| |
< BACK
Implementing a hepatitis B vaccination programme for intravenous drug users in a semi-rural location
Julie Barton, Nurse Health Advisor, Sussex Partnership NHS Trust
Abstract
The East Sussex Substance Misuse Service covers a large urban and rural geographical area formally referred to as Hastings and Rother in the east and Eastbourne, Wealden and Lewes in the west. The population for the East Sussex area is in the region of 500,000.
There are no recent drug misuse prevalence studies for Sussex, but the South East Public Health Observatory in their 2006 report noted that there are estimated to be 50,000 problem drug users in the South East, of whom a third would be expected to be IVDU's.
The Substance Misuse Service operates from 2 main sites in Eastbourne and Hastings with additional outreach clinics including GP shared care.
Harm Reduction Services across the county
Nurses in both teams have responsibility for ensuring there is 100% offer of vaccinations in line with the National Treatment Agency's KPI's, across the SMS as well as the Needle Exchange service managed by partner agency CRI.
The Harm Reduction Nurse has the responsibility of co-ordinating the vaccination programme. This paper addresses the hepatitis B vaccination programme in the west of the county (Eastbourne, Wealden and Lewes) in line with DoH guidelines.
The process
- Development of Patient Group Direction (PGD) using the 0, 7 & 21-day schedule.
- Ratification of the PGD in March 2006.
- Vaccination programme initially delivered from the Tier 2 Needle Exchange Service where the nurse was based with the idea of 'capturing' clients accessing this service. This opportunity also allowed other Harm Reduction (HR) initiatives to be addressed including safer injecting, safer sex (condom distribution), general health screening as well as access to HIV, HCV & HBV testing.
- However, a more pragmatic approach was needed, as the PGD was deemed too restrictive allowing limited flexibility around the vaccination schedule.
- Evidence based practice was sought. Budd et al (2004) recommended flexibility around vaccination schedule with the aim of improving the number of IVDU's completing the primary vaccination schedule.
- Vaccination programme then extended to the Tier 3 Supervised Consumption Clinic with the nurse attending one morning a week to offer vaccination to all clients attending the clinic. Again this included HR advice and access to condoms. All completed schedules are recorded in the client's notes.
- Staff encouraged to promote the benefits of the hepatitis B vaccination through their client reviews and to record in the client's notes when this information had been given. Client's that had initially refused vaccination had the benefits reinforced to them during reviews to encourage uptake.
- The vaccination programme was then extended to the GP shared care/ rural outreach clinics with the nurse attending these clinics weekly to offer and vaccinate clients.
Recording & outcomes
- All clients agreeing to vaccination have individual recording sheets, which they sign after they have read the patient information
TOP
Biography
I am a registered Mental Health and General Nurse working in the substance misuse field for the last five years. During this time I have been responsible for developing needle exchange services within the newly commissioned service with the non-statutory partner agency CRI and the pharmacy based provision throughout the Trust area. I have successfully established a central needle exchange provision in the seaside town of Eastbourne which is now supported by nine pharmacy outlets in surrounding rural and smaller towns. I have successfully introduced a registration scheme and risk assessment for all injecting drug users which includes up to date information on current injecting practices, overdose risk,BBV testing and hepatitis B vaccinations. I am currently based within the needle exchange offering BBV screening and hepatitis B vaccinations.
Having recently completed my non medical prescribing qualification, I am currently developing within the NHS Trust, supported by the non-medical prescribing lead the possibility of being able to prescribe a limited range of prescription only medication i.e. antibiotics for infected injecting sites for this chaotic group of clients who may not normally access primary care services. I have also been part of the development of the local Harm Reduction Strategy and continually seek to promote this across all services that I work with.
Having gained the City & Guilds 7407(1) qualification in teaching practice I have designed and currently deliver in partnership with the NHS Trust and the non-statutory agency CRI a Safer Injecting study day which is aimed at all disciplines who are in contact with Intravenous Drug Users through their work.
In my 20 years as a nurse having worked in many areas I feel that it is in the field of substance misuse that I have made my greatest gains both professionally and personally finding this area of nursing the most rewarding.
|
|
