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BACK Hep
B vaccination patient group directive
(click
here to download the original word document, 60kB)
See
also: Hep B service description
NHS LANARKSHIRE
LANARKSHIRE
NHS ACUTE TRUST
PATIENT GROUP DIRECTION
FOR
THE ADMINISTRATION OF
HEPATITIS
B (Engerix B) VACCINE
FOR
IMMUNISATION
OF INDIVIDUALS CONSIDERED
TO
BE AT
HIGH
RISK OF HEPATITIS B INFECTION
(PGD
HEP B - April 2002)
BY REGISTERED NURSES
WORKING FOR THE LANARKSHIRE NHS ACUTE TRUST.
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This document
authorises the administration of Hepatitis B Vaccine by the registered
group of Nurses, to clients who meet the criteria for inclusion under
the terms of the document.
The registered
nurse seeking to administer Hepatitis B Vaccine must ensure that all clients
have been assessed and meet the criteria before administering the vaccine.
The purpose of
this Patient Group Direction is to help clients by ensuring that they
have ready access to a quality assured service. This service will provide
a timely, consistent and appropriate immunisation service for individuals
considered to be at high risk of Hepatitis B infection.
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PATIENT GROUP DIRECTION
FOR THE ADMINISTRATION
OF HEPATITIS B (ENGERIX B) VACCINE TO INDIVIDUALS IDENTIFIED AS BEING
AT HIGH RISK OF HEPATITIS B INFECTION
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Clinical indication
to which this protocol applies
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Definition of situation/condition |
- Primary course of immunisation
against Hepatitis B infection to facilitate the NHS Lanarkshire
Hepatitis B Vaccination Programme for individuals at high risk
of Community Acquired Hepatitis B infection
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Clinical criteria for inclusion |
Clients 16 years
of age and over who are members of following high risk groups:-
- Injecting drug users
- Sexual Partners of Injecting
drug user
- Males who have sex with males
and female sexual partners they may have
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Clinical criteria for exclusion |
- Hypersensitivity to a component
of the vaccine
- Acute severe febrile infection.
The presence of a minor infection, however, is not a contraindication
for immunisation.
- Pregnancy - advise the client
to seek medical advice
- Clients receiving anticoagulant
therapy or who have a bleeding disorder - advise the client to
seek medical advice
- Clients who cannot consent to
the treatment.
- Clients with a history of Hepatitis
B infection or immunisation
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Action if excluded from treatment |
- The action to be taken depends
on the reasons for exclusion. Practitioners are expected to use
their judgement in accordance with the guidelines given above
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Action if client declines treatment
from nurse
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- If the client declines immunisation
from a nurse then information about disease transmission and the
subsequent risks must be reiterated along with a recommendation
for the client to seek medical advice.
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Characteristics
of staff authorised to take responsibility for the supply or administration
of medicines under the group protocol
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Qualifications required
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- Registered Nurse with current
Nursing and Midwifery Council registration
- Experience in the field of substance
misuse.
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Additional requirements specialist
qualifications, training, experience and competence necessary |
- The nurse needs to be knowledgeable
with the recommendations given in the current version of "Immunisation
against Infectious Disease" published by the Department of
Health, Welsh Office, Scottish Office Department of Health and
DHSS (Northern Ireland) including appendices and amendments.
- The nurse should practice by
the "Guidance for the Administration of Medicines" and
"Guidance for Professional Practice" as current with
the NMC
- Training in the recognition and
treatment of anaphylaxis, Basic Life Support Training.
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Continuing training requirements |
- The practitioner needs to keep
up to date with the amendments to "Immunisation against Infectious
Disease" published by the Department of Health, Welsh Office,
Scottish Office Department of Health and DHSS (Northern Ireland)
- The nurse is required to attend
updates as specified by the Blood Borne Virus Liaison Nurse
- Commitments to continuing education
including 5 days of study every 3 years, and maintenance of a
nursing personal profile.
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Description of
treatment available under the group protocol
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Name of Medicine |
- Hepatitis B Vaccine. Engerix
B prefilled Syringe is the only product licensed for the dosage
schedule that this patient group direction describes.
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Pharmaceutical Form and Strength |
- Engerix B Prefilled syringe containing
a suspension of Hepatitis B Virus antigen recombinant (S Protein)
absorbed, 20 microgram per 1ml.
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Legal Status |
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Dose |
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oute/Method of Administration |
- Intramuscular injection preferably
into the deltoid muscle. (Avoid buttocks)
- If an alcohol swab has been used
to clean the injection site allow the alcohol to evaporate before
injecting.
- Must not be given by intradermal
or intravenous injection
- Do not mix with other vaccines
in the same syringe and do not inject at the same site as other
vaccines
- The vaccine should be well shaken
before use and will then be slightly opaque.
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Frequency of Dose |
- A course of four separate 1.0ml
doses given as follows
- Dose 1 - Day 0
- Dose 2 - Day 7
- Dose 3 - Day 21
- Booster dose - at 1 year.
- This rapid schedule is applied
in the exceptional circumstances that the NHS Lanarkshire Hepatitis
B Vaccination Programme for Groups of People at high risk of Community
acquired Hepatitis B infection is servicing.
- It is understood that client
attendance and the presence of temporary exclusion criteria may
require some modification around this regimen. If a dose is delayed
it should be given as soon as is practicable. There must always
be a delay of 14 days between doses 2 & 3.i.e. if dose 2 has
to be delayed until day 14, then dose 3 should be given on day
28.
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Duration of Treatment |
- This Patient Group Direction
provides an opportunity for Primary Immunisation with a booster
at 1 year. Further booster vaccination is not anticipated for
approx. 5 years
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Follow up Treatment |
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Advice to be given to client
before or after the treatment |
- The following will be provided
to the client
- A copy of the Hepatitis B (Engerix
B) vaccine patient information leaflet (Appendix A)
- A copy of the NHS Lanarkshire
Hepatitis B Vaccination Programme for Groups of People at high
Risk of Community acquired Hepatitis B infection consent form
(Appendix B)
- The following verbal advice will
also be provided:
- Advice to contact the Blood Borne
Virus Nurse or medical help as appropriate if the client experiences
any adverse effects
- An explanation of the value of
completing a course of four vaccinations.
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Identifying and managing possible
adverse reactions
Referral for medical advice |
- There may be mild soreness, redness
or hardness at the site of the injection. This should last only
a few days.
- The client may feel unwell, or
have a fever, tiredness, dizziness, faintness, headache, sickness,
stomach pains, diarrhoea, swollen glands and flu-like symptoms
aches and pains in muscles and joints. These should be treated
syptomatically
- The client should seek medical
advice if any of the following unwanted effects are experienced:
a rash, itching and reddening of the skin, swelling of the eyes
and lips, swollen or painful joints, unexplained or easy bruising,
fever with pins and needles. numbness, loss of movement and difficulty
with vision.
- Clients will be advised that
it is their best interests to remain on the premises for approx.
20 minutes after the injection has been given. The client should
be advised to seek urgent medical attention if they experience
tightness in the throat or shortness of breath
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Facilities and supplies required
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- The following should be available
at sites where vaccines are to be administered.
- Refrigerator (or cool boxes for
storing vaccines if at an outreach clinic)
- Adrenaline 1:1000 in case of
anaphylactic shock (Min i jet)
- Access to emergency services
(via a mobile phone)
- Safe storage areas for medicines
and equipment
- Equipment for disposal of used
and unused materials i.e. sharps boxes
- Clean and tidy work areas
7. Oxygen
8. Basic equipment
for resuscitation
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Details of treatment records
required |
- A record of the site of administration
of the vaccine should be made.
- Details of the manufacturer ,
batch number and expiry date of the vaccine should be documented
- Date of administration
- The signature of the person administering
the vaccine
- The Lanarkshire Hepatitis B Vaccination
for Immunisation of Individuals Considered to be at High Risk
of Hepatitis B Infection Registration form (Appendix C) will be
used for this purpose.
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Management and
Monitoring of group protocols
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Names and signatures of professionals
drawing up the protocol |
Jane Smith, Blood Borne
Virus Liaison Nurse
................. Date
.....
Willie Kirk, Blood Borne
Virus Risk Reduction Nurse
................. Date
.....
Dave Robinson, Harm reduction
Nurse
................. Date
.....
Alastair Thorburn, Lanarkshire
Primary Care NHS Trust Prescribing Adviser.
................. Date
.....
Kathleen MacArthur, Lanarkshire
Acute Hospitals NHS Trust, Blood Bourne Virus Pharmacist
................. Date
.....
Rosemary Robertson, Senior
Nurse, Homeless Healthcare Tean
................. Date
.....
George Lindsay, Lanarkshire
Primary Care NHS Trust Chief Pharmacist
............... Date .......
Dr N Kennedy, Consultant
in Infectious Diseases
................Date .......
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Professional advisory groups
which have approved the protocol |
John Logan,
Chairman NHS Lanarkshire
Blood Borne Virus Standing Committee
................. Date
.....
David Cromie
Chairman
NHS Lanarkshire Area Immunisation
Committee
................. Date
.....
George Lindsay
Chairman, Lanarkshire Primary
Care NHS Trust Drugs and Therapeutics Committee
.................
Date .....
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Senior person in each profession
designated with the responsibility to ensure that only fully competent,
qualified and trained professionals operate within Directions. |
Joan James,
Associate Director
of Nursing
.................
Date .....
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Manager authorising the protocol |
Joan James, Associate
Director of Nursing
.................
Date .....
Ian Calder,
Pharmacy Manager,
Monklands Hospital, Lanarkshire NHS Acute Trust
.................
Date .....
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Date of ratification of the protocol |
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Review Date
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- One year from final ratification and annual thereafter
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Lanarkshire
Primary Care NHS Trust and Lanarkshire NHS Acute Trust
Nurse
Agreement
Patient
Group Direction for the Administration of Hepatitis B Vaccine to individuals
considered to be at high risk of Hepatitis B infection
I
____________________________ , confirm that I have read and understood
the above Patient Group Direction(PGDHepBApril2002). I confirm that I
have the necessary competence, training and knowledge to apply the Patient
Group Direction. I will ensure my competence is updated as necessary.
I will retain a copy of the Patient Group Direction to ensure that it
is readily available to me in the clinical setting in which supply or
administration of the medicine will take place.
I
understand that it is the responsibility of the nurse to act in accordance
with the UKCC Guidelines for Professional Practice and Guidelines for
the Administration of Medicines and to keep an up to date record of training
and competency.
Signature
of Nurse __________________________________________________
Name
of Nurse (block capitals) ______________________________________
NMC
PIN number;___________________________________________________
Date
_______________________________________________________________
This
record will be kept in triplicate one for nurse's own record, one for
their employer held file and one for a central record of nurses authorised
to apply the PGD. That record will be maintained by the Lanarkshire Primary
Care Trust and Lanarkshire NHS Acute Trust's Department of Nursing.
See
also: Hep B service description TOP
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