Setting up for your immunisation consultation
Allocate enough time
Your room layout
- Is the patient’s privacy ensured?
- Is there space for more than two people?
- Is the sharps box accessible, and safely out of reach from children?
- Can the vaccines be drawn up out of sight (strongly recommended)?
- Set the room to suit whether you are left or right handed if this is possible.
Vaccine storage & stock
- Cold chain documentation is up to date, i.e. daily recordings etc.
- Enough vaccine in stock, stock expiry dates.
- Supplies of needles, syringes, cotton balls.
- Anaphylaxis/adrenaline kit.
- Oxygen (O2) and associated equipment.
Appropriate resources are available
- Handouts, e.g. Ministry of Health leaflets, Let's talk about immunisation flip chart (MoH), IMAC fact sheet Tips for immunising children etc.
- Distractions, e.g. stickers, toys, bubbles etc.
Do you have any cuts, abrasions that need covering
- Consider how to cover them or wear gloves.
Pre-vaccination immunisation history, assessment, contraindications and consent
For children on the National Immunisation Register (NIR)
- Ensure you complete a Status Query at each immunisation visit to get the most up to date, documented immunisation history. This is particularly important if the patient is new to your practice, an infrequent attendee or they attend other health care providers.
- Do not rely on a parental immunisation history alone.
Are catch-up immunisations required?
- If a child is behind with their vaccinations ensure that you have a documented catch up schedule.
At the consultation
Obtain informed consent
- Provide written & verbal information for parents/guardians/vaccinees to ensure information is given at an appropriate level.
- Be confident and competent about the vaccines, the disease they protect against, e.g. efficacy rates, post-immunisation responses and aftercare.
- Keep up to date with current issues make sure you have evidence based responses.
- Ensure parents/guardians/vaccinees are able to wait for 20 minutes post-immunisation.
Complete a pre-vaccination check list
- Use the pre-vaccination checklist in the Immunisation Handbook 2014 3rd Edition
- Identify any contraindications, specific precautions or reasons to defer immunisation, refer to the Immunisation Handbook 2014 3rd Edition.
- Be prepared to discuss “Conditions that are not contraindications to immunisation”, refer to the Immunisation Handbook 2014 3rd Edition.
There are times when you would seek additional advice either from a colleague, general practitioner or other specialist about specific precautions to immunisation. Examples include:
- Bleeding Disorders and vaccine administration,
- Immune-compromised vaccinee whether the result of medication or illness,
- Pregnancy and immunisation, when there isn’t a clear recommendation,
- Child with an undiagnosed or evolving neurological condition,
- Past vaccine reactions.
Any advice received and outcome should be documented.
Vaccine preparation, site, needle angle and vacinee positioning
- Wash your hands.
- Does the vaccine colour and appearance fit the description on the data sheet or does it show signs of thermal damage.
- Check you have the correct vaccines with a colleague or the parent/caregiver.
- Most vaccines (excluding live vaccines) contain an adjuvant and should be gently agitated before use; this may occur in the drawing up process but should be repeated prior to administration to ensure uniform suspension.
- Draw up and mix as directed on the data sheet that comes with the vaccine.
- Ensure that you change the needle after drawing up; do not prime the “giving” needle.
- If you are planning to use the stickers on the vaccine syringes, these should be removed prior to the vaccine being administrated not after, due to the risk of needle stick injury.
- For more detail refer to the Immunisation Handbook 2014 3rd Edition.
- Vastus lateralis site, refer to the Immunisation Handbook 2014 3rd Edition.
- Deltoid, refer to the Immunisation Handbook 2014 3rd Edition.
Vaccination sites by age
- Infants 0 months to 12 months - Vastus lateralis.
- Young child 12 months to 14 months - Vastus lateralis.
- Young child 15 months to 3 years - Vastus lateralis or deltoid.
- Older child 3 years and over - Deltoid.
Note: If you vaccinate using an alternative site you should clearly document your rationale for this, refer to the Immunisation Handbook 2014 3rd Edition.
- Intramuscular injection 90°, refer to the Immunisation Handbook 2014 3rd Edition.
- Subcutaneous injection 45°, refer to the Immunisation Handbook 2014 3rd Edition.
As the vaccinator you need to be in control of the situation and give clear directions and advice to the parent if they are assisting to hold the vaccinee, refer to the Immunisation Handbook 2014 3rd Edition.
Safety for vaccinators
- All needles, syringes and vials should be disposed of immediately following use into an approved sharps container, refer to the Immunisation Handbook 2014 3rd Edition.
- Spillages and needle-stick injury - all work places should have a policy on blood and body fluid exposures. All staff should be familiar with this policy, refer to the Immunisation Handbook 2014 3rd Edition.
Post vaccination advice
- Some of this information will have already been covered during the informed consent process. However it is important to ensure that both verbal and written advice post-immunisation advice is given and any questions are answered prior to the vaccinee leaving.
- Refer to the Immunisation Handbook 2014 3rd Edition.
- Make an appointment for the next immunisation visit.
Documentation and recording on National Immunisation Register (NIR)
- Standard 4 of the Immunisation Standards for Vaccinators outlines the minimum requirements for documentation; refer to the Immunisation Handbook 2014 3rd Edition.
- Your practice may have additional requirements.
- Complete the Immunisation Certificate in the Well Child Book, or a standalone Immunisation Certificate, at the 15 month and 4 year immunisation visits if the child is up to date with their vaccinations.
- Documentation should be completed before the vaccinee leaves the clinical setting.
National Immunisation Register (NIR)
- All providers and vaccinators are required to complete an Authorised User Agreement form, and send this to the NIR, before they access and message information to and from the NIR.
- Infant registration at the practice and enrolment with a PHO: on notification of the birth of a baby the NIR sends a “Nomination Message” to the practice advising the practice to register the baby on their Practice Management System (PMS). The practice then sends a welcome letter, enrolment form and the first immunisation appointment for the baby to the parent.
- Update the NIR after immunisations are given. If your practice has vaccine doses recorded for a child that are not included in the earlier Status Query results you need to advise the NIR team.
References and resources
Successful strategies towards BEST Practice for vaccination 2017
Ministry of Health publications
Immunisation Handbook 2014 3rd Edition
Provides clinical guidelines for health professionals on the safest and most effective use of vaccines in their practice.
National Standards for Vaccine Storage and Transportation for Immunisation Providers 2017
The National Standards for Vaccine Storage and Transportation for Immunisation Providers 2017, describes the standards and outlines the requirements for providers to achieve these standards. These standards supersede the National Guidelines for Vaccine Storage and Distribution 2012 and the cold chain information in the Immunisation Handbook 2014.
Vaccines for the National Immunisation Schedule
A summary of vaccine information for vaccinators and health professionals presented as an A4 chart, code HE1308
After your child is immunised
A post-vaccination information leaflet for parents and caregivers, code HE1504
A stand alone form replicating the immunisation certificate in the Well Child Book, completed at 15 months and 4 years of age, code HE7013