering the secondary school immunisation program unless they request otherwise.

A range of resources to assist councils to provide an immunisation service to adolescents is available on the department web page vaccination – adolescents.

Possession and administration of vaccines

In the State of Victoria, the possession and administration of particular substances is determined by the Drugs, Poisons and Controlled Substances Act 1981 and the Drugs, Poisons and Controlled Substances Regulations 2017.

Roles and responsibilities of immunisation team members under the legislation

Persons responsible for managing immunisation programs must be clear about their legal authority and that of each of their immunisation team members under the relevant legislation.

Authorised person

Under the regulations, an authorised person is defined as a person who can administer and/or possess Schedule 4 (S4) (prescription only) drugs.

In the case of a local council immunisation service S4 drugs refers to vaccines, and other drugs used in the treatment of anaphylactic reactions to the vaccines used in local government immunisation programs.

Table 1: Overview of who can possess, administer and/or supply vaccines in the context of a local council immunisation service

¹ and other drugs used in the treatment of anaphylactic reactions to the vaccines used in local government immunisation programs

² unless the program manager is an authorised person

Legislated roles in the context of delivering local council immunisation services

Medical practitioner

A medical practitioner is an authorised person and is permitted to possess, administer and supply vaccines. In the absence of a nurse immuniser, a medical practitioner must be present and assume medical responsibility for all local government immunisation sessions. He/she must sight all persons to be vaccinated, authorise all vaccinations, supervise administration as they see fit and remain on-site for the duration of the session.

Nurse immuniser (Division 1 Registered Nurse who has completed an immuniser program of study)

Nurse immunisers must be a Division 1 Registered Nurse and have successfully completed a recognised nurse immuniser training program and can possess vaccines and administer vaccines to an approved client group. It is not necessary for a medical practitioner to be present if a nurse immuniser is present.

Division 1 Registered Nurse (without nurse immuniser qualifications)

A Division 1 registered nurse who is NOT a nurse immuniser may administer a vaccine/s if a medical practitioner has sighted the patient, ordered the vaccination, supervised the nurse as they see fit and remains on site for a minimum of 15 minutes post-vaccination.

Environmental Health Officer

An environmental health officer employed or appointed by a municipal council is an authorised person to possess vaccines. Environmental health officers are not to administer vaccines nor draw up vaccines for others to administer.

Division 2 Enrolled Nurse

A Division 2 enrolled nurse is not an authorised person to possess vaccines, administer or supply vaccines including the preparation and drawing up of vaccines unless under the close supervision of a medical practitioner, following their order. The medical practitioner must remain on the premises to administer adrenaline in the event of an anaphylactic reaction.

Program managers

The manager/coordinator of the program, depending on their qualifications, may or may not be an authorised person. If the manager is not an authorised person they have a responsibility to support the authorised person in performing his/her duty within the context of the relevant legislation.

Administrative officer

An administrative officer is not an authorised person and is unable to possess, administer or vaccines including the preparation and drawing up of vaccines.

Sharing of vaccines with other vaccine providers

The Drugs, Poisons and Controlled Substance Act 1981 (the Act) does not allow sharing (supply) of imprest or stock medicines purchased under the authorisation of a Health Services Permit, registered medical practitioner/nurse practitioner or municipal council. Sharing (supply) of imprest or stock medicines can be especially problematic for medicines requiring verification of cold chain management and in situations where a medicine is recalled.

Obtaining consent for vaccination

Common law requires that valid consent is given prior to a medical procedure, including administering a vaccine. For consent to be considered legally valid, the Australian Immunisation Handbook describes the following elements as necessary:

• It must be given by a person with legal capacity, and of sufficient intellectual capacity to understand the implications of receiving a vaccine.
• It must be given voluntarily in the absence of undue pressure, coercion or manipulation.
• It must cover the specific procedure that is to be performed.
• It can only be given after the potential risks and benefits of the relevant vaccine, the risks of not having it, and any alternative options have been explained to the person.
• The person must have the opportunity to seek more details or explanations about the vaccine or its administration.
• The information must be provided in a language or by other means that the person can understand. Where appropriate, involve an interpreter or cultural support person.

Obtain consent before each vaccination, after establishing that there are no medical condition(s) that contraindicate vaccination. Consent can be verbal or written.

Immunisation providers should be familiar with further issues relating to consent for immunisation are addressed in the Australian Immunisation Handbook including:

• Consent on behalf of a child or adolescent
• Consent on behalf of an adult lacking capacity
• Resources to communicate the risks and benefits of vaccines

Models for obtaining valid consent – children attended by parent/guardian

For children under 18 with the parent / guardian in attendance

Verbal

• provide information covering the elements required for valid consent noted above
• assess the child’s suitability for immunisation
• discuss with parent/guardian any matter of concern
• the parent/guardian is asked that they have read and understood the information
• the parent/guardian verbally consents to immunisation
• verbal consent is noted in the medical record.

Written

• provide information covering the elements required for valid consent noted above
• assess the child’s suitability for immunisation
• discuss with parent/guardian any matter of concern
• the parent/guardian is asked that they have read and understood the information
• parent/guardian reads and understands immunisation consent form
• parent/guardian consents to immunisation and signs consent form
• signed consent is stored with the clinical record and noted in the vaccinee’s medical record.

Mature minor consent

The law recognises that as children become older and more mature, they are more capable of making their own decisions about a wide range of issues including decisions about their healthcare and wellbeing. These young people are referred to as 'mature minors' – see the Policy and Advisory Library – Education health.vic for more information.

Requirements for medical records related to immunisation

It is the responsibility of local government immunisation providers and management to ensure that the administration of all vaccination records complies with relevant legislation:

• Health Records Act 2001
• Privacy and Data Protection Act 2014
• Australian Immunisation Act 2015
• Australian Immunisation Register Amendment (Reporting) Act 2021
• Public Records Act 1973

In addition to the above legislation, the use and management of vaccination records are also governed by the following:

• Local Government Functions - Retention & Disposal Authority: PROS 09/05
• New Tax System (Family Assistance) Act 1999 (Cth)

The following standard is recommended:

• Australian Standards for Record Management - AS ISO 15489.

It is recommended local government immunisation providers seek independent legal advice regarding their medical record keeping obligations.

Privacy

Each local government should have its own privacy policy. Copies should be readily available to the public upon request, including at immunisation sessions.

Local government immunisation providers must comply with the Privacy and Data Protection Act 2014and Health Records Act 2001 whenever personal information about clients or staff is collected, stored, transmitted, shared, used or disclosed.

Local government immunisation providers should be aware of client privacy when conducting administrative procedures, collecting, and storing personal information.

Privacy notification

A privacy notification must be written in accordance with the Health Privacy Principles identified in the Health Records Act 2001 and available to all clients accessing the council’s immunisation service.

Personal immunisation and clinical records

A clinical record should be established for each vaccinee and kept by the local government immunisation provider. Use of a personal immunisation record does not negate the requirement to check the AIR. Any discrepancies between the personal immunisation record and the immunisation history statement on AIR should be corrected.

The personal immunisation record and clinical record should include the following information for each vaccinee including:

• vaccinee’s full name, date of birth and Medicare number or individual healthcare identifier if available
• Aboriginal and/or Torres Strait Islander status (yes or no or both)
• details of vaccine given, including dose, brand name, batch number and route and site of administration
• name (and signature in client personal record) of the person providing the vaccination
• date of the vaccination
• date the next vaccination is due
• receipt of valid consent for vaccination.

The client should be informed a record of the immunisation(s) given will be available on the AIR and the Child Health Record if applicable.

Immunisation program management software

Where local government immunisation providers use an immunisation program software database for the generation of their clinical records, staff using these systems should be aware of legislative requirements associated with the storage of these records.

Reporting data to the Australian Immunisation Register (AIR)

The Australian Immunisation Register Rule 2015 and the Australian Immunisation Register Amendment (Reporting) Act 2021 lists the specific vaccine data to report, how and when to report. These include:

• National Immunisation Program (NIP) vaccines, COVID-19 vaccines, influenza vaccines
• how to report: electronic, or if this is not reasonably practical then in written form
• when to report: within 24 hours, and no more than 10 working days after the vaccination.
• personal information: Medicare number or Individual Healthcare Identifier (if applicable), name, contact details, date of birth, gender.
• vaccine information: brand name, dose number and batch number, date given.
• provider information: provider number, name and contact details.

Data recorded on AIR is collected under the New Tax System (Family Assistance) Act 1999 (Cth) This Act authorises immunisation providers to forward immunisation data to the AIR. It is important that data is submitted promptly to AIR as it provides:

• an important means of accountability and evaluation of the childhood, adolescent, and adult immunisation programs
• a central immunisation register for all ages
• reminder notices will be issued to selected age cohorts for missed vaccine dose(s)
• a method to determine immunisation coverage at local, state, and national levels
• monitors effectiveness of the HPV vaccine program on cervical cancer rates.
• An Immunisation History Statement which is required to confirm enrolment for a placement in early childhood services in accordance with the No Jab No Play legislation and is also required for enrolling in primary school. It is also used to determine a family’s entitlement to Commonwealth payment benefits. If a child’s AIR record is inaccurate, the family may lose access to these benefits.
• payments for vaccine encounters are dependent on accurate and timely reports to AIR.

Accessing AIR data

Access to AIR records for immunisation providers and use of the data must comply with relevant legislation:

• Privacy Act 1988
• Australian Immunisation Act 2015
• New Tax System (Family Assistance) Act 1999 (Cth) [25]
• Human Services (Medicare) Regulations 2017.

For further information about sharing health information please refer to the Privacy Act 1988

All staff involved in the delivery of council’s immunisation service must understand the conditions related to the use of this data.

Further information is available from the AIR website.

Reporting suspected child abuse

Medical practitioners and registered nurses are mandated officers under the Children, Youth and Families Act 2005 section 182 in the reporting of suspected child abuse.

When a health professional assesses a child is in need of protection as outlined in the Children, Youth and Families Act 2005 and makes a notification to Child Protection Services in good faith, the Children, Youth and Families Act 2005, supersedes all other legislation and giving of information to a protective intervener does not constitute unprofessional conduct or breach of professional ethics, or make that person subject to any liability.

Each council should develop a policy and procedure that ensures all staff (including casual / part time staff) are aware of their responsibilities regarding mandated reporting of suspected child abuse.

Occupational health and safety

The Occupational Health and Safety Act 2004 and related regulations aim to keep Victorian workplaces safe. The Act, in conjunction with the Australian Guidelines for the Prevention and Control of infection in Healthcare 2019 should guide the development of occupational health and safety protocols for local government immunisation providers. Local government immunisation providers should maintain up to date, easily retrievable protocols relevant to their scope of practice in immunisation concerning all relevant aspects of occupational health and safety including, but not limited to:

• blood spills
• disposal of infectious waste
• needle stick injuries
• medication errors
• equipment used
• prevention of transmission of infectious diseases in the health care setting
• safety of interior and exterior of venues where immunisation sessions are held.

All staff should be familiar with the content of the protocols and how to follow them.

Immunisation services

The following recommendations are to assist local government immunisation providers in the practical implementation of immunisation programs. It is suggested that local government immunisation providers utilise information found within these guidelines in the production of their own policies and procedures relevant to their immunisation clinical governance.

In planning, implementing and managing immunisation services, local government immunisation providers should ensure that their services comply with current legislation, professional standards and codes of practice. Providers should conduct a regular review of immunisation services as part of their yearly planning exercise and make appropriate alterations as necessary in order to ensure optimal quality of immunisation services.

Refer to section: Clinical governance.

Venues and timing of sessions

The venue should be large enough to provide seating for people to wait the required minimum 15 minutes after vaccination, as well as allowing for those waiting to be immunised.

Ideally venues should be ‘parent and child friendly’. Consider accessibility to the venue both by private car, public transport and for parents with prams and strollers. Male and female toilets with access for disabled persons, baby change and feeding facilities should be available. The venue acoustics and temperature should be able to be kept comfortable, with heating and/or air-conditioning as dictated by the climate.

Venues familiar to parents make good choices, e.g: suitably sized health centres are ideal. Make every effort to avoid "cattle market" sessions at large town halls, by creating seating arrangements conducive to family friendly discussions.

Where possible a separate room or screening should be provided to offer some privacy in the area where injections are administered. At the time of immunisation, the vaccinee or the carer holding the infant/child for immunisation must be seated. Providers should ensure that the environment is culturally appropriate for clients.

Immunisation for vulnerable people

It is recommended that immunisation providers develop a policy for the provision of immunisation targeting those clients who are vulnerable. Refugee/humanitarian entrants, children of relative carers, in out of home care and families living in difficult circumstances may have incomplete immunisation.

Local governments may wish to promote immunisation for vulnerable people for example: Maternal and Child Health services, a home visiting service, Aboriginal Health Services, Youth Services and Refugee Health Services.

Immunisation providers use all clinical encounters to assess immunisation status and where indicated vaccinate

Staffing of immunisation services

Local government immunisation providers should ensure that the immunisation team comprises suitably trained and experienced staff. Providers need to ensure that staff are familiar with relevant legislation and understand the implications for their practice.

Staffing requirements will depend on the anticipated size of the sessions. Staff numbers should be sufficient to allow for appropriate management of unforeseen events or emergencies.

Job descriptions of personnel involved in immunisation should be reflective of their roles in immunisation practice.

Refer to section: Clinical governance.

Ongoing education

Continuing Professional Development of staff is an aspect of Clinical governance. Local governments must establish procedures for ongoing training and support. Procedures should enable team members to have access to current immunisation information and shared with the maternal and child health nurses if relevant.

Registered nurse immunisers participate in ongoing continual professional development and complete 20 hours per year.

Professional development opportunities:

• Immunisation Unit – monthly newsletter and resources
• Immunisation Nurses Special Interest Group (INSIG)
• Melbourne Vaccine Education Centre (MVEC)
• Public Health Association of Australia (PHAA) bi-yearly conference
• PHN seminars
• National Centre for Immunisation Research and Surveillance (NCIRS)
• Annual CPR and immunisation emergencies update

Refer to section: Clinical governance.

Resources

Immunisation providers maintain current and easily retrievable immunisation guidelines at all locations where the vaccines are administered

The Australian Immunisation Handbook online and App for iPhone and android devices.

Immunisation Unit Victoria to order free resources, download fact sheets, translated information, newsletters and more.

Provision of advice to parents/community members

It is recommended that local governments have clinical staff available to answer immunisation related telephone queries of parents/guardians. If the answer to a query is not immediately available such as a medical enquiry, the parent/guardian should be contacted later with the information or referred appropriately. It should be noted that persons answering the phones should not go outside their area of expertise and competence.

Hospital-based immunisation services

Local government immunisation providers should ensure that general information on adult and childhood vaccination is available for parents/guardians/vaccinee. This should include information including the disease, contraindications, precautions, vaccine side effects, vaccine safety, vaccine content and the importance of vaccination.

Sharing knowledge about immunisation is suitable for families with vaccine hesitancy.

Better Health Channel has immunisation fact sheets for consumers.

Culturally and linguistically diverse clients

Translated information should be provided in the appropriate language.

The Australian Government Department of Health, Childhood Immunisation Education.

The Australian Government supports a 24-hour interpreter service.

When providing immunisation advice, do not go outside your area of expertise and competence

The ICN Code of Ethics for Nurses - Nurses value the legal and moral right of people, including children, to participate whenever possible in decision making concerning their nursing and health care and treatment, and assist them to determine their care on the basis of informed decision making. This may involve ensuring people who do not speak English have access to a qualified health interpreter. Nurses recognise and respect the rights of people to engage in shared decision making when consenting to care and treatment. Nurses also value the contribution made by persons whose decision making may be restricted because of incapacity, disability or other factors, including legal constraints. Nurses are knowledgeable about such circumstances and in facilitating the role of family members, partners, friends and others in contributing to decision-making process.

The vaccinator must obtain valid consent prior to any vaccination being administered

Secondary school vaccination program

In Victoria, local government immunisation providers administer the majority of vaccinations due in adolescence through their provision of the secondary school vaccination program.

It is recommended that each local government immunisation provider develop their own policies and procedures relevant to the conduct of immunisation sessions in schools in their local government area. The following guidance and resources, particular to the secondary school immunisation program, should inform local council policies and procedures.

Roles and responsibilities

Table 3: Council immunisation provider’s roles and responsibilities

Adolescents considered ‘mature minors’

The law recognises that as children become older and more mature, they are more capable of making their own decisions about a wide range of issues including decisions about their healthcare and wellbeing. These young people are referred to as 'mature minors' – see Adolescent vaccinations outside of school and catch-up immunisation.

Service delivery

Follow standard immunisation procedures

As with all immunisation services and sessions standard procedures (refer to section: Vaccination procedures), including pre-vaccination screening, safe administration and post-vaccination observation and treatment for adverse reactions if relevant.

Avoiding mass psychogenic illness

Vaccination is a medical procedure requiring a calm, orderly process to assist each student through vaccine consent, pre immunisation check and administration. In order to minimise the possibility of clusters of children in the same school experiencing a high degree of anxiety leading to side effects, the following actions are recommended and are best implemented by councils at the time of booking dates to attend the school.

1. Organise sessions to be run in a venue that allows privacy for each student being vaccinated so that other students are not watching the procedure prior to their vaccine being administered
2. Ensure the student is seated for vaccination
3. The vaccination area should be free of staircases and concrete as these can contribute to injury following a fainting episode
4. It is important for a person familiar to each class be present at the venue in order to assist with identification of children, control their behaviour and create a calm environment
5. Ensure the vaccine session is run with only one class present at a time. This will minimise the sense of mass anxiety that some students can engender in other vulnerable students
6. Following vaccination, students are required to wait a minimum of 15 minutes in a nearby location, however this time should be longer if a student is feeling dizzy or unwell after vaccination
7. Preferably students should be observed in a quiet space attached to the area where vaccines are administered. This area needs to be readily accessible to immunisation staff in the event of a faint or other immediate adverse event
8. Following vaccination, adolescents should refrain from strenuous activity and driving (eg. students eligible to drive/undergoing driving instruction) for up to 30 minutes in the event of a delayed fainting episode.

Follow up of unvaccinated students and adolescents not attending school

Adolescents (including refugee and other humanitarian entrants) aged 10 – 19 years are eligible for free vaccinations under the National Immunisation Program. While these vaccines are most often delivered by local councils in a secondary school setting, young people who are not attending secondary school, or for who prefer or need to access the vaccines in a different setting, can still access free vaccinations.

For students who missed vaccination due to absenteeism or because of incomplete or inadequate consent details, the following actions are recommended:

• The local government provider should supply the school immunisation program coordinator with details of immunisation sessions to which parents/guardians may bring students for catch-up.
• A follow-up letter should be forwarded to parents/guardians with details of available immunisation sessions for catch-up.
• Consideration may also be given to placing reminder notices in school newsletters with details of local government immunisation sessions and also suggesting their family doctor as an alternative.

Cold chain management

It is the responsibility of local government to ensure the management of vaccine cold chain and equipment within their immunisation service complies with the recommendations.

The National Vaccine Storage Guidelines – Strive For 5

Cold chain management resources.

Vaccine and stock logistics

Ordering and receiving government supplied vaccines

Receiving vaccines

It is recommended that a detailed inventory of vaccines is kept including:

• types and quantities of vaccines received
• batch numbers
• expiry dates
• date of receipt

To minimise vaccine wastage, ensure that vaccines are used within their expiry date, rotate vaccines in the fridge. Regardless of the date of delivery the vaccine with the earliest expiry should be used first.

Maintain enough vaccine consumables such as Biohazard waste containers, needles, syringes, equipment for standard precautions, adrenaline.

Vaccination procedures

• Following vaccine storage guidelines
• Preparing for vaccination
• Administering vaccines
• After vaccination
• Recognising and treating anaphylaxis
• Reporting an adverse event following vaccination

Paracetamol use in the local council setting

A registered immunisation nurse acting under the Secretary Approval, employed or appointed by a municipal council may possess paracetamol as a Schedule 2 poison if it is necessary for immunisation programs coordinated by the council. However, paracetamol administration would need to be in accordance with policy and guidelines of the municipal council. A municipal council would need to hold a health services permit in order to purchase Schedule 2 or Schedule 3 paracetamol from a wholesaler.

Immunisation catch-up schedules – staff responsible

Vaccine catch-up schedules should be developed by clinical staff who have the required knowledge and expertise to ensure that the issues detailed above have been satisfactorily addressed.

If the vaccine catch-up schedule was developed by administrative staff rather than clinical staff, the nurse immuniser should review the schedule and ensure these issues have been addressed before administering vaccines.

Monitoring and evaluation of immunisation services

It is recommended that data gained through monitoring and reviews of the service is analysed and interpreted to assist local government immunisation providers to ensure optimal quality of immunisation services and to improve the efficient and effective use of available personnel and resources.

Refer to section: Clinical governance.

Vaccine coverage

Childhood vaccinations

Coverage reports are distributed by DH Victoria to immunisation providers on a quarterly basis. These reports are inclusive of individual vaccine coverage and coverage at NHMRC target ages of 12 and 24 months and 60 months (five years). Coverage rate assessments for local government are based on all children residing in their municipality (regardless of where immunised).

To ensure the most accurate data in coverage rates, it is recommended that local government immunisation providers engage in active follow up of all children residing in their municipality.

It is also recommended that local government immunisation providers routinely check through their monthly AIR Statement of Payment. These Statements provide feedback on data reported which requires clarification.

Rates of vaccine-preventable disease

The incidence of vaccine preventable diseases is the outcome measure that demonstrates the effectiveness of an immunisation program in terms of control, elimination or eradication of a particular disease. Local government surveillance report.

Data on vaccine coverage

For previous data on vaccine coverage, and other data on vaccination, see the current coverage data tables for all children.

Policies and procedures (including emergency procedures)

• Review all policies and procedures regularly.
• In the case of a serious adverse reaction or other emergency event occurring, a debriefing of team members and a review of actions should be undertaken shortly after the event.

Refer to section: Clinical governance.

Client satisfaction survey

In the interests of public health, local government immunisation providers have a responsibility to provide sessions that both deliver quality immunisation services and are also user friendly to encourage parents/guardians to return for follow-up vaccinations.

Refer to section: Clinical governance.