i
A project of the South Australian Immunisation Coordination Unit (South
Australian Department of Human Services) and the Commonwealth
Department of Health and Aged Care in collaboration with members of the
National Immunisation Education Course Committee, a former working party
of the National Immunisation Committee.
O N
Ms Maggi Osbourn RN, RM, BN, Grad Dip Legal Studies,
DipApplSc (Community Health Nursing)
South Australian Department of Human Services
i
Project Leaders
Ms Ann Kempe MSc (Hons), BA, DipApplSc, RM, RN
South Australian Department of Human Services
S A T
A GUIDE FOR COURSE ASSESSORS, EDUCATORS
& TRAINING ORGANISATIONS
i
National Guidelines for
Immunisation Education for
Registered Nurses & Midwives
M M U N
immmunisation
© Commonwealth of Australia 2000
ISBN 0 644 35539 5
This work is copyright. It may be reproduced in whole or in part for study or
training purposes subject to the inclusion of an acknowledgment of the source
and no commercial usage or sale. Reproduction for purposes other than those
indicated above requires the written permission of the Commonwealth
Department of Health and Aged Care GPO Box 9848, Canberra ACT 2601.
D E D I C AT I O N
These guidelines are dedicated
to the memory of Ms Leeanne
Norton. Her professionalism
and commitment ensured a
quality outcome to the project.
First published in November 2000
Designed By: Swell Design
N AT I O N A L G UI D E LI NE S F O R I M M U N I S AT IO N E DU C AT I O N F O R R E G I S T E R E D N U R S E S & M I DW I V E S
ii i
Foreword
The aim of these National Guidelines
for Immunisation Education for
Registered Nurses and Midwives is
to ensure that registered nurse and
midwife vaccinators are trained as
safe and effective immunisation
providers. The Guidelines outline the
core areas of knowledge and
competencies, which the members
of the National Immunisation
Committee believe a registered nurse
or midwife should demonstrate to
achieve this aim. In some states and
territories existing legislation also
supports registered nurses/midwives
in their role of immunisation
providers.
The Guidelines can be used as a
resource by those involved in
immunisation program management
and education to assist with the
planning and implementation of
immunisation education strategies
for registered nurses/midwives at
undergraduate or post-graduate
level, or through in-service modes
of education.
iv
Contents
However, institutions/organisations
developing immunisation courses or
other training strategies for
immunisation providers, should also
seek endorsement of these
courses/strategies from the
appropriate professional nursing
organisation.
I am sure that this publication will
support the highest possible
standards of education and
encourage consistency in
immunisation knowledge and
skills throughout Australia.
John Mathews
Head
National Centre for Disease Control
Foreword
iv
Acknowledgments
vii
Background
1
Introduction to the use of these Guidelines
3
Core areas of knowledge and skills recommended for registered
nurse and midwife vaccinators
Theoretical foundations of immunisation
Topic 1.1 Immunisation: a public health perspective
7
8
9
Topic 1.2 The immune system and vaccine and vaccine action
11
Topic 1.3 Epidemiology of vaccine preventable diseases
12
Topic 1.4 Immunisation myths and realities
13
Summary
14
Clinical theory and practice
15
Topic 2.1 Legal aspects of immunisation: legislative and common
16
law issues
Topic 2.2 Recognition and management of adverse events following
18
immunisation
Topic 2.3 Vaccines used in the current Australian Standard Vaccination
20
Schedule (NHMRC)
I M M U N I S AT I O N
N AT I O N A L G UI D E LI NE S F O R I M M U N I S AT IO N E DU C AT I O N F O R R E G I S T E R E D NU R SE S & M I DW I V E S
v
Topic 2.4 Management, handling, storage and transporting
22
vaccines (the cold chain)
Topic 2.5 Administration of vaccines
24
Topic 2.6 Health promotion resources for immunisation
25
Summary
27
Abbreviations and acronyms
28
Endorsees of these Guidelines
29
Contact details for Commonwealth, State and Territory
Government Health Authorities
30
References and resource material
31
Standards for childhood vaccination
33
Acknowledgments
This document was written in
collaboration with members of the
National Immunisation Education
Course Committee (NIECC) which
was a sub-committee of the National
Immunisation Committee (NIC) in
1997/1998.
Members of the National
Immunisation Education
Course Committee
*Ms Leeanne Norton (Chair),
Business Manager, Faculty of
Nursing, University of SA.
Ms Ann Kempe (Deputy Chair), SA
Immunisation Coordinator, SA
Immunisation Coordination Unit SA
Department of Human Services.
Ms Yvonne Epping, Immunisation
Coordinator, ACT Department of
Health and Community Care.
vi
I M M U N I S AT I O N
Ms Sue Campbell-Lloyd, Manager,
Immunisation, NSW Department
of Health.
Ms Nan Miller, Senior Project Officer,
Territory Health Services, NT.
Ms Maggi Osbourn, Clinical Nurse
Consultant, SA Immunisation
Coordination Unit, SA Department of
Human Services.
Ms Kathy Bell, Project Officer,
National Aboriginal Community
Controlled Health Organisation.
Ms Yvette Roe, Project Officer,
National Aboriginal Community
Controlled Health Organisation.
Ms Karen Peterson, Immunisation
Coordinator, Queensland Health
Department.
Ms Gill Bricher, Lecturer, School of
Nursing, University of SA.
N AT I O N A L G UI D E LI NE S F O R I M M U N I S AT IO N E DU C AT I O N F O R R E G I S T E R E D N U R S E S & M I DW I V E S
vi i
Ms Carole Traylor, Professional
Officer - Projects, Royal College of
Nursing, Australia.
Members of the National
Immunisation Committee (at
time of endorsement)
Ms Karen Peterson, Immunisation
Coordinator, Queensland Health
Department.
Ms Liz Foley, Professional Officer Projects, Royal College of Nursing,
Australia.
Mr Greg Sam (Chair), Director,
Immunisation and Vaccine
Preventable Diseases Section,
Commonwealth Department of
Health and Aged Care.
Dr John Aloizos, Royal Australian
College of General Practitioners.
Mr Geoff Clark, Executive Officer
(Nursing Board of Tasmania),
representing the Australian Nursing
Council Inc.
Dr Rosemary Lester, Manager,
Prevention and National Health
Priorities Section, Department of
Human Services, VIC.
Dr John Litt, Royal Australian College
of General Practitioners.
The members of the National
Immunisation Committee were also
consulted throughout the
development of this document.
*The committee members were
saddened by the death of Ms
Norton in mid-1998. Ms Norton
contributed a great deal to
ensure the academic rigour
of this document.
Dr Rosemary Lester (Deputy Chair),
Manager, Prevention and National
Health Priorities Section, Department
of Human Services, VIC.
Ms Ann Kempe, SA Immunisation
Coordinator, SA Department of
Human Services.
Dr Jag Gill, Director, Disease Control,
Health Department of WA.
Ms Yvonne Epping, Immunisation
Coordinator, ACT Department of
Health and Community Care.
Ms Sue Campbell-Lloyd, Manager,
Immunisation, NSW Department
of Health.
Ms Diana Terry, National General
Practice Immunisation Coordinator,
Australian Divisions of General
Practice.
(NB Dr Cathy Mead, Executive
Officer, National Public Health
Partnership, Chaired the National
Immunisation Committee in 1997
and part of 1998).
Ms Nan Miller, Senior Project Officer,
Territory Health Services, NT was
a member of the NIC during the
development of these guidelines
in 1997–98.
Dr Sophia Couzos, Public Health
Officer, National Aboriginal
Community Controlled Health
Organisation.
Dr Peter Eizenberg, Australian
Divisions of General Practice.
Dr Christine Selvey, Head,
Immunisation, Centre for Disease
Control, Territory Health Services, NT.
Ms Helen McFarlane, Director, Sexual
Health and Immunisation Section,
Office of Aboriginal and Torres Strait
Islander Health, Department of
Health and Aged Care.
Dr Avner Misrachi, Senior Medical
Officer, Public and Environmental
Health, Department of Health and
Human Services, Tasmania.
v ii i
I M M U N I S AT I O N
N AT I O N A L G UI D E LI NE S F O R I M M U N I S AT IO N E DU C AT I O N F O R R E G I S T E R E D N U R S E S & M I DW I V E S
ix
Background
In 1993, the National Health and
Medical Research Council (NHMRC)
identified the improvement of
education programs for health
professionals as a major priority in its
National Immunisation Strategy. The
Strategy recommended that regular
updates or advice on current
practices be used to maintain the
professional education of
immunisation providers.
In addition, the 1994, Standards for
Childhood Immunisation state that:
Vaccines (should be) administered by
properly trained individuals who
receive ongoing education and
training on current immunisation
recommendations. (Refer to page
33–34 for a summary of standards
for childhood immunisation).
Only properly trained individuals
should administer vaccine. The
adoption by all States and Territories
of a standardised training curriculum
would ensure consistency in the
implementation and application of
immunisation procedures throughout
Australia for all staff involved in
providing such services.
Training and education should include
current guidelines and
recommendations of the NHMRC, as
specified in the NHMRC Australian
Immunisation Handbook, as well as
the Standards for Childhood
Immunisation (Commonwealth
Department of Human Services and
Health) and other immunisation
information sources.
In November 1996, members of the
National Immunisation Committee
(NIC) decided that a working party
should be set up to develop national
education guidelines for registered
nurses/midwives involved as
immunisation service providers. In
this way the Commonwealth
Department of Health and Aged Care
could assist with implementation of
Standard 13 of the 1994, Standards
for Childhood Immunisation.
N AT I O NA L G UI D E LI NE S FO R I M M U N I S AT I O N E D U C ATI O N FO R REG I ST E RE D N U R S E S & M I DW I V E S
1
In early 1997, the Department of
Health and Aged Care funded the
South Australian Immunisation
Coordination Unit (South Australian
Department of Human Services) to
provide the Secretariat for the
National Immunisation Education
Course Committee (NIECC) and
between 1997 and 1998, the NIECC
developed these National Guidelines
for Immunisation Education for
Registered Nurses and Midwives.
Handbook. This publication received
final endorsement from of the
National Immunisation Committee in
November 2000.
Educational organisations may wish
to contact their State/Territory
immunisation coordinators to discuss
this document (refer to page 30 for
contact details).
While the original intent of the NIECC
was to develop national guidelines for
all professionals involved in
immunisation, it was later decided
that the final guidelines should be
directed at registered
nurses/midwives only. The National
Immunisation Committee felt there
were already existing mechanisms to
coordinate training for general
practitioners and Aboriginal Health
Workers across Australia, however,
the Guidelines could be used as a
supplement to the education and
training of these health service
providers if appropriate.
I M M U N I S AT I O N
The aim of the National Immunisation
Education Course Committee (NIECC)
was to develop national guidelines for
the development of immunisation
courses and other education
strategies for registered
nurses/midwives. This document has
been developed to encourage a
consistent approach to immunisation
education. The information is based
on already published national
documents on immunisation
including:
1. National Health and Medical
Research Council (NHMRC)
current (2000–2002) Australian
Standard Vaccination Schedules.
K E E P I T C O O L : T H E VA C C I N E C O L D C H A I N
providers on maintaining the
cold chain.
5. Commonwealth Department of
Health and Aged Care, 2000,
Immunisation Myths & Realities:
Responding to Arguments against
Immunisation – A guide for
providers, 3rd Edition.
These Guidelines are reviewed on a
regular basis. Persons using this
publication as a reference should
ensure that they have the latest
edition.
Broad Learning Outcomes
3. Commonwealth Department of
Human Services and Health
(1994), Standards for Childhood
Immunisation.
A broad set of learning outcomes
should be stated at the beginning of
any curriculum that is developed
using these education guidelines.
The statement of the general learning
outcomes of a course that has been
developed using these guidelines
could include the following:
4. Commonwealth Department of
Health and Aged Care (2000),
Keep it cool: the vaccine cold
chain; Guidelines for immunisation
At the end of the course (developed
using these guidelines) the participant
should have:
2. NHMRC Australian Immunisation
Handbook 7th edition 2000.
The principal authors reviewed these
Guidelines in 2000 to take account of
recent revisions of source documents
such as The Australian Immunisation
2
Introduction to the use of these Guidelines
N AT I O N A L G UI D E LI NE S F O R I M M U N I S AT IO N E DU C AT I O N F O R R E G I S T E R E D N U R S E S & M I DW I V E S
3
• the knowledge, skills, attitudes
and experience to competently
deliver a quality immunisation
service to the community;
1. Theoretical foundations
of immunisation
• the knowledge, attitudes and skills
to actively promote, communicate
and educate the community and
other health professionals, about
the diverse range of issues related
to immunisation; and
• a commitment to continuous selfeducation to ensure they are
professionally competent to
practice as an immunisation
service provider.
Specific learning outcomes, which
meet the broad learning outcomes
stated above, have been developed
for each of the core subject areas in
these course guidelines. Please refer
to pages 7 to 27 for details.
Recommended subject areas
and topics
These education guidelines are
presented under two broad subject
headings that could be delivered
either internally or externally. Each
subject area includes a list of
recommended topics with suggested
learning outcomes for each topic.
These recommended subject areas
and topics are listed below.
4
1.1
Immunisation: a public
health perspective
1.2
The immune system
and vaccine action
1.3
Epidemiology of vaccine
preventable diseases
1.4
Immunisation: myths
and realities
2. Clinical theory and practice
of immunisation
2.1
Integration of knowledge
Each topic should contain the
relevant readings from current
journals, NHMRC and
Commonwealth Department of
Health and Aged Care publications,
other national documents, audiovisual presentations and appropriate
learning exercises. This material
should help the student to integrate
the theoretical knowledge to their
clinical practice.
Legal aspects of
immunisation: legislative
and common law issues
Clinical practice
and assessment
2.2
Recognition and
management of adverse
events following
immunisation
2.3
Vaccines used in the current
NHMRC Australian Standard
Vaccination Schedule
2.4
Management, handling,
storage and transporting
vaccines (the cold chain)
2.5
Administration of vaccines
2.6
Health promotion resources
for immunisation
Supervised clinical practice is
recommended to be included in any
education strategy for immunisation.
It is an essential component to
ensure the integration of the
theoretical knowledge with clinical
practice. The clinical assessment
process should have the ability to
assess the knowledge, skills and
attitude of the learner and a
competency approach to this
integration is also recommended. The
use of a preceptor is one
recommended strategy that could
assist the student to integrate theory
with clinical practice.
I M M U N I S AT I O N
For more information on nursing
competency please refer to:
• Australian Nursing Council Inc.,
(2000) National Nursing
Competencies for the Registered
Nurse and within this publication:
Australian Nursing Council Inc.,
(2000) National Competency
Standards for the Registered
Nurse and Enrolled Nurse; and
• Australian Nursing Federation
(1997) Competencies for the
Advanced Practitioner.
Role of the preceptor/mentor
A preceptor can assist the student to
become a competent nurse/midwife
vaccinator by acting as a teacher or
role model while the student
integrates immunisation theory with
his or her clinical practice. The
preceptor can also review the
student’s clinical competency
in the field.
The role of a preceptor is a complex
one that includes being:
• a professional role model
• a teacher
• a resource person
• a reviewer of progress
and assessor
• responsible for direct client care.
K E E P I T C O O L : T H E VA C C I N E C O L D C H A I N
G UI DE LI NE S F OR IM M U N I S ATI O N P RO V I D E R S O N M A I N T A I NI NG T H E CO LD CHA I N
5
Theoretical assessment
A method of theoretical assessment
is recommended for inclusion in any
immunisation education strategy. A
method of assessing the theoretical
knowledge and understanding of the
subject serves two purposes:
Core areas of
knowledge and skills
recommended for
registered nurses and
midwife vaccinators
• to assess the learner’s knowledge
base and understanding of the
theoretical foundations and clinical
practice of immunisation; and
• to familiarise the learner with the
major texts which are a major
resource for clinical practice,
particularly the current NHMRC
Australian Immunisation
Handbook.
Once a student has satisfactorily
completed both theoretical and
clinical assessments, they should be
competent to proceed as an
autonomous immunisation provider.
Formal recognition by the institution
or organisation of completion of an
accredited course is also
recommended because it promotes
professional recognition of the
student’s achievement.
6
I M M U N I S AT I O N
K E E P I T C O O L : T H E VA C C I N E C O L D C H A I N
N AT I O N A L G UI D E LI NE S F O R I M M U N I S AT IO N E DU C AT I O N F O R R E G I S T E R E D N U R S E S & M I DW I V E S
7
Subject area one:
Theoretical foundations of immunisation
Topic 1.1
Immunisation: a public health perspective
Aim
Recommended topics
Suggested learning outcomes
The aim of this subject is to provide a
strong theoretical foundation to
immunisation practice.
1.1 Immunisation: a public health
perspective
At the completion of this topic
learners will be able to:
1.2 The immune system and
vaccine action
• describe the aims of an
immunisation program
1.3 Epidemiology of vaccine
preventable diseases
• outline international and national
population health perspectives of
immunisation
Practitioners will also be able to use
this information to better inform their
clients, colleagues and the
community.
Practitioners will be able to make
improved clinical decisions in relation
to immunisation because of a deeper
understanding of the theoretical base
of immunisation practice.
8
1.4 Immunisation: myths and
realities
• describe the importance of the
public health perspective to
individual practice
• state the concept of
population/community immunity as
compared to individual immunity.
I M M U N I S AT I O N
Recommended content
for this topic:
• Concepts of control, elimination and
eradication of vaccine preventable
diseases and their impact on global
and national immunisation programs,
and practical strategies which
demonstrate these concepts.
• Information on the signs and
symptoms, occurrence, mode of
transmission and control, of vaccine
preventable diseases.
• Current information on the
epidemiology of vaccine preventable
diseases using national and
state/territory data sources, including
data from the Australian Childhood
Immunisation Register (ACIR) and
surveys conducted by the Australian
Bureau of Statistics (ABS), and the
importance of surveillance for
immunisation providers in terms of
program management.
N AT I O N A L G UI D E LI NE S F O R I M M U N I S AT IO N E DU C AT I O N F O R R E G I S T E R E D N U R S E S & M I DW I V E S
9
Topic 1.2
The immune system and vaccine and
Vaccine action
• The distribution of the health dollar
for preventative health (including
immunisation) in Australia in
comparison to supporting those
with a health problem.
Suggested learning outcomes
At the completion of this topic
learners will be able to:
• Definition of immunisation
terminology including
immunogenicity, reactogenicity
efficacy, protection, herd immunity
etc, and application of terminology
to immunisation practice.
• have a basic knowledge of the
immune system
• describe the relationship between
the immune system and vaccine
action
• Current national/state/regional
strategy documents and other
quality management tools
underpinning immunisation
programs as a benchmark for
program evaluation. For example
NHMRC National Immunisation
Strategy (1993), Standards for
Childhood Immunisation (1994),
Keep it cool: the vaccine cold
chain (2000).
• relate this information to practice
with regard to maintaining the
NHMRC Australian Standard
Vaccination Schedule.
• Revision of the immune system for
example, active and passive
immunity, acquired immunity,
antigens, antibodies etc.
• The normal physiological immune
function interaction with specific
vaccines for example live attenuated
vaccines and implications for the
NHMRC Australian Standard
Vaccination Schedule.
• Knowledge of the immune system
and its influence on the construction
of the NHMRC Australian Standard
Vaccination Schedule (for example
number of doses, timing, spacing
of booster doses etc).
• The role of vaccine providers in
encouraging the community to
maintain the recommended NHMRC
Australian Standard Vaccination
Schedule to maximise individual and
community protection.
• Global perspective and Australia’s
relationship with the World Health
Organisation’s (WHO) Expanded
Program on Immunisation (EPI).
10
Recommended content for
this topic:
I M M U N I S AT I O N
N AT I O N A L G UI D E LI NE S F O R I M M U N I S AT IO N E DU C AT I O N F O R R E G I S T E R E D N U R S E S & M I DW I V E S
11
Topic 1.3
Epidemiology of vaccine preventable diseases
Suggested learning outcomes
At the completion of this topic learners
will:
•
•
•
•
Recommended content for
this topic:
• The epidemiology of vaccine
preventable diseases and vaccine
have knowledge of the
preventable disease rates at
epidemiology of vaccine preventable
national and state/territory levels in
diseases and vaccine coverage at a
Australia.
national and state/territory levels,
• Comparison of disease rates and
including coverage of different
vaccine coverage in Australia with
populations within Australia
specific countries.
have an awareness of the
• Discuss the national perspective of
comparison of Australian vaccine
past and current vaccine
coverage with international
preventable disease rates.
coverage in both developing and
Introduce Communicable Diseases
developed countries
Intelligence and other data
understand the necessity to apply
sources.
this knowledge to immunisation
• State/territory vaccine coverage
service provision
data using data from ACIR, ABS
understand the application of
surveys, etc.
epidemiology to immunisation
• Discussion on mechanisms that
practice.
could be used to feedback
coverage and disease surveillance
data to vaccine providers.
12
I M M U N I S AT I O N
Topic 1.4
Immunisation: myths and realities
Suggested learning outcomes
At the completion of this topic
learners will be able to:
• state some of the common
arguments against, or myths
about, immunisation
• respond to these arguments
against immunisation from a basis
of current scientific knowledge
• explore their personal beliefs
regarding immunisation and relate
these to the scientific evidence
• discuss these issues with
client/patients with confidence.
Recommended content for
this topic
• Differences in the interpretation
of knowledge, for example
scientific compared with
alternative ‘knowledge’.
• The common arguments or myths
against immunisation.
• The current scientific evidence
which refute the most common
arguments.
• The role of the media in presenting
immunisation to the public and
how to discuss this with
clients/patients.
• The issue of individual rights in
relation to choosing not to
immunise.
• The role of valid consent
procedures in dealing with the antiimmunisation perspective.
• The importance of a practitioner’s
communication skills when
discussing this issue with
community members.
N AT I O N A L G UI D E LI NE S F O R I M M U N I S AT IO N E DU C AT I O N F O R R E G I S T E R E D N U R S E S & M I DW I V E S
13
Summary of Theoretical foundations
of immunisation
A summary of this subject area
should be included which clarifies the
expected learning outcomes and
allows students to assess whether
they have achieved them. This
subject area should demonstrate the
foundations of immunisation and
prepare the learner for clinical
experience.
Recommended content for a
summary on Theoretical
Foundations of Immunisation.
Subject area two:
Clinical theory and practice
• immunisation is a global
preventative population health
activity.
• the importance of the ability to
present scientific evidence in
responding to arguments/myths of
immunisation without prejudice.
The summary should make a link to
the following section or subject area,
Clinical Theory and Practice.
Aim
Recommended topics
The aim of this subject area is to
provide students with a mechanism
to put the theoretical knowledge
about immunisation into clinical
practice as an immunisation provider.
2.1 Legal aspects of immunisation:
legislative and common law
issues
2.2 Recognition and management
of adverse events following
immunisation
2.3
Vaccines used in the NHMRC
Australian
Schedule Standard Vaccination
2.4 Management, handling, storage
and transporting vaccines (the
cold chain)
• a public health perspective
expands the focus beyond clinical
practice.
2.5 Administration of vaccines
• a public health perspective informs
practitioners with regard to
improving and maintaining
immunisation coverage in
Australia.
2.6 Health promotion resources
for immunisation
• knowledge of epidemiology
focuses client care beyond
individual care to include the
broader community.
14
I M M U N I S AT I O N
N AT I O N A L G UI D E LI NE S F O R I M M U N I S AT IO N E DU C AT I O N F O R R E G I S T E R E D N U R S E S & M I DW I V E S
15
Topic 2.1
Legal aspects of immunisation
Suggested learning outcomes
• state the common components of
valid consent procedures
At the completion of this topic
learners will be able to:
• apply the components of valid
consent to practice
• outline the relevant state/territory
acts and/or regulations which
relate to vaccines as prescription
only drugs and their impact
on clinical practice as an
immunisation provider
• recognise the need for
professional accountability
• outline the relevant state/territory
acts and/or regulations relating to
professional practice and their
impact on clinical practice as an
immunisation provider
• apply all of the above to clinical
practice.
Recommended content for
this topic
• Relevant state/territory acts and/or
regulations which cover vaccines
as prescription only drugs.
• outline the relevant state/territory
acts and/or regulations relating to
consent to medical procedures and
their impact on clinical practice as
an immunisation provider
• Documents required for practice
arising from the acts, and/or
regulations for example standing
drug orders, and implementation
of these documents to
immunisation service provision.
• recognise the impact of specific
aspects of common law decisions
on immunisation practice
(particularly Rogers v. Whitaker
1993 and subsequent cases)
• Relevant state/territory acts and/or
regulations relating to professional
practice, for example, nurses act
and their impact on, and relevance
to immunisation service provision.
16
I M M U N I S AT I O N
• Relevant state/territory acts and/or
regulations relating to consent to
medical procedures and their
implementation in immunisation
service provision.
• The history of informed consent
(Bolam principle) and the impact of
the Rogers v. Whitaker decision for
consent procedures.
• The current legal requirements for
consent for immunisation and their
implementation in immunisation
practice.
• The components of valid consent
(for example comparison of effects
of diseases and vaccines) and the
developed resources for obtaining
valid consent in the specific
state/territory.
• Supervised clinical practice should
occur which applies all aspects of
this topic.
G UI DE LI NE S F OR IM M U N I S ATI O N P RO V I D E R S O N M A I N T A I NI NG T H E CO LD CHA I N
17
Topic 2.2
Recognition and management of adverse
events following immunisation
Suggested learning outcomes
At the completion of this topic
learners will be able to:
• describe possible common, mild,
moderate and severe adverse
events following immunisation and
the statistical likelihood of their
occurrence
• recognise an adverse event
following vaccination
• appropriately treat a client/patient
with a mild, moderate or severe
adverse event
• describe the relevant state/territory
and national adverse event
reporting system and report an
adverse event to vaccines to the
appropriate authority
• apply all of the above to clinical
practice.
18
Recommended content for
this topic
• Description of common, mild,
moderate and severe adverse
events which can occur with
specific vaccines on the current
Australian Standard Vaccination
Schedule and their statistical
likelihood of occurrence.
• The signs, symptoms and clinical
management of anaphylaxis.
• Requirements in the clinical setting
for treatment of adverse events
after immunisation (particularly
anaphylaxis).
• Future management of
patients/clients who have had a
previous adverse event to
vaccines.
• Information about reporting
adverse events following
immunisation vaccines to the
appropriate state/territory authority
or the Adverse Drug Reactions
Advisory Committee (ADRAC).
• Risk and benefit information about
adverse events following vaccines.
• Possible future directions of
immunisation (for example new
vaccines).
• Supervised clinical practice should
occur which applies all aspects of
this topic.
NOTE: Health professionals
providing an immunisation
service need to maintain
their CPR skills.
• Current information for recipients
of vaccines regarding the
incidence of common/
moderate/severe adverse events
and their management, including
take home advice.
I M M U N I S AT I O N
G UI DE LI NE S F OR IM M U N I S ATI O N P RO V I D E R S O N M A I N T A I NI NG T H E CO LD CHA I N
19
Topic 2.3
Vaccines used in the current Australian
Standard Vaccination Schedule
Suggested learning outcomes
At the completion of the topic
learners will:
• have knowledge of the uses,
contraindications and precautions
of vaccines in the current
recommended Australian Standard
Vaccination Schedule
• be familiar with vaccines used in
the current Australian Standard
Vaccination Schedule and for
special groups
• have knowledge of how to
complete a client/patient
immunisation using catch-up
immunisation and other variations
to the recommended schedule
• have basic knowledge of travel
vaccines and where clients can
access these vaccines
• have basic knowledge of special
vaccines (eg. rabies) and where to
access these vaccines.
20
• apply all of the above to clinical
practice
Recommended content for
this topic
• Pharmacological information about
vaccines in the recommended
schedule including indications for
use, dosage and frequency,
contraindications.
• Revision of epidemiology of certain
diseases and the need to apply this
information to the schedule for
special groups, for example,
Hepatitis B use for at risk groups,
pneumococcal infection and
recommendations for Aboriginal
adults.
• Revision of immunology, vaccine
efficacy and reactogenicity and the
spacing of vaccines, particularly in
relation to catch up schedules.
• State/territory variations to the
Australian Standard Vaccination
Schedule.
• State/territory resources for travel
vaccine information and
international schedules.
• How to deal with clients with
inadequate or no written
immunisation records.
• Supervised clinical practice should
occur which applies all aspects of
this topic.
• Information regarding the
differences between live
attenuated and inactivated
vaccines and special precautions.
• Vaccines for special purposes, for
example Hepatitis A, BCG.
• Passive immunisation with
immunoglobulin and its uses.
• The use of vaccines in outbreaks
of vaccine preventable diseases,
for example measles, mumps,
rubella.
• Professional responsibility to
maintain pharmacological
knowledge about vaccines.
• Interchangeability of vaccines
I M M U N I S AT I O N
G UI DE LI NE S F OR IM M U N I S ATI O N P RO V I D E R S O N M A I N T A I NI NG T H E CO LD CHA I N
21
Topic 2.4
Management, handling, storage and
transportation of vaccines (the cold chain)
Suggested learning outcomes
At the completion of this topic
students will be able to:
• describe the current NHMRC
recommendations for the storage,
transportation and temperature
monitoring of vaccines used in the
national immunisation program in
Australia
• identify vaccines which are
affected by extremes of cold and
heat
• identify vaccines affected by
exposure to light
• describe the state/territory system
for managing "cold chain" failure
through faults in the storage,
transportation or temperature
monitoring of vaccines
• describe the state/territory system
in relation to auditing of vaccine
wastage and the cold chain
monitoring
• apply all of the above to clinical
practice.
22
Recommended content for
this topic
• Professional responsibility for
administering effective (potent)
vaccines.
• The cost of individual vaccines,
acceptable levels of wastage and
mechanisms to improve efficacy.
• WHO formula for calculating doses
needed in order to reduce
wastage.
• The state/territory procedure for
supplying free child and (where
applicable) free/subsidised adult
vaccines.
• WHO cold chain recommendations
and guidelines and their role in the
national immunisation program in
Australia.
• Procedures and equipment
required for managing cold chain.
• Responsibility for management of
vaccines at clinic level.
• Interpretation of monitors used in
transporting and storage of
vaccines and recording of
temperatures.
• State/territory vaccine audit
protocols for wastage and cold
chain management.
•
State/territory protocols for
management of cold chain
breakdowns.
• Supervised clinical practice should
occur which applies all aspects of
this topic.
• The relationship between efficacy
of vaccines and maintaining
recommended temperature range
for storage and transportation of
vaccines.
I M M U N I S AT I O N
G UI DE LI NE S F O R I M M U N I S ATI O N P ROV I D E R S O N M A I N T A I NI NG T H E CO LD CHA I N
23
Topic 2.5
Administration of vaccines
Suggested learning outcomes
At the completion of this topic
students will:
Topic 2.6
Health promotion and resources for
immunisation
• Research which justifies the
change to injection technique (The
Australian Immunisation Handbook
7th edition 7–13).
• have knowledge of all aspects of
the recommendations relating to
administration of vaccines, for
example, sites, route needle
gauge/length and angle of insertion
• Best practice medication
management (eg. the ‘6 drug
rights’ or the ‘6 Rs’).
• consider the occupational health,
safety and welfare issues relating
to immunisation
• Documentation requirements for
immunisation.
• be aware of the documentation
requirements with regard to
immunisation
• be able to apply all of the above to
clinical practice.
• Reiterate consent process prior to
administering vaccines.
• Concept of opportunistic
immunisation and health
professional’s role should reflect
Standard 4 of the Standards for
Childhood Immunisation
(Commonwealth of Human
Services and Health).
Recommended content for
this topic
• Disposal of syringes, needles etc.
• National recommendations re sites,
route, needle gauge/length and
angle of insertion and speed of
administration.
• Post-immunisation waiting time.
• Safety of provider/clients/patients.
• Take home information for parents.
• Provider attitude and its influence
on patients/clients continuing with
immunisation.
• Revision of physics (angles, depths
and fluid under pressure), anatomy • Supervised clinical practice should
occur which applies all aspects of
and physiology (muscle fibres
this topic.
and absorption).
24
I M M U N I S AT I O N
Suggested learning outcomes
At the completion of this topic
students will be able to
• describe how to access their local
and national promotional resources
• recognise the need to form and
maintain networks, particularly
with other vaccine providers
• utilise national and local databases
to develop strategies for improving
immunisation uptake, for example
ACIR
• initiate strategies to promote
immunisation locally for example
working with service groups,
meeting with key community
people
• understand the need to target
immunisation to certain groups, for
example; people from non English
speaking backgrounds, Aboriginal
and Torres Strait Islander people,
working parents, remote and
isolated families
• understand the need to recognise
cultural differences of
communities, through appropriate
community consultation, as related
to immunisation and apply this to
health promotion strategies
• apply all of the above to clinical
practice.
• realise the importance of updating
theoretical knowledge regularly to
maintain national standards
N AT I O N A L G UI D E LI NE S F O R I M M U N I S AT IO N E DU C AT I O N F O R R E G I S T E R E D N U R S E S & M I DW I V E S
25
Summary of the Clinical Theory and Practice
Recommended content for
this topic
• Relate to Standard 2 of Standards
for Childhood Immunisation which
advocates the removal of barriers
to immunisation.
• Provide information on how to
access NHMRC publications and
resources for professionals and
the community.
• The importance of professional
networking at local and regional
level.
• The importance of maintaining
resources current and in line with
organisational policy.
• Cross cultural awareness.
• Discuss the Ottawa Charter and its
application to immunisation service
delivery, health promotion and
education to different
communities.
A summary of this subject area
should be included which clarifies the
expected learning outcomes and
allows students to assess as to
whether they have achieved them.
This section should demonstrate the
clinical theory and practice required
ensuring the nurse/midwife is safe
and competent to practice as a
vaccine service provider.
This aspect of training should
incorporate a clinical placement,
which may or may not include a
preceptor relationship. The focus
should be on competency
assessment, which aims to integrate
immunisation theory and practice.
• Discuss community promotional
opportunities and working with
other health and non health
professionals.
Recommended content for the
summary on Clinical Theory
and Practice:
• Promote the importance of respect
of cultural differences and the
need to work with key community
representatives.
• stress professional responsibility
to administer effective vaccines by
maintaining the cold chain.
• the importance of a professional
and caring approach in clinical
practice which encourages open
discussion about immunisation
with clients/patients.
• the professional’s responsibility to
upgrade knowledge re
immunisation regularly as per
Standard 13 Standards for
Childhood Immunisation.
• stress the importance of the
benefits of liaison and professional
networking that best meets the
needs of the community, as
defined by the community.
• the need to use the clinical setting
to integrate the knowledge.
• reiterate NHMRC
recommendations as best practice.
• stress professional responsibility
to know the law which governs
immunisation practice.
26
I M M U N I S AT I O N
K E E P I T C O O L : T H E VA C C I N E C O L D C H A I N
N AT I O N A L G UI D E LI NE S F O R I M M U N I S AT IO N E DU C AT I O N F O R R E G I S T E R E D N U R S E S & M I DW I V E S
27
Proudly endorsed as an educational
resource by:
Abbreviations and acronyms
ABS
Australian Bureau of Statistics
ACIR
Australian Childhood Immunisation Register
Association for Australian Rural
Nurses Inc
Australian Association of Maternal
Child and Family Health Nurses
NHMRC National Health and Medical Research Council
NIC
National Immunisation Committee
NIECC
National Immunisation Education Course Committee
WHO
World Health Organisation
Australian College of Midwives Inc
Australian Confederation of Paediatric
and Child Health Nurses
Australian Council of Community
Nursing Services
Nurses Board of the Northern Territory
Nurses Board of the ACT
Nurses Board of Tasmania
Nurses Board of Western Australia
Nurses Board of South Australia
Nurses Board of Queensland
Nurses Registration Board – NSW
Nurses Board of Victoria
Australian Infection Control
Association
Australian Nursing Council Inc
Australian Nursing Federation
Council of Remote Area Nurses of
Australia Inc
Royal College of Nursing Australia
28
I M M U N I S AT I O N
N AT I O N A L G UI D E LI NE S F O R I M M U N I S AT IO N E DU C AT I O N F O R R E G I S T E R E D N U R S E S & M I DW I V E S
29
Contact details for Commonwealth, State and
Territory Government Health Authorities
Commonwealth
(02)6289 1555
The following references may also
be used by lecturers to assist in the
compilation of correct course
content:
Australian Capital Territory (02) 6205 2300
New South Wales
Public Health Unit
(look under 'Health' in the white pages)
Northern Territory
(08) 8922 8044
Queensland
(07) 3234 1500
South Australia
(08) 8226 7177
Tasmania
(03) 6233 3762
or 1800 671 738 (Tasmania only)
Victoria
(03) 9637 4144
Western Australia
(08) 9321 1312
References and resources
National Health and Medical
Research Council (NHMRC)
(2000–2002) Australian Standard
Vaccination Schedule.
NHMRC (2000) The Australian
Immunisation Handbook 7th edition,
Commonwealth Department of
Health and Aged Care. Australian
Government Publishing Service,
Canberra.
Commonwealth Department of
Human Services and Health (1994),
Standards for Childhood
Immunisation. Australian
Government Publishing Service,
Canberra.
Commonwealth Department Health
and Aged Care (2000), Keep it cool:
the vaccine cold chain; Guidelines for
immunisation providers on
maintaining the cold chain. Australian
Government Publishing Service,
Canberra.
Commonwealth Department of
Health and Aged Care (2000),
Immunisation Myths & Realities:
Responding to Arguments against
Immunisation – A guide for providers
(3rd Ed). Australian Government
Publishing Service, Canberra.
NHMRC (1993) National
Immunisation Strategy.
Australian Nursing Council Inc.,
(2000) National Nursing
Competencies for the Registered
Nurse.
Australian Nursing Council Inc.,
(2000) National Competency
Standards for the Registered Nurse
and Enrolled Nurse.
30
I M M U N I S AT I O N
N AT I O N A L G UI D E LI NE S F O R I M M U N I S AT IO N E DU C AT I O N F O R R E G I S T E R E D N U R S E S & M I DW I V E S
31
Australian Nursing Federation (1997)
Competencies for the Advanced
Practitioner.
Standards for childhood vaccination
High Court of Australia judgement
(1992) in Rogers v. W hitaker.
The following is a summary of the
standards for childhood vaccination
which were developed by the
National Immumsation Committee in
consultation ith the National
Immunisation Education subcommittee which consists of
representatives from professional
organisations. They are intended as a
guide rather than a legalistic
Staunton, PJ and Whyburn B (1993),
Nursing and the Law, Harcourt Brace
and Co Australia.
WHO (1986) Ottawa Charter for
Health Promotion.
The following websites also
provide useful information:
http://www1.hic.gov.au/general/acircirghome
imposition on providers, and can
provide the basis for quality
assurance at all levels in the health
system. As such they have been
endorsed by the Australian Medical
Association, the Royal Australian
College of General Practitioners and
the Australian College of Paediatsics
and have been welcomed by a variety
of other professional bodies.
http://www.abs.gov.au/
Standard 1
Vaccination services are readily available.
Standard 2
There are no barriers or prerequisites to vaccination services.
Standard 3
NHMRC recommended childhood vaccines are offered free,
without cost to parent or guardian.
Standard 4
Vaccination providers utilise all clinical encounters to assess
vaccination status and, when indicated, vaccinate children.
Standard 5
Providers educate parents and guardians about vaccination.
Standard 6
Providers question parents or guardians about contraindications
and, before vaccinating a child, inform them in specific terms
about the benefits and risks of the vaccines their child is about
to receive.
Standard 7
Providers withhold vaccination only for true contraindications.
http://www.health.gov.au/pubhlth/cdi/cdihtml.htm
http://www.ncirs.usyd.edu.au/
http://www/pubhlth/immunise/index.htm
http://www.who.int/
32
I M M U N I S AT I O N
N AT I O N A L G UI D E LI NE S F O R I M M U N I S AT IO N E DU C AT I O N F O R R E G I S T E R E D N U R S E S & M I DW I V E S
33
Standard 8
Providers offer and administer, where possible, all vaccines for
which a child is due at the one visit.
Standard 9
Providers use accurate and complete recording procedures.
Standard 10 Providers report adverse events following immunisation
promptly, accurately and completely as set out in section 1.6.
Standard 11 Providers adhere to appropriate procedures for vaccine coldchain management.
Standard 12 Vaccination providers maintain current and easilv retrievable
vaccination guidelines at all locations where the vaccines are
administered.
Standard 13
34
Vaccines are administered by properly trained individuals who
receive ongoing education and training on current vaccination
recommendations.
I M M U N I S AT I O N