SPECIMEN
ENTER PCT NAME
Protocol for the administration of 23-valent Pneumococcal Polysaccharide vaccine to
adults by Health Care Assistants and Assistant Practitioners
Purpose of Protocol
To enable suitably trained Health Care Assistants and Assistant Practitioners working for or on
behalf of ENTER PCT OR GP NAME who have undertaken relevant training (as outlined
below), to administer pneumococcal vaccine to adults as a single dose, as a duty delegated by
the General Practitioner (GP employee) or a registered nurse (PCT employee).
Staff characteristics
Staff group(s)
Additional
requirements
Health Care Assistants and Assistant Practitioners






Continuing
training
requirement

Completion of HCA training course on administration of
influenza and pneumococcal vaccines to adults
Completion of period of supervised practice and assessment
against NVQ unit CHS3 Administration of medication to
individuals (Level 3)
Training and competence in the correct procedure of
administering medication via intra-muscular injection
Knowledge of ENTER PCT NAME policy on management of
Anaphylaxis in the community
Access to and knowledge of the DH guidance ‘Immunisation
against infectious disease’
Annual update in Basic Life Support and treatment of
anaphylaxis.
Demonstration of competence in relation to this medication
within the PDP and appraisal process.
Consent
Refer to PCT policy on consent
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Clinical condition
Clinical condition to be treated: All High-risk patients requiring pneumococcal vaccination
Criteria for inclusion
All patients aged 65 and over
Any adult (over the age of 16 years) who has a
confirmed diagnosis of one of the following diseases:
 Chronic heart / renal / respiratory disease,
 Diabetes,
 Chronic liver disease,
 Immunosuppression,
 Cochlear implants,
 CSF shunts
Criteria for exclusion
Patients with one of the following:
 Aged under 16 years
 Current acute illness
 Pregnancy/breastfeeding
 Previous severe reaction to any vaccine or vaccine
component
 Unable to give informed consent
 Healthy adults under the age of 65 years
 Previous pneumococcal vaccination with the
exception of those with absent or dysfunctional
spleen or chronic renal disease
Circumstances for further
advice/action
1. Consent not given: Counsel with regards to the
risks of pneumococcal infections and the protective
effect of the vaccine
2. Severe reaction to any vaccine or pneumococcal
polysaccharide vaccine or any vaccine component:
Refer to GP
3. Immunocompromised patients; Refer to GP for
individual assessment
4. Pregnancy or breast feeding: Refer to GP
5. Acute febrile illness: Re-arrange vaccination at
appropriate date
Recommended treatment, route
and legal status
Pneumococcal polysaccharide vaccine to be
administered by intramuscular injection into the
deltoid muscle ( may also be given subcutaneously)
If administering influenza immunisation at the same
time, use different site of injection
Prescription Only Medicine (POM)
Dosage & Criteria
Adults 0..5ml
Frequency of administration &
Normally a once only injection
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maximum dosage
Routine booster every 5 years for those with no spleen
or splenic dysfunction or chronic renal disease
Follow-up & advice
Re-immunisation is not normally advised
Side effects & their management
Local side effects: Redness, swelling, hardness at
injection site
Systemic side effects: Low grade fever
Treat with paracetamol
Special
considerations/Concurrent
medication
No drug interactions known
The immune response to pneumococcal vaccination is
reduced in those who are immunosuppressed or
immunodeficient, including HIV patients. Patients
should be individually assessed by the GP for the risk
vs benefit of immunisation
Immunosupressant therapy e.g. Corticosteroids,
chemotherapy or radiotherapy may result in reduced
antibody response. The benefits are such that
immunisation should be considered. Refer to GP for
advice.
Clinical aspects
The following will be required:
1. Patient specific direction – written by the General Practitioner
2. Patient identification – required prior to the administration of medication (confirmed by the
patient declaring his or her name, date of birth and home address)
3. Consent – Informed consent must be obtained from the patient. Health Care Assistants
and Assistant Practitioners are advised to familiarise themselves with the ENTER PCT NAME
Consent Policy
4. Record Keeping – The following should be recorded in the patients notes or on the
computer system according to the GP practice system
o Name of drug, dose, route and site of administration
o Date administered
o Batch number and expiry date
o Signature of person administering – written or electronic.
o Checklist for influenza and pneumococcal immunisations
o Patients assessed as not appropriate for vaccination and any alternative action
taken
o If the patient has declined the vaccination and any alternative action taken
o Any reaction should be recorded in the clinical record
Adverse reactions
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Health Care Assistants and Assistant Practitioners must ensure that Adrenaline 1:1000 or an
Anaphylactic shock pack is available.
If a general adverse reaction does occur:
 Record in patients notes
 Inform patients General Practitioner as soon as possible
 Local reactions should be seen by either the general Practitioner or practice nurse
If anaphylactic reaction occurs:
 Give treatment in accordance with the PCT policy on the Management of
Anaphylaxis in the community
 Record in patients notes
 Inform patients General Practitioner as soon as possible
Relevant training
1. Health Care Assistants and Assistant Practitioners will undertake training covering the
following aspects of the administration of the 23-valent pneumococcal polysaccharide vaccine
 Appropriate anatomy and physiology
 Correct procedure for the administration of the vaccine via intra-muscular injection
 Vaccine delivery, storage and stock control requirements, maintaining the cold chain
 Cautions and side effects related to the administration of
 Inactivated influenza vaccine.
 Documentation
 Legal aspects of drug administration
2. Health Care Assistants and Assistant Practitioners will have successfully completed NVQ
unit CHS3 Administer medication to individuals (level 3) and Basic Life Support. The course
includes assessment of competence at performing CPR and underpinning knowledge of
consent issues
3. Health Care Assistants and Assistant Practitioners will undergo a period of supervised
practice and assessment and will be directly observed administering intramuscular injections of
the 23-valent pneumococcal polysaccharide vaccine by the general practitioner or practice
nurse and an occupationally competent NVQ assessor.
Assessment of competence
Assessment of competence will be undertaken during the period of supervised practice on 2
separate occasions. Supervised practice will be provided by the practice nurse or general
practitioner and assessment will be performed by an occupationally competent NVQ
assessor.
Competence will be assessed by direct observation and questioning of the Health Care
Assistants and Assistant Practitioners ability to:
 Prepare the patient for the procedure
 Safely administer the medication (including choice of site, needle size and injection
technique) and observation of the patient post procedure
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Correct disposal of clinical waste
Correct documentation
Correct procedure followed for delivery, storage and stock control of the vaccine
The Health Care Assistant and Assistant Practitioner will also be assessed, by oral
questioning, on issues relating to the therapeutics of inactivated influenza vaccine
Significant events
Any significant event which occurs during or as a result of administration of medication
must be reported to the Practice Manager / General Practitioner (GP employee) or the
Registered Nurse / Manager (PCT employee), and the incident reported via the PCT
significant event reporting framework.
Audit: Health Care Assistants and Assistant Practitioners will be expected to participate in
audit in relation to patient outcomes and the development of this role.
Health Care Assistants and Assistant Practitioners must be familiar with the following
documents:
ENTER PCT DOCUMENTS AS APPROPRIATE e.g.
 Medicines Policy
 Consent Policy
 Documentation Policy
 Significant Event Reporting Policy
 Clinical Nursing Procedures
 NMC Guidelines for the Administration of Medication 2004
 NMC Guidelines for Records and Record Keeping 2004
This protocol has been devised by:
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Signature:
Date:
Signature:
Date:
This protocol has been accepted by ENTER PCT NAME Medicines Management
Group:
Signature
Date:
Review: It is the responsibility of the lead of the staff groups to whom this protocol
applies to ensure the review process takes place.
This protocol becomes valid on ENTER DATE and becomes due for review on
ENTER DATE
Protocol for 23-valent Pneumococcal Polysaccharide Vaccine
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Agreement for Health Care Assistants and Assistant Practitioners within
ENTER PCT NAME
This protocol is to be read, agreed and signed by all Health Care Professionals it
applies to:
Approved base: …………………………………………………………………..
Staff name:
……………………………………………………………………
Designation:
……………………………………………………………………
Signature:
…………………………………………………………………….
Date:
……………………………………………………………………..
Managers signature: ………………………………………………………………
Date:
…………………………………………………………………….
The Health Care Professional should retain a copy of the document after signing
and the original be retained in their personal file.
General Guidance for the Administration of Vaccines
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General
1. The identity of the vaccine must be checked to ensure the right product is
used in the appropriate way on every occasion
2. The expiry date must be noted. Vaccines must not be used after the expiry
date on the label.
3. The date of immunisation, title of vaccine and batch number must be
recorded on the recipients record. When two vaccines are given at the same
time, the relevant sites should be recorded to allow any reactions to be
related to the causative site. It may be considered good practice to record all
sites of administration
4. The recommended storage conditions must have been observed
Reconstitution of vaccines
1. Freeze dried vaccines must be reconstituted with the diluent supplied and
used within the recommended period after reconstitution
2. The diluent must be added slowly to avoid frothing, a sterile syringe and
21G needle should be used for reconstituting the vaccine and a smaller
gauge needle for injection, unless only one needle is supplied with a prefilled syringe
3. Vaccines must not be mixed before administration. Exceptions are vaccines
pre-mixed by the manufacturer
Cleaning of skin
If skin cleansing is required, soap and water are adequate. If spirit swabs are used,
the skin should be allowed to dry before the vaccine is administered. This is
essential for live vaccines, which may be inactivated by alcohol.
Route of administration
Most vaccines are given by intramuscular or deep subcutaneous route. The deltoid
muscle is the preferred choice in adults
Recommended choice of needle lengths
Children
Women < 90kg
Women > 90kg
Men 60 – 118 kg
=
=
=
=
25mm needle
25mm needle
38mm needle
25mm needle
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SPECIMEN
ENTER PCT NAME
CHECKLIST FOR INFLUENZA AND PNEUMOCOCCAL IMMUNISATIONS
Individual organisations may wish to use an alternative consent form or may record
the outcome of the discussion with the patient on consent directly onto the clinical
system
To be completed by the patient and/or nurse
Name of patient ………………………………………………………M/F…………
Address……………………………………………………………………………….
Date of Birth………………………………………………………………………….
Name of GP …………………………………………………………………………
Do you feel unwell today?
YES/NO
*Have you ever had the pneumococcal vaccine before?……………YES/NO
Did you have a reaction to pneumococcal vaccine or have you
had a reaction to any other vaccine?…………………………………….YES/NO
Are you pregnant or breast feeding?……………………………………..YES/NO
**Do you have lowered immunity due to disease or treatment,
for example steroids?……………………………………………………
YES/NO
If you have answered YES to any of the above questions – speak to the nurse
before you are given your immunisation
Have the advantages/disadvantages of this immunisation
been discussed with you?………………………………………………
YES/NO
Have you had advice about side effects, temperature control?
YES/NO
Has a patient information leaflet been provided?
YES/NO
Signature of patient for consent to immunisation
*Revaccination is only recommended in patients with no spleen or dysfunctional spleen or chronic
renal disease. Children under 5 who had the conjugate pneumococcal vaccine for children will need
1 dose of the vaccine for older children and adults.
**Lowered immunity may result in reduced vaccine response. The benefits of immunisatiom are
such that they usually outweigh any risks. Check with GP.
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