Insert name Hospital and Health Service
flu clinic guidelines
Insert subtitle here (optional)
2014
Hospital and Health Service flu clinic guidelines
Published by the State of Queensland (Queensland Health), May, 2014
This document is licensed under a Creative Commons Attribution 3.0 Australia licence.
To view a copy of this licence, visit creativecommons.org/licenses/by/3.0/au
© State of Queensland (Queensland Health) 2014
You are free to copy, communicate and adapt the work, as long as you attribute the
State of Queensland (Queensland Health).
For more information contact:
Chief Health Officer Branch/Clinical Innovation Division/Communicable Diseases Unit,
Department of Health, GPO Box 2368, Fortitude Valley BC, QLD 4006, email
pandemic_cdu@health.qld.gov.au, phone 33289724 or 33289728.
An electronic version of this document is available at
http://www.health.qld.gov.au/pandemicinfluenza
Disclaimer:
The content presented in this publication is distributed by the Queensland Government as an information source only.
The State of Queensland makes no statements, representations or warranties about the accuracy, completeness or
reliability of any information contained in this publication. The State of Queensland disclaims all responsibility and all
liability (including without limitation for liability in negligence) for all expenses, losses, damages and costs you might
incur as a result of the information being inaccurate or incomplete in any way, and for any reason reliance was placed
on such information.
Insert name HHS flu clinic guidelines
- ii -
Contents
1.
Introduction ................................................................................................ 1
1.1
1.2
1.3
1.4
1.5
1.6
1.7
1.8
2.
Command, control and coordination arrangements ................................... 3
2.1
2.2
3.
Review........................................................................................................ 1
Approval and implementation ..................................................................... 1
Purpose ...................................................................................................... 2
Scope ......................................................................................................... 2
Supporting documents ................................................................................ 2
Objectives ................................................................................................... 2
Assumptions ............................................................................................... 3
Activation .................................................................................................... 3
Management within a flu clinic .................................................................... 3
Roles and responsibilities ........................................................................... 4
Concept of operations ................................................................................ 4
3.1
Site selection .............................................................................................. 4
Primary flu clinic ......................................................................................... 4
Additional flu clinics .................................................................................... 4
3.2 At risk groups.............................................................................................. 4
Aboriginal and Torres Strait Islander peoples ............................................. 5
3.3 Support to non-Queensland health service providers.................................. 6
3.4 Health service operations ........................................................................... 6
Clinical assessment .................................................................................... 6
Referral pathways ....................................................................................... 7
3.5 Infection control .......................................................................................... 7
3.6 Specimen collection .................................................................................... 7
3.7 Case and contact management .................................................................. 7
3.8 Antiviral distribution and supply .................................................................. 8
3.9 Documentation and surveillance ................................................................. 9
3.10 Human resources ....................................................................................... 9
Training ...................................................................................................... 9
References ....................................................................................................... 10
Insert name HHS flu clinic guidelines
- iii -
1.
Introduction
This guideline is designed to give Hospital and Health Service (HHS) planners
access to information needed to plan for the establishment and management of a flu
clinic. It should be read in conjunction with the outreach clinic checklist (available
from http://www.health.qld.gov.au/pandemicinfluenza). This document is a guide
only, it is not prescriptive or exhaustive and should be modified and expanded to
reflect the outcomes of operational planning.
Using this guideline:
 transfer this template’s text to the appropriate template within your HHS
 document the outcome of local planning under each section using the resources
provided in the pandemic influenza: flu clinic toolkit
 delete the tips boxes when you have completed a section
 the end result will be a completed, HHS specific guideline
Or
 use the toolkit to update your current guideline.
1.1
Review
This guideline is due for review on: DD-MM-YYYY
Date of last review: DD-MM-YYYY
Supersedes: insert the name of the superseded guideline.
Business area contact insert the name of the business area contact.
1.2
Approval and implementation
Policy custodian: insert the position of the officer (SO or above) who will have
responsibility for implementation of the document.
Responsible executive team member: insert the position of the executive
management team member responsible for authorising implementation of the
document.
Approving officer: include name and position of officer approving the document.
Approval date: DD-MM-YYYY
Effective from: DD-MM-YYYY
Version Control:
Version
Date
Prepared by
Comments
Insert details of any changes made to this document
Insert name Hospital and Health Service flu clinic guidelines
-1-
1.3
Purpose
This guideline describes how insert name HHS will establish and manage a flu clinic.
1.4
Scope
This guideline relates to all insert nameHHS employees, contractors and consultants
and all organisation and individuals acting as its agents for Queensland Health.
1.5
Supporting documents
The overarching document is the Queensland Health pandemic influenza pla.
Supporting documents include:
 outreach clinic checklist
 non appointed contact tracing officer iLearn module
 appointed contact tracing officer iLearn module
 Drug Therapy Protocol – pandemic influenza program
 Pandemic influenza health management protocol
(The Plan and supporting documents are available at
http://www.health.qld.gov.au/pandemicinfluenza)
Related documents
 Disaster Management Act 2003
 Health (Drugs and Poisons) Regulation 1996
 Public Health Act 2005
 Health Act 1937
 Australian Health Management Plan for Pandemic Influenza (AHMPPI)
 Australian Guidelines for the Prevention and Control of Infections in Healthcare
1.6
Objectives
1.
to reduce the impact on scarce health resources through the use of a controlled
triage system
2.
to rapidly assess, treat and (if appropriate) refer suspected, probable or
confirmed cases of pandemic influenza to health and social support services for
further management if appropriate
3.
to initiate voluntary self-isolation procedures for suspected, probable or confirmed
cases and household contacts
4.
to initiate case and contact data collection
5.
identify the need for home support services and facilitate appropriate referrals
Insert name Hospital and Health Service flu clinic guidelines
-2-
1.7
Assumptions
The arrangements detailed in this plan are based on the following operational
assumptions:
 a standardised Incident Management System will be in place in Queensland Health
 a public information system will inform and direct suspected and probable cases of
pandemic influenza to local flu clinics
 there will be a need to increase health service capacity to staff flu clinics. This could
be achieved by sourcing staff from within the HHS as well as sourcing staff that are
not currently employed by Queensland Health
 there will be a data management system for patient information (currently under
review at a national level).
1.8
Activation
Within insert name HHS, the insert role has the authority to activate the
establishment of flu clinics.
2.
Command, control and coordination
arrangements
Command, control and coordination arrangements are consistent with the Queensland
Health disaster plan (http://qheps.health.qld.gov.au/emu/ ) (Queensland Department of
Health 2013a).
The Incident Management Team within insert name HHS sits within the Health
Emergency Operations Centre (HEOC) and controls the resources, decisions and
coordination of all emergency and response activities within insert name HHS.
2.1
Management within a flu clinic
Within insert name HHS, the insert role within the flu clinic will be responsible for
reporting to the HEOC. Consideration should be given to the most appropriate and
reliable form of communication for local conditions.
Consideration should be given to the roles that will lead, coordinate and implement
the flu clinic strategy within the HHS. HHS planners should consider constructing job
cards for positions within the flu clinic. Refer to the field officer job card for an
example of job card content and structure (QHEPS link only!).
Insert name Hospital and Health Service flu clinic guidelines
-3-
2.2
Roles and responsibilities
3.
Concept of operations
3.1
Site selection
to outreach that
clinica checklist
ItRefer
is recommended
list of keyhttp://www.health.qld.gov.au/pandemicinfluenza
contacts that will support the establishment andfor
points to be considered
site
selection.
In consideration
of local
requirements
management
of flu clinicsduring
in each
HHS
be created
and maintained
to enable
rapid
site selection
bealso
performed
consultation with
the Local
Disasterwithin the
response.
This should
list could
identifyinresponsibilities
of relevant
agencies
Management
Group.
HHS.
Refer to the
outreach clinic checklist for further guidance.
(http://www.health.qld.gov.au/pandemicinfluenza)
Site selection will depend on the administration model used. A number of different
models may be used depending on HHS requirements and resources. Suggested
models for consideration include:
 mobile outreach clinics
 GP clinics
 clinics established at community centres, schools and / or sporting complexes
The selection and acquisition of sites is being coordinated by insert role. This includes
the development of formal agreements if required.
Within insert name HHS, final authorisation of any arrangements is the responsibility
of insert role.
Primary flu clinic
The primary flu clinic in insert name HHS could be located at insert list of potential
sites. The model for the flu clinic is briefly describe model. eg. community based
clinics, outreach clinics etc.
Additional flu clinics
Additional flu clinics in insert name HHS could be located at insert name of facility.
The model(s) for the additional flu clinic is/are briefly describe model. eg. community
based clinic, mobile clinic.
3.2
At risk groups
At risk groups will need to be confirmed when knowledge of the pandemic influenza
virus becomes available, however it is expected that the impact on vulnerable
populations will be greater than that on the broader population (Australian Department
of Health 2014). Refer to the AHMPPI (Australian Department of Health 2014) and the
Queensland Health pandemic influenza plan (Queensland Department of Health 2014)
for further information on at risk groups.
Planners should identify potential at risk groups within the HHS and consider
strategies to target these groups. Strategies include identifying preferred service
models and hours of operation, raising community awareness of clinics, location of
Insert name Hospital and Health Service flu clinic guidelines
-4service and language of service provision.
Aboriginal and Torres Strait Islander peoples
Based on seasonal influenza and experiences from past pandemics the AHMPPI has
identified Aboriginal and Torres Strait Islander peoples as a potential at risk group
(Australian Department of Health, 2014).
In remote Aboriginal and Torres Strait Islander communities, clinics generally operate
at capacity and there may not be enough resources to operate a standalone flu clinic.
Lessons identified from the 2009 H1N1 pandemic suggests that consideration should
be given to setting up ‘fever clinics’ within existing health clinics. It is recommended
that set times are allocated for fever clinics during which time only people with
influenza like illness symptoms are to be assessed. This allows for group education
and may help to reduce cross infection.
In areas serviced by an Aboriginal and Islander Community Controlled Health Service
(AICCHS) it is recommended that HHS planners partner with these organisations to
establish flu clinics specially targeted towards the Aboriginal and Torres Strait Islander
population. In areas where there is no AICCHS, alternative service delivery models
could include:
 mobile outreach van that provides assessment and treatment
 negotiate with Check-UP and/or Medicare Local to flu clinic(s)
In addition to the primary mass vaccination clinic within insert name HHS, a flu
clinic(s) specifically targeted towards Aboriginal and Torres Strait Islander peoples will
be available at indicate where specific alternative vaccination program will be
available.
The standard Indigenous identification question should be asked and recorded
correctly and consistently of all clients presenting to a flu clinic. This ensures that
patients who identify as being of Aboriginal or Torres Strait Islander origin receive
treatment for pandemic influenza that is relative to their increased risk. The exact
wording according to the Australian Institute of Health and Welfare [AIHW] (2010) is:
"are you of Aboriginal or Torres Strait Islander origin?" For a person who is unable to
answer, the question is: “Is (person’s name) of Aboriginal or Torres Strait Islander
origin?”
Refer to the Aboriginal and Torres Strait Islander communities pandemic influenza
toolkit http://www.health.qld.gov.au/pandemicinfluenza for further information.
Insert name Hospital and Health Service flu clinic guidelines
-5-
3.3
Support to non-Queensland health service
providers
Consideration should be given to supporting non-Queensland health service
providers operating within the HHS to establish a flu clinic. This could be particularly
appropriate for targeting people from Culturally and Linguistically Diverse
backgrounds and Aboriginal and Torres Strait Islander peoples.
In insert name HHS, support will be given to non-Queensland Health service providers
insert name eg. AICCHS, GP, RFDS to establish and manage a flu clinic.
Describe how support will be provided
3.4
Health service operations
Clinical assessment
The first priority when a patient presents to the flu clinic is to assess the need for, and
urgency of, further assessment. If a patient at the flu clinic is acutely unwell they will
require urgent transport to hospital for medical attention. Processes must be in place to
facilitate this.
It is recommended that the early warning and response system tools developed by
the Patient Safety Unit are used for recording observations. These tools assist in the
recognition and response to clinical deterioration. For further information please
contact the Patient Safety Unit within the Queensland Department of Health ph.
3646 9890 (QHEPS link!).
Insert name Hospital and Health Service flu clinic guidelines
-6-
Referral pathways
Clinical referral pathways should be established within the HHS for:
 referral of suspected cases to the flu clinic for assessment and treatment
 flu clinic to refer cases and/or contacts to health and social support services for
further management if appropriate
Case(s) will need to meet the admission criteria for each service. The criteria will
change as community demand increases and resource availability decreases.
Changes to admission criteria will be communicated by the State Health Emergency
Coordination Centre (SHECC).
3.5
Infection control
The Australian guidelines for the prevention and control of infection in healthcare
(Australian Commission on Safety and Quality in Health 2010) informs infection control
practice within Queensland Health. When a pandemic occurs, the appropriateness of
recommended infection prevention and control measures will be reviewed by the
Communicable Diseases Network Australia (CDNA) and relevant experts. Advice
confirming or altering existing measures will be provided to the SHECC and distributed
to HHSs and key stakeholders.
The Public Health Laboratory Network will provide guidance on:
 the type of clinical specimen required
 sample collection guidance
 when it is no longer necessary to test all cases (Australian Department of Health
2014)
This information will be communicated via the SHECC.
3.6
Specimen collection
3.7
Case and contact management
Contact tracing is essential for early surveillance activities and will be continued in the
targeted action stage if clinical severity is high and case identification is effective
(Australian Department of Health 2014).
Flu clinics play an important role in contributing to the management of cases and
contacts by:
Insert name Hospital and Health Service flu clinic guidelines
-7-
 identifying and assessing probable cases of pandemic influenza
 identifying household contacts of a probable case
 collecting data for cases and contacts presenting at a flu clinic
 supplying antiviral medication to case and household contacts as per national
recommendations
 requesting case and household contacts to isolate themselves at home
 assessing the capacity for cases and contacts to remain safely in their home
environment whilst undertaking voluntary home isolation and quarantine
The following e-learning training packages have been developed:
 non appointed contact tracing officer iLearn module
 appointed contact tracing officer iLearn module
HHS planners should consider the staffing levels and skill mix required to respond to
a surge in contact tracing requirements within the HHS. Upon HHS request,
13HEALTH (13 43 25 84) is also able to assist in contact tracing activities.
3.8
Antiviral distribution and supply
All Queensland Health endorsed flu clinics will be provided with antivirals for supply to
attending patients in accordance with national recommendations
The appropriate strategy for the use of antivirals will depend on stage of the
pandemic, the epidemiology (transmissibility and clinical severity) and virological
(antiviral resistance) characteristics of the virus, pre-existing immunity, vaccine
availability and practicalities such as logistics of antiviral delivery and availability
(Australian Department of Health 2014). In the event of a pandemic, the CDNA will
provide information outlining the use of antivirals (Australian Department of Health
2014).
Refer to the pandemic influenza guidelines, antiviral distribution
http://www.health.qld.gov.au/pandemicinfluenza
to develop this area of planning.
The Drug Therapy Protocol – Pandemic Influenza Program (Queensland Department
of Health 2014) states the circumstances in which and conditions under which a
Pharmacist, Queensland Ambulance Service officer, Registered Nurse and Indigenous
Health Worker is authorised to administer or supply oseltamivir phosphate and
zanamivir. It applies to individual health professionals who have endorsement /
authorisation under the Queensland Health (Drugs and Poisons) Regulation 1996.
Insert name Hospital and Health Service flu clinic guidelines
-8-
3.9
Documentation and surveillance
National operational surveillance guidelines will be provided by the Australian
Department of Health.
3.10 Human resources
The availability of staff will dictate the number and size of the clinic(s) to be
activated. Extra staff to operate the clinics may be accessed from community based
services, hospital wards, agencies and other companies. Consideration should be
given to establishing a skill mix that is able to accommodate the assessment and
treatment of children as well as adults. Medical Officers must be available to advise
nursing staff in regards to any person that may have a contraindication to receiving
antivirals.
Refer to the flu clinic calculator tool
(http://www.health.qld.gov.au/pandemicinfluenza) for guidance on staffing
Staff for the flu clinics should not be drawn from existing emergency department,
intensive care, public health or infection control staff as these specialised health care
professionals possess technical skills that are essential to the pandemic response
within their specialist areas.
All staff working in the flu clinic must:
 Be screened to ensure they do not have high risk factors. No staff identified with
high risk factors should be employed in a flu clinic.
 Be provided with the appropriate personal protective equipment (PPE) for the work
performed and type of patient contact.
The influenza vaccination status of staff providing direct care should be reviewed and
seasonal influenza and pandemic vaccination (when available) should be encouraged.
Training
Both clinical and non-clinical staff working in a flu clinic will require training to safely
perform their required roles. Please refer to the outreach clinic checklist
http://www.health.qld.gov.au/pandemicinfluenza
for specific recommendation on training content.
In insert name HHS clinical staff working within the flu clinic will be provided with
specific training on describe content eg. safe application and use of PPE.
Training will be provided by name/ position and will consist of describe training
model. E.g. on-line; videoconferencing; workshop.
Insert name Hospital and Health Service flu clinic guidelines
-9-
References
Australian Commission on Safety and Quality in Health Care 2010, Australian
guidelines for the prevention and control of infection in healthcare, viewed April 8 2014,
http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/cd33_infection_control
_healthcare.pdf
Australian Commission on Safety and Quality in Health Care 2012, National safety and
quality health service standards, viewed April 8 2014,
http://www.safetyandquality.gov.au/wp-content/uploads/2011/09/NSQHS-StandardsSept-2012.pdf
Australian Department of Health, 2014, Australian Health Management Plan for
Pandemic Influenza, Commonwealth of Australia, Canberra
Australian Institute of Health and Welfare 2010, national best practice guidelines for
collecting Indigenous status in health data sets, viewed 8 April 2014,
http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442458760
Queensland Department of Health 2013a, Queensland Health disaster plan,
Queensland Health, Brisbane
Queensland Department of Health 2013b, recognition and management of the
deteriorating patient guidelines, viewed 7 January 2014,
http://qheps.health.qld.gov.au/psu/rrcd/docs/rmdp-guidelines.doc
Queensland Department of Health 2014, Queensland Health pandemic influenza plan,
State of Queensland, Brisbane, http://www.health.qld.gov.au/pandemicinfluenza
Queensland Health 2012, Collection of indigenous status in health data sets, viewed 8
April 2014, http://www.health.qld.gov.au/qhpolicy/docs/pol/qh-pol-349.pdf
Queensland Department of Health 2014, Drug therapy protocol – pandemic influenza
program, viewed 8 April 2014, http://www.health.qld.gov.au/ph/documents/ehu/dtppand-program.pdf
Department of Health
Hospital and Health service flu clinic guidelines
www.health.qld.gov.au
Insert name Hospital and Health Service flu clinic guidelines
- 10 -