Influenza is the cornerstone of vaccine provision from community pharmacy. If you've offered an influenza service in the past it may be prudent to access your previous records and contact patients alerting them to the fact that they need another vaccine for this season. The aim of this PGD is to protect patients against the prevailing strains of influenza type A and or be in line with national guidance. Flu is an infectious disease which is caused by RNA viruses/Influenza spreads around the world since seasonal waves. Influenza is often confused with the common cold.
Influenza is more severe than the common cold and the cold is caused by different virus. The most serious complication of the disease is Pneumonia and is most prevalent in patients who are elderly, diabetic or have COPD. There are three types of influenza virus A, B & C. A & B the most common and C is the least common. Wild birds the natural host for a large variety of influenza A. Occasionally viruses are transmitted to other species and may cause outbreaks which he may result in human influenza pandemics. The Type A viruses are the most severe of the three groups of influenza viruses.
Note Spanish flu, in 1918 which affected 500 million people and resulted in 20 million plus deaths and the more recent swine flu of 2009 which killed over 17,000 people globally. This genus has one species influenza B virus. Influenza B almost exclusively affects humans and is less common influenza A. This type of influenza mutates at a rate two to three times slower than Type A and consequently is less genetically diverse. This rate of antigenic change and limited chances of antigenic shift ensures that pandemics influenza B do not occur. Influenza C is less common than other types and usually only causes mild disease in children. This genus has one species Influenza C which affects humans, dogs, pigs and sometimes cause both severe illness and local epidemics. Influenza reaches its peak in the winter season in both the northern and southern hemispheres.
The majority Flu first timers, see this graph and assume that we should start vaccinating at around forty seven weeks in November. However, this is wrong. Vaccines are preventative. The vaccine season should start around the 37th week mark which is September or even sooner. Keep in mind the influenza release for GPs is scheduled via the NHS flu plan. It states that they should contact eligible patients and invite them to attend for vaccinations in around September. This table shows the percentage uptake of the vaccine in specific at risk groups. Note people aged 65and over we've been quite successful hitting need the European Union target of 75 percent.
The main areas the NHS wants to prioritize within the UK this year are people aged under 65 in a clinical at risk group so despite that continued efforts for a number years around only a half of patients in clinical risk groups have been vaccinated. Increasing uptake is important because of the increase risk that people in clinical risk groups are at from the effects of flu. Most notably there's a very poor uptake in children under the age of 16 in at risk groups this is a key priority of the NHS and is one of the main reasons pharmacies have been commissioned to offer this service this year. The vaccine is given once a year and comprises of a non-live attenuated viral protein which cannot give that patient influenza. All the formulations of IM flu vaccinations to this year are actually did on the PGD. The flu vaccination is manufactured on the recommendation of the World Health Organization.
Any patients with an acute infection should be deferred to GPs, please note that patients with minor infections without fever or systemic upset will be included.
Lastly, if the vaccines are contraindicated in children between the ages 2 and 17, an inactivated intramuscular vaccine can be given. Keep in mind the intranasal vaccine is a live vaccine this means that you shouldn't give the live vaccine to an immune compromised patient. Immuno compromised patients are often people taking chemotherapy or undergoing radiotherapy or have high-dose cortical steroids immune suppressants or take medicines which affect the immune system. Check chapter 14 of the BNF for a bit more clarity on this. Remember, you're making a clinical decision as to whether the patient can have a prescription-only medicine, if you're unsure check the documentation. If you're still unsure give us a call at PharmaDoctor.
With the child's head slightly tilted backwards, place the tip of the applicator just inside the nostril and with a single motion push the plunger as rapidly as possible to deliver 0.1 millilitres a Fluenz until the dose divider clip prevents you from going any further. Remove the applicator from the nostril, now pinch the dose divider clip and remove from the plunger. Place the tip of the applicator just inside the other nostril and depress the plunger as rapidly as possible to deliver the remaining 0.1milliliters of Fluenz into the child's other nostril.
Following the administration the used nasal applicator should be disposed of in line with standard arrangements for clinical waste. Perform hand hygiene. Record the administration as per your local policy. No need to repeat in either nostril if the child sneezes, blows their nose or their nose drips following administration. We are sure that the vaccine will still be effective if any if these occur.
After giving the vaccination it's good practice to give the patient the "patient information leaflet". Ask the patient to wait a few minutes whilst you finalise the payment or finalise the risk assessment form. If it's on the private sector keep in mind that a VAT charge is not applicable.
Patients often ask "how effective is the flu vaccine?" Well, it's around seventy to ninety percent effective. No vaccination can 100 percent guarantee that you won't get the disease. "A friend of mine said she got flu after being administered the flu jab. "Will I get the same? Well, the short answer to this is "no!". The majority of flu vaccinations are intramuscular inactivated vaccines which wouldn't cause any flu symptoms. There may be some self-limiting side effects which look like flu, however these are very unlikely. The most common side effect to occur is really a sore arm. The next question is "can I not get the flu vaccination on the NHS?" And is often comes from patients and it's really dependent on whether you've been commissioned within your area.
For pharmacies in London, there is commission for the 2014-2015 period and almost certainly you can give it to "at risk" patients which is defined by the PGD itself. However, outside London this a little bit uncertain and you'd have to talk to your local authority for more information. So, just quickly this is are cap of the NHS eligibility criteria for the flu vaccination this year. However, this may differ regionally so make sure that you check your SLA and the associated PGD. This question asks "I would like to get a flu jab I'm a busy business woman and can't afford the side effects" My answer to that is, the side effects to the flu vaccination itself aren't severe, very very very rarely would they affect the day-to-day activities of the patient. The most common side effect that a patient get is a localised reaction. A sore arm. Which is self-limiting and should be over in two to three daysà time. As for the 2014 - 2015 period, children between the age of two and seventeen, can actually get the intranasal Fluenz vaccination. Free of charge from the NHS.
You'd have to check with your local authority to check whether you're being commissioned for that service. For further resources make sure that the check out the product SPC for the vaccines that you're using, there's quite a few out there on the market, so make sure that you get the right one. The other thing to check is the Green Book which is the vaccination Bible for the NHS, make sure that you access the online version of it as the pocket book is out-of-date. It dates back from 2006.
Influenza is more severe than the common cold and the cold is caused by different virus. The most serious complication of the disease is Pneumonia and is most prevalent in patients who are elderly, diabetic or have COPD. There are three types of influenza virus A, B & C. A & B the most common and C is the least common. Wild birds the natural host for a large variety of influenza A. Occasionally viruses are transmitted to other species and may cause outbreaks which he may result in human influenza pandemics. The Type A viruses are the most severe of the three groups of influenza viruses.
Note Spanish flu, in 1918 which affected 500 million people and resulted in 20 million plus deaths and the more recent swine flu of 2009 which killed over 17,000 people globally. This genus has one species influenza B virus. Influenza B almost exclusively affects humans and is less common influenza A. This type of influenza mutates at a rate two to three times slower than Type A and consequently is less genetically diverse. This rate of antigenic change and limited chances of antigenic shift ensures that pandemics influenza B do not occur. Influenza C is less common than other types and usually only causes mild disease in children. This genus has one species Influenza C which affects humans, dogs, pigs and sometimes cause both severe illness and local epidemics. Influenza reaches its peak in the winter season in both the northern and southern hemispheres.
The majority Flu first timers, see this graph and assume that we should start vaccinating at around forty seven weeks in November. However, this is wrong. Vaccines are preventative. The vaccine season should start around the 37th week mark which is September or even sooner. Keep in mind the influenza release for GPs is scheduled via the NHS flu plan. It states that they should contact eligible patients and invite them to attend for vaccinations in around September. This table shows the percentage uptake of the vaccine in specific at risk groups. Note people aged 65and over we've been quite successful hitting need the European Union target of 75 percent.
The main areas the NHS wants to prioritize within the UK this year are people aged under 65 in a clinical at risk group so despite that continued efforts for a number years around only a half of patients in clinical risk groups have been vaccinated. Increasing uptake is important because of the increase risk that people in clinical risk groups are at from the effects of flu. Most notably there's a very poor uptake in children under the age of 16 in at risk groups this is a key priority of the NHS and is one of the main reasons pharmacies have been commissioned to offer this service this year. The vaccine is given once a year and comprises of a non-live attenuated viral protein which cannot give that patient influenza. All the formulations of IM flu vaccinations to this year are actually did on the PGD. The flu vaccination is manufactured on the recommendation of the World Health Organization.
So, who can have the influenza vaccine from a pharmacy?
As always you need to consult your specific PGD and SLA. However, there are some general rules to follow any patient who has had said significant reaction to a vaccine or to any other excipients will be excluded. Similarly, some influenza vaccines are made from egg products, so if the patient is allergic to eggs they'll be excluded. Please note this does not mean patients with dietary intolerance to eggs. Patients with bleeding disorders or taking anticoagulants such as warfarin can be administered vaccine via a subcutaneous route. This will be demonstrated in your practical training.Any patients with an acute infection should be deferred to GPs, please note that patients with minor infections without fever or systemic upset will be included.
Lastly, if the vaccines are contraindicated in children between the ages 2 and 17, an inactivated intramuscular vaccine can be given. Keep in mind the intranasal vaccine is a live vaccine this means that you shouldn't give the live vaccine to an immune compromised patient. Immuno compromised patients are often people taking chemotherapy or undergoing radiotherapy or have high-dose cortical steroids immune suppressants or take medicines which affect the immune system. Check chapter 14 of the BNF for a bit more clarity on this. Remember, you're making a clinical decision as to whether the patient can have a prescription-only medicine, if you're unsure check the documentation. If you're still unsure give us a call at PharmaDoctor.
Before you administer make sure you prepare!
Ensure that there is sufficient space in the room and that everything is in place for you to do the actual vaccination. Anticipate the patient, make sure that you reduce the amount of anxiety that the patient is experiencing by when you make up the vaccination itself put in a basket make the patient sit down and put the basket behind them. This is to ensure that they don't see the needle and don't have the anxiety levels building up. The inactivated vaccine is administered intramuscularly into the inferior deltoid of either arm. After giving the vaccine, occasionally the needle catches a small blob blood which comes out on the skin this is not serious and with a bit of pressure and a small it adhesive dressing, this can be easily overcome. This year also sees the introduction of the nasal flu vaccine "Fluenz".Fluenz Pharmacy PGD
There's no need to wear gloves or an apron in the administration of Fluenz vaccine to a primary school-aged child. To administer Fluenz the child should sit directly opposite the vaccinator. Before starting the procedure the child's identity should be verified and check that consent has been given. Explain the procedure to the child. Check the expiry date on the applicator. Remove the applicators rubber cap. Do not remove the dose divider clip at the other end to the applicator at this stage.With the child's head slightly tilted backwards, place the tip of the applicator just inside the nostril and with a single motion push the plunger as rapidly as possible to deliver 0.1 millilitres a Fluenz until the dose divider clip prevents you from going any further. Remove the applicator from the nostril, now pinch the dose divider clip and remove from the plunger. Place the tip of the applicator just inside the other nostril and depress the plunger as rapidly as possible to deliver the remaining 0.1milliliters of Fluenz into the child's other nostril.
Following the administration the used nasal applicator should be disposed of in line with standard arrangements for clinical waste. Perform hand hygiene. Record the administration as per your local policy. No need to repeat in either nostril if the child sneezes, blows their nose or their nose drips following administration. We are sure that the vaccine will still be effective if any if these occur.
After giving the vaccination it's good practice to give the patient the "patient information leaflet". Ask the patient to wait a few minutes whilst you finalise the payment or finalise the risk assessment form. If it's on the private sector keep in mind that a VAT charge is not applicable.
Patients often ask "how effective is the flu vaccine?" Well, it's around seventy to ninety percent effective. No vaccination can 100 percent guarantee that you won't get the disease. "A friend of mine said she got flu after being administered the flu jab. "Will I get the same? Well, the short answer to this is "no!". The majority of flu vaccinations are intramuscular inactivated vaccines which wouldn't cause any flu symptoms. There may be some self-limiting side effects which look like flu, however these are very unlikely. The most common side effect to occur is really a sore arm. The next question is "can I not get the flu vaccination on the NHS?" And is often comes from patients and it's really dependent on whether you've been commissioned within your area.
For pharmacies in London, there is commission for the 2014-2015 period and almost certainly you can give it to "at risk" patients which is defined by the PGD itself. However, outside London this a little bit uncertain and you'd have to talk to your local authority for more information. So, just quickly this is are cap of the NHS eligibility criteria for the flu vaccination this year. However, this may differ regionally so make sure that you check your SLA and the associated PGD. This question asks "I would like to get a flu jab I'm a busy business woman and can't afford the side effects" My answer to that is, the side effects to the flu vaccination itself aren't severe, very very very rarely would they affect the day-to-day activities of the patient. The most common side effect that a patient get is a localised reaction. A sore arm. Which is self-limiting and should be over in two to three daysà time. As for the 2014 - 2015 period, children between the age of two and seventeen, can actually get the intranasal Fluenz vaccination. Free of charge from the NHS.
You'd have to check with your local authority to check whether you're being commissioned for that service. For further resources make sure that the check out the product SPC for the vaccines that you're using, there's quite a few out there on the market, so make sure that you get the right one. The other thing to check is the Green Book which is the vaccination Bible for the NHS, make sure that you access the online version of it as the pocket book is out-of-date. It dates back from 2006.
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