Childhood Immunisation Policy - Halton and St Helens PCT

CLINICAL POLICY 

Childhood Immunisation Policy 

For use in: 

PCT-wide 

Target Audience: 

All Trust clinical staff involved in the delivery of 

the childhood immunisation programme 

Purpose: 

To provide a safe and effective immunisation 

service to children 

Document Owner: 

Susan Large 

Approved by: 

Clinical Guidelines Group or Equivalent 

Ratified by: 

Policy Sub-Committee (PSC) 

Policy Indexed No: 

HStHCL265 

Version Number: 1.0 

Effective From: November 2010 

Review Date: November 2013 

Statutory and legal requirements 

Implementation Lead 

Policy based on the UK childhood 

immunisation programme to protect children 

against vaccine preventable diseases. 

Roslyn Connelly 

The Trust is committed to creating an environment that promotes equality and embraces 

diversity, both within our workforce and in service delivery. This document should be 

implemented with due regard to this commitment 

This document seeks to uphold the duties and principles contained within the Human Rights 

Act. All Staff within the PCT should be aware of its implications 

This policy is due for review by November 2013. After this date, this policy and associated 

process documents may become invalid. All users should ensure that they are consulting the 

current version of this document.

Key individuals involved in developing the document (Internal Staff Only) 

Name(s) 

Sue Large 

Roslyn Connelly 

Lynne Shaw 

Lin Charlesworth 

Designation 

Lead Nurse Child Health Service Development 

Assistant Director Children’s Services 

St.Helens 

Immunisation trainer 

Immunisation trainer 

Distributed to the following for approvals and comments 

Committee(s) 

Members of the Policy Sub Committee (PSC) 

Members of the Clinical Policies Guidelines 

Group (CPG) 

Members of the Immunisation Committee 

Individual(s) 

Julie Banat 

Karen Worthington 

Lesley Brownlow 

Pat Byrne 

Michelle Bradshaw 

Health visitors, school nurses, community 

nurses 

Gill Clare 

Dot Keates 

Stephen McDowell 

Michelle Falconer 

Halton staff 

Fiona Johnson 

Jeannette Owens 

Carmel Farmer 

Linda Spooner 

Designation 

Service Manager Health Visiting St.Helens 

Service Manager Health Visiting Halton 

Service Manager School Nursing St.Helens 

Service Manager School Nursing Halton 

Assistant Director Children’s Services Halton 

Skill mix teams 

Senior Pharmacist (Medicines Governance) 

Professional Development Lead 

CPR/First Aid Training Manager 

Immunisation Coordinator 

Practice Nurses 

Director of Public Health 

Infection Control Nurse Specialist 

Lead Nurse Safeguarding Children 

Professional Development Manager 

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Revision History and Version Control 

Revision 

Date 

Reason for Change Version No. By Who Version No. 

25.05.10 Anaphylaxis updated S.Large 0.1 

27.05.10 Document review 0.1 S.Large 0.2 







20.07.10 Review at V&I Group 0.8 S.Large 0.9 



05.10.10 Review from CGG 0.11 S.Large 0.12 

22.11.10 Final Version published 0.12 1.0 

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Table of Contents 

Introduction ..................................................................................................................................6 

Purpose........................................................................................................................................6 

Objectives .................................................................................................................................6 

Outcome....................................................................................................................................6 

Scope...........................................................................................................................................7 

Childhood Immunisation...............................................................................................................7 

Access to Immunisation ...............................................................................................................7 

Patient Group Directions..............................................................................................................8 

Training Requirements.................................................................................................................9 

Consent......................................................................................................................................10 

Parents Who Decline Immunisation ...........................................................................................11 

Therapeutic Holding of Children.................................................................................................11 

Risk Assessment of Premises....................................................................................................11 

Cold Chain .................................................................................................................................12 

Infection Control.........................................................................................................................12 

Administration of Vaccines.........................................................................................................12 

Anaphylaxis................................................................................................................................12 

Childhood Immunisation Procedural Guidelines ........................................................................13 

Equipment Required ..................................................................................................................13 

Referral to Secondary Care .......................................................................................................14 

Record Keeping .........................................................................................................................14 

Patient Safety.............................................................................................................................15 

Management of Adverse Effects ................................................................................................15 

Adverse Incident Reporting........................................................................................................15 

Domiciliary Immunisation ...........................................................................................................16 

Duties and Responsibilities ........................................................................................................17 

Duties within the Organisation.................................................................................................17 

Document Storage and Filing.....................................................................................................18 

References.................................................................................................................................19 

Appendix 1 .................................................................................................................................21 

Glossary of Terms ...................................................................................................................21 

Appendix 2 .................................................................................................................................22 

Appendix 3 .................................................................................................................................24 

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Process Map for Childhood Immunisations Preschool ............................................................24 

Appendix 4 .................................................................................................................................25 

Looked after Children ..............................................................................................................25 

Appendix 5 .................................................................................................................................26 

Appendix 6a ...............................................................................................................................27 

Appendix 6b ...............................................................................................................................28 

Risk Assessment of an Environment for Immunisation Sessions............................................28 

Appendix 7 .................................................................................................................................29 

Childhood Immunisation Procedural Guidelines......................................................................29 

Appendix 8 .................................................................................................................................32 

Appendix 9 .................................................................................................................................33 

Appendix 10 ...............................................................................................................................36 

Immunisation data is recorded according to local requirements..............................................41 

Appendix 11 ...............................................................................................................................43 

Appendix 12 ...............................................................................................................................44 

Appendix 13 ...............................................................................................................................45 

Equality Impact Assessment Tool ...........................................................................................45 

Appendix 14 ...............................................................................................................................46 

Dissemination and Training Plan.............................................................................................46 

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INTRODUCTION 

Immunisation is the most effective method of preventing disease and maintaining the public 

health of the population (DH 2006). 

The World Health Organisation recommends that the national target for uptake of antigens in 

the Childhood Immunisation programme is 95% by age 24 months for completed courses of 

each of the primary programmes. NHS Halton and St.Helens recorded a 96% uptake of 

DTaP/IPV/Hib and 90% uptake of MMR during the year 2008-09. (NHS Imms Statistics, 

England 2008-09) 

The Department of Health’s (DH) immunisation programme is described in ‘Immunisation 

Against Infectious Disease’ (2006), also known as ‘The Green Book’. All immunisations must be 

in line with the Green Book (2006) and any subsequent recommendations from the Department 

of Health (DH), Joint Committee for Vaccination and Immunisation (JCVI) and other relevant 

bodies, e.g. NICE. The ‘Green Book’ should be accessed on line to ensure updated 

recommendations and guidelines are followed 

This policy is to be read in conjunction with relevant PCT policies, ‘Maintenance of the Cold 

Chain Policy 2008’, ‘Resuscitation Policy 2010’, ‘Health Record Policy 2010’, ‘Consent to 

treatment Policy 2009’, ‘Medicine and controlled drugs policy 2010’ and associated standard 

operating procedures and service specifications. 

PURPOSE 

This policy provides a framework to support professional practice to safely achieve the 

maximum uptake and delivery of the Childhood Immunisation Programme 

The aim of this policy is to ensure that all practitioners who administer childhood immunisations 

practice in accordance with national and local policies and guidance for evidence based 

practice, thus minimising the risk of errors. 

Objectives 

To provide a guide to good practice in the delivery of the Childhood Immunisation 

Programme 

To develop a clinical governance framework to support service delivery 

To identify roles and responsibilities of all staff who deliver the Childhood 

Immunisation Programme 

Outcome 

A safe and effective delivery of the Childhood Immunisation Programme. 

Improved vaccine uptake rates for children in the Trust 

Reduction in vaccine preventable diseases 

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SCOPE 

The scope of this policy applies to all staff members who are involved in the provision of 

immunisation advice or the preparation, administration and documentation of immunisations 

given to children aged 0-18 years. This will include all practitioners and staff involved in the 

delivery of the Childhood Immunisation Programme.This procedure excludes the administration 

of travel vaccines 

Healthcare professionals involved in any aspect of immunisation are accountable for their own 

actions and as such, have a responsibility to acquire and maintain their necessary skills and 

competencies in order to demonstrate their capability to offer safe and effective care. (NMC 

2008) 

CHILDHOOD IMMUNISATION 

Childhood immunisation is the schedule of vaccines offered to every child from the ages of 8 

weeks to 18 years (see appendix 2) This policy includes all childhood immunisations that are 

prescribed individually by a GP, or hospital consultant or included as part of a Patient Group 

Direction (PGD). 

The process for pre school childhood immunisation is detailed in appendix 3a and school age 

children process in appendix 3b 

Any practitioner who has concerns or queries regarding immunisation should refer primarily to 

the guidance in the ‘Green book’ or updated DH guidance on immunisation. Unanswered 

enquiries should be directed to the Immunisation Coordinator. 

Immunisation programmes should be based on a multi-professional team approach, where each 

member’s skills and knowledge contribute to improving the public health of the local population. 

The Immunisation Programme should be delivered flexibly to enable new vaccines to be 

included. 

Only practitioners with additional training in Vaccination and Immunisation approved by the 

Primary Care Trust (PCT) may administer vaccines. All child health staff should endeavour 

when appropriate, to either immunise children who have not completed the programme or 

arrange for them to attend an immunisation session. 

ACCESS TO IMMUNISATION 

The PCT is responsible to ensure that all children have access to the immunisation programme, 

namely: 

 

 

 

All children resident within Halton or St.Helens boroughs 

All children registered with a GP whose practice forms part of the PCT 

Children attending local authority maintained schools in Halton and St.Helens, 

independent schools and all school age children resident elsewhere but attending 

schools in the two boroughs. 

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‘At risk’ groups determined by the Health Protection Agency (HPA) and national 

campaigns. 

Some children are more at risk of low take up of immunisation and staff in Health Visiting and 

School Nursing teams should ensure that these groups have equitable access to 

immunisations. These children include: 

Children in care 

Young people who missed previous immunisations 

Children with physical or learning difficulties 

Children of lone parents 

Children not registered with a general practitioner 

Children in larger families 

Minority ethnic groups and non English speaking families 

Vulnerable children e.g. travellers, asylum seekers or homeless families 

Children in hospital or have a chronic illness 

PATIENT GROUP DIRECTIONS 

(Patient Group Direction Policy 

Halton and St.Helens NHS 2010) 

The Trust’s Patient Group Direction Policy 2010 and Medicine and Controlled Drugs policy 2010 

contains information and guidance on Patient Group Directions. 

For nurse led sessions, vaccines are administered under Patient Group Directions (PGDs), 

which are drawn together locally by the PCT PGD Development Group. The PGD is then 

approved by The Trust. 

The Service Lead or designated Authorising Manager is responsible for ensuring that fully 

competent, qualified and trained professionals operate within the PGDs and have their own 

current authorised PGDs. They must maintain a list of the practitioners they have authorised to 

use specific PGDs and a copy forwarded and retained by the Clinical Governance Department 

All immunisers must have read and signed their personal PGD and these documents are 

retained safely and be easily accessible to the individual and relevant others. 

Before using a PGD it is the individual nurse’s responsibility to ensure that they are competent 

to deal with each patient under its terms and comply fully with the details in the PGD. See The 

Trust’s Patient Group Direction Policy 2010 and Medicine and Controlled Drugs Policy 2010. 

. 

The practitioner must ensure: 

They have read and understood the PGD 

They have signed the PGD 

The authorising manager has signed the PGD 

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Has attended an immunisation update within the last twelve months 

The PGD is stored safely and readily accessible to both the practitioner and 

relevant others 

The PGD is available for reference before the administration of vaccines to the 

individual or groups at immunisation sessions 

Nurses may administer vaccines with a written instruction signed and dated by a doctor, under 

Patient Specific Direction. 

TRAINING REQUIREMENTS 

Only practitioners with additional training in Vaccination and Immunisation approved by the PCT 

may administer vaccines. 

All registered nurses are accountable for their practice and must ensure that they undertake the 

appropriate training to perform the task in a professional and competent manner. Competency 

must be maintained in accordance with current Nursing and Midwifery Council (NMC) 

guidelines. 

 

 

 

 

Initial immunisation training programme approved by the PCT 

Medicines management training, including Patient Group Directions 

Attend yearly immunisation updates. 

Undertake annual Basic Life Support and Anaphylaxis training 

All health professionals should follow the guidelines set out in the The Green Book (D.O.H. 

Immunisation against Infectious Disease 2006) with updated chapters available at 

www.dh.gov.uk All who administer or advise about immunisation should be well informed and 

up to date about vaccines, their benefits, possible reactions, and rare contraindications, and 

also informed about the diseases against which they offer protection and the risks of not 

immunising. 

All who administer, or give advice about immunisations must be proficient and competent in the 

following areas of core knowledge (HPA 2005), or know where to obtain the relevant 

information. 

Aims of immunisation: national policy and schedules 

Immune system and how vaccines work 

Vaccine preventable disease 

Different types of vaccine used and their composition 

Current issues and controversies regarding immunisation 

Communication with patients and/or parents 

Legal aspects of immunisation 

Storage and handling of vaccines 

Correct administration of vaccines 

Anaphylaxis and other adverse events 

Documentation, record keeping and reporting 

Strategies for improving immunisation rates 

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CONSENT 

All staff should practice in accordance with the current PCT Consent Policy, the Mental Capacity 

Act and the Mental Capacity Act code of Practice. Consent must be obtained before each and 

every immunisation. 

The practitioner who is to administer the vaccine should obtain valid consent or authorisation 

from the individual or parent/guardian. The explanation of the options available to the individual, 

guardian or relevant others should be given. This involves facilitating an understanding of the 

advantages, disadvantages, benefits and potential complications of the procedure and 

vaccines. Practitioners gaining consent must adhere to the consent for immunisation guidelines 

in the Consent to Examination or Treatment Policy. 

Initial written intent for the child to be invited to be immunised must be sought and is primarily 

gained by the health visitor at the visit shortly after the child’s birth. The signed intent form must 

be returned to the correct Child Health Department. The details will be inputted onto the 

computer, which in turn will generate the appropriate appointments and clinic lists. 

In cases where young children are not competent to either give or withhold consent, such 

consent must be given by a person with parental responsibility. If a child is in the care of the 

Local Authority, see appendix 4 for arrangements within the two boroughs. 

Where immunisations are routinely offered in the school setting, older children are seldom 

accompanied by parent/s or carer/s for immunisations and teachers do not have parental 

powers 

Young people aged 16 or 17 are presumed, in law, to be able to consent to their own medical 

treatment. Younger children who understand fully what is involved in the proposed procedure, 

referred to as ‘meeting the Fraser Guidelines’ or ‘Gillick’ competent, can also give consent 

although ideally their parents will be involved and the immuniser should attempt to make contact 

with the parents to gain a verbal consent. (DH 2006). Practitioners should use the checklist to 

assess competency (Fraser competency checklist appendix 5) 

If the health professional giving the immunisation feels a child does not meet the Fraser 

’competence’, then the consent of someone with parental responsibility must be sought. The 

immuniser should document any consent or refusal obtained, on the consent form. 

Should a child wish, or present, for immunisation, and there is no written or verbal consent, but 

the child meets the ‘Fraser Guidelines’ (appendix 5), then the immunisation can be given 

(Fraser competence, Consent to Examination or Treatment Policy 2009) The immuniser must 

ensure that the young person signs the consent form. An attempt should be made to contact the 

person with parental responsibility to obtain verbal consent. 

School Nurses may obtain verbal consent where possible from the parents/carers and record 

this in the child’s case notes. Immunisers who are immunising in a school setting should also 

follow the clinical guidelines in appendix 10. 

An interpreter or other suitable person should be available (where required) to enable the 

patient, client or parent to make an informed consent. 

Page 10 of 46

PARENTS WHO DECLINE IMMUNISATION 

If parents decline any of the immunisations due, explore the reasons why and offer further 

information and advice on risks and benefits of protecting against disease. Whilst, 

parents/guardians should not be unduly pressured, they need to be given sufficient information 

to make an informed decision. When two parents with parental responsibility, do not agree on 

vaccines to be given, advice should be sought from the Immunisation Coordinator; in some 

cases legal advice might be required. 

THERAPEUTIC HOLDING OF CHILDREN 

This predominately applies to three to four year old children. Therapeutic holding is, by 

definition, applied without a child’s consent however; safe holding by the parent reduces the risk 

of needle stick injury to the child. Therapeutic holding of children means immobilisation by the 

use of limited force. Parents/Carers are guided by nursing staff on how to hold the child in a 

safe position. The child should sit on the parent/carer’s lap who will immobilise the relevant limb 

of the child in readiness for the immunisation. Nurses should not hold the child routinely, unless 

requested by the parent/carer. Clinical judgment on what advice to give parents will always be 

on a case by case basis, the child’s welfare and safety will always be paramount. (RCN 

guidance 2010) 

RISK ASSESSMENT OF PREMISES 

A basic risk assessment should be undertaken in premises where immunisations are 

administered (appendix 6a) and updated annually or reviewed when there is a change in 

circumstances. 

It is essential that the criteria is met and where premises are found to be unsuitable or 

inadequate, the risk assessment is discussed with the service lead or line manager. 

When other services are using the same premises to immunise, only one risk assessment is 

required and shared with the relevant staff. The assessor will liaise with other teams and a copy 

of the risk assessment is stored at the premises by the clerical officer or GP practice manager. 

Assessments completed on external premises will be stored at the nearest clinic and copies 

sent to the service manager. 

A more detailed risk assessment is undertaken in the school setting (appendix 6b). It is 

essential to meet this criteria in order to deliver a session. Advice of the line manager is to be 

sought where environments do not meet the criteria. 

Immunisation should only take place in premises or homes where emergency assistance can be 

summoned immediately. The practitioner should ensure that a telephone is available and there 

is a second responsible adult who is able to summon emergency assistance if required 

Staff must be able to adhere to PCT Infection Control Policies and the PCT Cold Chain Policy 

whilst at the premises 

Page 11 of 46

COLD CHAIN 

Standards around vaccine storage, transportation and the maintenance of the cold chain are in 

accordance with the Trusts Medicine Policy and Cold Chain Policy. 

INFECTION CONTROL 

Equipment required in maintaining standard precautions in infection control must be available at 

each vaccination session: 

 

 

 

 

 

Disposable roll 

Gloves for spillages or bleeds- 

Infection control procedures should be followed as per policy. 

Clinical waste bags 

Sharps disposal- 

Sharps to be disposed of into a sharps box, directly after use 

Sharps boxes replaced when two thirds full 

Access to hand decontamination facilities- 

Alcohol gel should be available and used after every patient. Hands will also need 

to be washed with running water after 3 to 4 uses of gel to prevent a build up of 

residue. 

In the event of any needle stick injury, infection control procedures should be followed as per 

policy. 

ADMINISTRATION OF VACCINES 

Health care professionals should follow the guidelines set out in ‘The Green Book’ (DH 2006). 

Health professionals should endeavour to ensure that each child under their care is fully 

immunised, unless there is a true contraindication. 

Vaccines should either have been dispensed to the patient on prescription, or administered from 

stock held at the practice premises or health centre. The correct authorisation to administer 

must be in place e.g. PGD or Patient Specific Direction. 

Immunisers must understand and practice in accordance with the PCT Medicine and 

Controlled Drugs Policy and the NMC Standards for Medicine Management 2010. 

Registered healthcare professionals should ensure the drug Adrenaline (Epinephrine) 1:1000 

(1mg/1ml) is available for use in the treatment of anaphylaxis. (See the current Trust 

Resuscitation Policy and the PCT PGD for Adrenaline) 

ANAPHYLAXIS 

It is the policy of the Trust that all professional staff who administers medications and/or 

vaccinations is able to recognise and treat anaphylaxis. Such members of staff are to receive 

Page 12 of 46

annual training in the recognition and management of anaphylaxis; this is in addition to 

resuscitation training. (Resuscitation Policy 2010). 

The Resuscitation Policy states: 

Adrenaline Injection BP 1 in 1000 solution (1mg/ml) 2 x 1ml ampoules. 

The PGD for the administration of adrenaline (epinephrine) 1:1000 (1mg/mL) states: 

Frequency of administration 

The dose may be repeated, if necessary, if there is no improvement in the patient’s 

condition after a 5-minute interval. 

Monitor individual patient’s response: blood pressure, pulse and respiratory function. 

Further doses can be given at about 5-minute intervals according to the patient’s 

response. This is in accordance with advice given by the Resuscitation Council, 

‘Emergency treatment of anaphylactic reactions. Guidelines for healthcare providers’ 

(2008) 

Resuscitation Council (UK) 

Intramuscular Adrenaline dosage 

IM doses of 1:1000 adrenaline (repeat after 5 min if no better) 

• Adult 500 micrograms IM (0.5 mL) 

• Child more than 12 years: 500 micrograms IM (0.5 mL) 

or 300 micrograms (0.3mL) if child is small or prepubertal 

• Child 6 -12 years: 300 micrograms IM (0.3 mL) 

• Child less than 6 years: 150 micrograms IM (0.15 mL) 

Equipment required and appropriate dosage is listed at appendix 8 

CHILDHOOD IMMUNISATION PROCEDURAL GUIDELINES 

These guidelines apply to all practitioners whose duties involve the prescribing, administration 

or handling of vaccines. 

The basic procedural guidelines are to be followed when administering any childhood vaccine. 

(appendix 7). Practitioners will need to also refer to more detailed guidelines that are available 

for specific situations and areas e.g. School Nursing Immunisations in Schools (appendix 10), 

and Guidelines for Intramuscular and Subcutaneous Injections 2010. 

EQUIPMENT REQUIRED 

Vaccine supply including the manufacturer’s information leaflet 

Patient Documentation, as required by your employer 

Copy of PGD, if relevant 

Hand gel 

Page 13 of 46

Blue roll 

Kidney dish or appropriate receiver 

Non sterile gauze squares 

Micro pore tape or plasters if required 

Sharps disposal bin and transportation carrier 

Selection of syringes – 1ml or 2ml 

Selection of needles- 

-Green 21 gauge – 38 mm long - use for drawing up of vaccine 

only 

-Blue 23 gauge – 25 mm long – use to administer vaccines suitable 

for all ages 

-A 25G 16mm length needle (orange) is suitable for IM injection in pre- term or very 

small infants ONLY. 

16mm long, only to be used on pre-term or very small infants 

Anaphylaxis pack (appendix 8) 

REFERRAL TO SECONDARY CARE 

In incidences, where there has been a previous adverse reaction to a vaccine or there is a 

contraindication to the vaccine (The Green Book), the professional may refer to secondary care 

when they feel the child cannot be safely immunised in a community clinic. The referral pathway 

is to be followed (appendix 9). 

RECORD KEEPING 

Accurate records of vaccines given or reason for not giving are important for patient safety, 

monitoring immunisation uptake and facilitating recall of recipients of vaccines, if required. 

The following information must be recorded: 

See checklist for Health Visiting services appendix 11 

Assessment process indicating information about the child’s fitness for immunisation and 

verbal informed parental consent given. 

Name of patient, address, date of birth and GP 

Vaccine name, product name, batch number and expiry date. 

Dose administered 

Site(s) used – including clear description of which injection was administered in each site. 

Date immunisation given. 

Details of any ADRs and action taken 

Advice given and action to be taken if vaccine deferred or declined. 

Name, designation and signature of immuniser. 

Page 14 of 46

If following assessment and discussion the vaccine is not given, the reason for this must be 

recorded. This should also include any relevant follow-up advice provided. 

This information is recorded in the most appropriate notes at the time of administration. These 

include: 

Personal Child Health Record (PCHR) for children 

Child clinical records (Contact sheets are completed and one copy sent to the named 

health professional and one copy given to the parent) 

GP computerised record system 

School nurse sessional documentation (see procedures in appendix 10) 

I.T. systems 

Scheduled data collection form and unscheduled data forms, as required, are completed and 

returned to the Child Health Information System 

PATIENT SAFETY 

The safety of patients involved in the immunisation programme is paramount 

All immunisers must: 

Ensure the safety and efficacy of vaccines in accordance with the PCT’s Medicine and 

Controlled Drugs Policy 2010 and Maintaining the Cold Chain Policy 2008 

Work within the Nursing and Midwifery Council (NMC) The Code and The Guidelines for 

the Administration of Medicines 

Have access to emergency anaphylaxis and resuscitation equipment and drugs when 

undertaking Immunisation sessions 

Have available and adhere to the guidelines within the Department of Health 

‘Immunisation Against Infectious Disease’ (the Green Book) 2006 

Report incidents in accordance with the PCT’s Accident and Incident Reporting 

Procedures (Health and Safety Policy 2009) 

MANAGEMENT OF ADVERSE EFFECTS 

If an error is made, the immuniser must take any action to prevent any potential harm to the 

patient and report as soon as possible to the prescriber, line manager or employer (according to 

local policy) and document actions. (NMC Standard 24 2010) 

ADVERSE INCIDENT REPORTING 

In the event of a suspected or actual adverse incident the healthcare professional should: 

 

 

 

 

Inform and seek guidance and advice from the Service Lead 

Inform and seek clinical advice from the Immunisation Trainer or Immunisation 

Coordinator 

Inform the patient, client or parent of the error and action to be taken 

Report all errors or suspected errors in accordance with Trust Accident and Incident 

Reporting procedures (Health and Safety Policy 2009) 

Page 15 of 46

Clearly document action and outcomes in the recipient’s clinical records. 

Complete an incident form [IR1] and send to the Governance Department the same day. 

Report to the MHRA (Medicines and Healthcare Products Regulatory Agency), via the 

Yellow Card Scheme, any unwanted or harmful reactions following the administration of a 

vaccine ( The Green Book Chapter 9) 

use the NHS no. as an identifier 

If a patient experiences an adverse drug reaction to a medication, immediate action must be 

taken to remedy harm caused by the reaction. Actions are recorded in the patient’s notes, notify 

the prescriber (if you did not prescribe the drug) and notify via the Yellow Card Scheme 

immediately (Standard 25 NMC 2010) 

All incidents and/or breeches in patient safety must be reported to the Governance Department 

using the incident form (IR1). 

DOMICILIARY IMMUNISATION 

Children and families are routinely offered appointments to attend immunisation sessions, 

however in exceptional circumstances, home immunisations may be offered. 

Criteria: 

Failure to attend two appointments 

Mitigating domestic circumstances rendering parents unable to attend a session, e.g. 

multiple births, children with complex or additional needs. 

Looked after children and those on a child protection plan 

This criterion is not definitive and should only be used as a guide. Immunisers should use their 

own discretion and professional judgement. 

Source of referrals 

Health Visitors 

GP via health visiting team 

Children Centre staff 

Recommendations from LAC review or case conferences 

Parents (if fulfil criteria) 

Foster carers 

The following information must accompany each referral: 

Name of child 

Address and contact number 

Date of birth 

GP 

Named Health visitor 

Reason for referral 

Procedures 

The guidelines for domiciliary immunisation to be followed (appendix 12) 

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DUTIES AND RESPONSIBILITIES 

Duties within the Organisation 

Chief Executive 

The Chief Executive is responsible for ensuring compliance with the Policies and Guidelines, 

legislation, NHS guidance and for ensuring the policy is effective. 

Trust Board 

The Trust board is responsible for overall responsibility for ensuring the provision of effective 

clinical services within the organisation, and to ensure that the Trust complies with its statutory 

obligations. 

Assistant Directors Child Health 

Assistant Directors Child Health Services are responsible for ensuring effective implementation 

of this policy across their areas of responsibility. Assistant Directors will support and enable the 

operational service leads and clinical leads to fulfil their responsibilities and ensure the effective 

implementation of this policy within their speciality 

Assistant Directors will ensure that an effective audit is in place to identify that the policy is 

being adhered to. 

Child services lead 

Child service leads will ensure that: 

All relevant training needs are addressed to ensure there is full adherence to the policy. 

Practitioners have read and signed the appropriate Childhood Immunisation Patient 

Group Directions and send a copy to the Governance team 

Maintain a current list of practitioners using active PGDs. 

Any new employee completes the relevant training and is assessed as competent as 

soon as possible after joining the organisation. 

All Halton & St Helens Staff 

All Staff are responsible for adhering to and complying with the requirements of the policies, 

guidelines, protocols and Standard Operating Procedures (SOPs) contained within and 

applicable to their area of operation, particularly those stated in this policy 

All relevant practitioners have a responsibility to ensure they are authorised and competent to 

administer and/or advise on childhood immunisations and they have a responsibility to ensure 

that they read, understand and follow this policy at all times. 

Immunisers will have read and signed the appropriate Patient Group Directions and have 

access to an authorised up to date copy. 

Page 17 of 46

Temporary and Agency Staff, Contractors and Subcontractors 

All Staff are responsible for adhering to and complying with the requirements of the policies, 

guidelines, protocols and Standard Operating Procedures (SOPs) contained within and 

applicable to their area of operation. 

DOCUMENT STORAGE AND FILING 

The approved and ratified corporate document will be uploaded to the document portal. Follow 

the link below to view the policy document and its related pages: 

http://sharepointcompliance/default.aspx 

Page 18 of 46

REFERENCES 

Reference 

Immunisation against Infectious Disease (The Green 

Book) Salisbury D (Ed) The Stationery Office, 2006 

NHS Imms Statistics, 

England 2008-09 

Consent to Examination or Treatment Policy 

Halton and St.Helens NHS 2009 

The Code 

NMC 2008 

Standards for Medicines Management 

NMC 2010 

Medicine and Controlled Drugs Policy 

(Patient Group Directions) 


Patient Group Direction Policy 


Maintaining the Cold Chain Policy 


Referral Pathway for Childhood Immunisations in 

Secondary Care 


Resuscitation Policy 


Infection Prevention and Control Policy 


UK Guidance on Best Practice in Vaccine 

Administration 

The Vaccine Administration Taskforce 2001 

Mental Capacity Act 

DH 2005 

Prevention and management of exposure to BBV 

including prevention of sharps injuries 


Emergency treatment of anaphylactic reactions. 

Guidelines for healthcare providers 

Resuscitation Council, 2008 

Restrictive Physical Intervention and Therapeutic 

Holding For Children and Young People 

RCN 2010 

Health and Safety Policy 


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Accident and 

Incident 

Evidence Grade 

National 

directives/guidelines 

National statistics 

Trust Policy 

Professional 

Document 

Professional 

Document 




Trust Guidelines 



Professional 

Document 

National legislation 

Trust policy 

National 

directives/guidelines 

Professional 

Document 


Page 19 of 46

Guidelines for Intramuscular and Subcutaneous 

Injections 


reporting 

procedures 

Whole 

document 

Trust guidelines 

Page 20 of 46

APPENDIX 1 

Glossary of Terms 

DTaP……………………………………………Diphtheria, Tetanus, Pertussis Vaccines 

DtaP 

(reconstituted with other vaccines) 

dTaP 

IPV………………………………………….. Inactivated Polio Vaccine 

PCV…………………………………………….Pneumococcal vaccine 

Hib…………………………………………….. Haemophilus influenzae Vaccine 

MMR……………………………………….......Measles, Mumps and Rubella vaccine 

MenC…………………………………………..Meningitis C vaccine 

BCG………………………………………….. .Bacillus Calmette-Guérin vaccine 

Td………………………………………………Tetanus and Diphtheria Vaccine 

Hep B…………………………………………..Hepatitis B Vaccine 

PGD…………………………………………....Patient Group Direction 

IM……………………………………………….Intra muscular 

LAC……………………………………………..Looked After Children (children in care) 

MHRA…………………………………………. Medicines and Healthcare Products Regulatory 

Agency 

ADR……………………………………………Adverse Drug Reaction 

Page 21 of 46

APPENDIX 2 

CHILDHOOD IMMUNISATION PROGRAMME 

When to 

immunise 

Diseases protected against 

Vaccine given 

Two months old 

Diphtheria, tetanus, pertussis 

(whooping cough), polio and 

Haemophilus influenzae type b 

(Hib) 

Pneumococcal infection 

DTaP/IPV/Hib 

+ Pneumococcal conjugate 

vaccine, (PCV) 

Three months old 

Diphtheria, tetanus, pertussis, polio 

and Haemophilus influenzae type b 

(Hib) 

Meningitis C 

DTaP/IPV/Hib 

+ MenC 

Four months old 

Diphtheria, tetanus, pertussis, polio 

and Haemophilus influenzae type b 

(Hib) 

Meningitis C 


DTaP/IPV/Hib 

+ MenC + PCV 

Around 12 months 

Haemophilus influenza type b (Hib) 

Meningitis C 

Hib/MenC 

Around 13 months 

old 

Measles, mumps and rubella 


MMR 

+ PCV 

Three years and 

four months or 

soon after 

Diphtheria, tetanus, pertussis and 

polio 

Measles, mumps and rubella 

DTaP/IPV or dTaP/IPV 

+MMR 

Girls aged 12 to 

13 years 

13 to 18 

years old 

Cervical cancer caused by human 

papillomavirus 

types 16 and 18. 

Diphtheria, tetanus, polio 

HPV 

Td/IPV 

Page 22 of 46

When to immunise 

Diseases protected against 

Vaccine 

given 

At birth 

(to babies who have an 

increased risk of coming 

into contact with TB) 

Tuberculosis 

BCG 

At birth 

(to babies whose mothers 

are hepatitis B positive) 

Hepatitis B 

Hep B 

Page 23 of 46

APPENDIX 3 

Process Map for Childhood Immunisations Preschool 

Labour 

ward 

notify 

CHCS of 

birth. 

CHCS 

send birth 

notificatio 

n to HV. 

Birth 

visit 

conducte 

d by 

Health 

Visitor 

between 

10 -14 

Intent form 

from Red 

Book 

completed 

Form 

returned to 

CHCS (Child 

Health 

Computer 

S t ) 

Appointments sent by CHCS to child for 

scheduled immunisations (Pre-school) 

If Intent form is not 

returned to CHCS, the 

child does not receive any 

immunisation 

appointments. Within 3 

weeks of birth, CHCS 

chase up outstanding 

intents with HV 

Child attends 

clinic and 

receives 

scheduled 

immunisations 

Clinic clerk / 

immuniser 

returns 

scheduled 

sheet to CHCS, 

enters details 

in red book 

and onto GP 

computer 

system / 

yellow card 

Clinic details 

sent to CHCS 

via internal 

mail system 

within 24 

Child attends 

clinic 

opportunistically 

and receives 

unscheduled 

Clinic clerk or 

immuniser returns 

unscheduled sheet 

to CHCS, enters 

details in red book 

and onto GP 

computer system / 

yellow card 


sent to CHCS via 

internal mail 

system within 24 

hours 

Child does not 

attend clinic 

but parent / 

carer calls to 

cancel 

Clerk / 

immuniser 

records non 

attendance (A) 

on scheduled 

h t 



internal mail 


h 

New 

appointment 

sent to child 

Child does not 

attend 

Clerk / immuniser 

records non attendance 

(B) on scheduled sheet 



internal mail 


hours 

New 

appointment sent 

to child (report 

sent to GP 

practices to list 

Child suspended if 

2 x DNAs 

Missed 2 appt list sent monthly 

by CHCS to HVs to initiate 

face to face contact with parent 

Page 24 of 46

APPENDIX 4 

Looked after Children 

Consent for looked after children seems complex as different councils use different people to 

sign for consent but the basis for consent is the same. 

For children who are accommodated by the local authority, the parent with parental 

responsibility is the only person who should sign. Where the parent is not contactable, the 

local authority will have a designated person to sign. 

St Helens - the Service Manager on the rota 

Halton - the parent will have completed a card which the carer should have with 

them. 

NB Arrangements with Halton LA are to be revised. If a carer is not in 

possession of a card, then contact Christine Taylor LA Service Manager 

who will arrange for consent to be given. 

For children who are on an interim or full care order, the local authority share parental 

responsibility and so can make decisions. Where the parent is not available or disagrees with 

care, the local authority will have a designated person to sign. In St Helens, this designated 

person will be the carer for day to day routine care and the Service Manager for planned 

invasive treatment or blood tests. For Halton the card system is used as above 

The named nurse for children in care should know the arrangements for those on his/her 

caseload. In the case of St Helens he/she will be sent a notification of consent by the LAC 

administrator (health). This is currently under review in Halton 

Children who are on Residence Orders, Special Guardianship Orders or Adoption Orders are 

not in care. Their carers/adoptive parents can sign as parents sign. 

Where there are queries please contact the LAC health team 01744 671245/25 or 

Sandra.campbell2@hsthpct.nhs.uk 

Page 25 of 46

APPENDIX 5 

Assessing Fraser Competence Checklist 

This form is to be used by Health Professionals assessing young persons (ages 11-16) consent to 

treatment in the absence of a person with responsibility or refusal to consent. 

Name of Child/Young Person………………………………. Venue/ School ….…………………… 

D.O.B……………………………………….. 

Yes No 

Parent/Guardian has provided consent 

Parent/Guardian has refused consent to this treatment/procedure 

Has the young person refused to tell the Parent/Guardian or to allow 

the health professional to discuss it with their parents 

If answered “yes” to any of the above points, what actions have been taken and what evidence do 

you have to support this (Please write all relevant evidence in the space provided). 

…………………………………………………………………………………………………………………… 

…………………………………………………………………………………………………………………… 

…………………………………………………………………………………………… 

The Young Person: 

 

Understands the benefits of proposed treatment 

 

Understands the risks of proposed treatment 

 

Understands what the treatment involves 

 

Understands the implications of not having the treatment 

 

Understands the alternatives available 

 

Understands what effects on their lives of having or not 

having the treatment will be 

 

Understands the language and clinical terms 

 

Understands the procedure to be carried out 

 

Demonstrates the ability to communicate a choice 

Name of Professional Completing this form…………………………………………………. 

Signature……………….. …………………. 

Date……………………… 

Designation…………………………………. 

Page 26 of 46

APPENDIX 6A 

Date: 

BASIC CHECKLIST OF PREMISES USED FOR IMMUNISATION SESSIONS 

Assessor: 

Location 

Contact Person: 

(Staff member with responsibility for organising immunisation sessions) 

ESSENTIAL CRITERIA Not suitable Adequate Good 

Is there sufficient clinical work 

space for nurses to work 

effectively including management 

of anaphylaxis 

Are there hand-washing facilities 

available in the room or 

nearby 

Is the room lit well enough to 

perform the task 

Are the noise levels low enough to 

enable full concentration 

Are the table and chairs of 

suitable height and suitable for 

the purpose 

Is there a telephone access 

available 

Is there a suitable space for 

patients/clients to wait with 

minimal disturbance 

Is there a private area for 

patients/clients who feel ill 

Does the room meet PCT health 

and safety requirements 

Are the premises suitable to be used for immunisations sessions 

If any part of this checklist is classed as unsuitable, discuss with line manager Yes No 

Further action required Yes No 

Details 

Date for review: 

Page 27 of 46

APPENDIX 6B 

Risk Assessment of an Environment for Immunisation Sessions 

RISK ASSESSMENT FOR: ______________________________ (school, community setting) 

PRIOR TO IMMUNISATION SESSION ON: __________________________ 

ROOM: ________________ School Reception direct phone number: __________________ 

Number of pupils: ________ 

Requirement Y/N Comments Checked on 

day of 

immunisation 

session 

1. Is there an identified waiting area, with an agreement that 

pupils arrive at the session at regular intervals 

2. Has it been agreed that a member of staff who is not 

actively involved with teaching a class can be available at 

the session to oversee the pupil’s behaviour 

3. Has an appropriate room been agreed and confirmed for 

the prearranged date/s (Please identify room above) This 

needs to be confirmed with the Head of Year or member of 

the Senior Management Team. 

4. Is the room well ventilated and of optimal temperature. 

5. Is the room of adequate size for the number of immunisers 

and pupils that will be attending for their immunisation 

6. Is there adequate lighting in all areas 

7. Is the room free from hazards, e.g. equipment, trailing 

electrical wiring etc 

8. Is there an identified recovery area with gym mats, 

preferably screened from other pupils to preserve their 

privacy and dignity 

9. Will there be sufficient free-standing tables/desks with flat 

surfaces for the immunisation equipment and for nurses to 

immunise safely 

10. Is the room easily accessible for emergency services, 

preferably on the ground floor 

11. Can 2 desks/chairs need to be positioned near the 

entrance of the room for clerks 

12. Has the member of school staff confirmed that there are 

no pupils on work experience, no college visits, no exams 

and no school trips 

If any part of the assessment is unacceptable, discuss with line manager or service lead 

The above requirements have been agreed between School and the School Health Nursing Service to ensure that 

pupils receive their immunisations safely. These arrangements must not be changed without discussion with the 

named nurse for the school. 

Signature of Assessor: ....................................... Date: ........................... 

Agreed by School Health Nurse: .......................................... 

Date: …........................ 

Signature of Head of Year: .................................. Date: .......................... 

Copy to Head Teacher Copy to immunisation file Date to be reviewed: 

Page 28 of 46

APPENDIX 7 

Childhood Immunisation Procedural Guidelines 

NB. 

Practitioners are to arrive at the premises 15 minutes before the start of the session in 

order to prepare themselves and the room. Adequate time should be allocated to 

check/review all information necessary for the safe administration of vaccines. 

Preparation 

Action 

Rationale 

1. Ensure safe and suitable environment for clinic and 

appropriate equipment is available 

2. Check immunisation schedules and clinic lists to identify 

vaccines required 

3. Ensure suitable vaccines are available, checking expiry 

date and cold chain has been maintained. 

4. Ensure Patient Group Directives authorisation in place or 

individual prescription if immunisation not covered by 

Patient Group Directive. 

5. There is immediate access to adrenaline (epinephrine) 

pack in the event of an anaphylactic reaction and there 

is a means to call for assistance e.g. telephone should 

emergency help be required (check mobile reception). 

Check expiry date of adrenaline 

1. Invite and welcome child/parent into area 

Pre administration of vaccine 

2. Confirm the correct identity with the child/carer and with 

clinical or electronic records 

3. Confirm which vaccine is to be given with the 

child/parent and the clinical or electronic records. If 

there are any anomalies in the schedule or history, 

contact the informatics department to confirm 

4. Check individual child’s vaccine history against the 

child’s records, immunisation schedule and parent held 

record (red book). Where there are concerns or 

discrepancies, the GP practice and/or information 

services are to be contacted to discuss. 

5. When delivering an immunisation session within the 

school setting, if the immunisation history is not 

available, the immunisation can proceed if the parent or 

young person confirms that the immunisation has not 

previously been given. If the parent or young person 

has any doubt regarding previous immunisations the 

immunisation should be postponed. 

6. If have unanswered concerns, refer to the ‘Green Book’, 

immunisation coordinator or Immunisation Trainer 

7. Check for contra-indication especially with regard to 

pregnancy, illness, medication, allergies, fever, previous 

adverse reaction and any recent vaccinations. 

To ensure patient safety and minimise the 

risk of drug errors 

To aid in emergency assistance 

To establish the correct identity and 

immunisation schedule 

To gain informed consent 

Page 29 of 46

8. Ensure the child/parent is aware of common adverse 

reactions and action to take if they have any concerns 

9. Explain the procedure 

10. Ensure that the child/parent understands about the 

vaccines to be given and gain verbal informed consent 

11. Establish current health status to assess if child is fit for 

immunisation 

To assess if fit for immunisation 

12. Immediately prior to immunising the child, having 

assessed fitness to be immunised, select the correct 

vaccine, check dosage, expiry date and prepare. 

Reconstitute if necessary according to the 

manufacturer’s instructions 

Immunisers must not prepare substances for injection in 

advance of their immediate use or administer 

medication drawn into a syringe or container by another 

practitioner when not in their presence.(NMC 2010) 

13. Be aware of the dose of adrenaline that may be 

required for the individual child. Adrenaline must not be 

pre-drawn 

Administration of vaccine 

Action 

1. Check the route of administration and be familiar with 

the method of delivery 

2. Ensure safe positioning of child and administer vaccine 

at correct site using appropriate equipment and 

technique 

Note 

Medical and nursing staff must give routine vaccines by 

the intra-muscular or deep subcutaneous route only. 

The sites which can be used are the middle third, upper 

outer aspect of the thigh or arm according to the 

manufacturers recommendations. BCG vaccine is given 

by intradermal injection. 

Where two or more injections need to be administered 

at the same time, they should be given at separate 

sites, preferably in a different limb. If more than 1 

injection is to be given in the same limb, they should be 

administered at least 2.5cm apart and documented 

accordingly 

Only the outer aspect of the thigh is to be used in a 

child under 1 year old 

3. Dispose of equipment as per policy. 

Post administration of vaccine 

To minimise the risk of drug errors 

Rationale 

To decide on appropriate route and 

treatment 

To offer evidence based practice 

Action 

1. Observation of a patient following immunisation 

The Department of Health does not state a specific 

Rationale 

(See Immunisation against Infectious 

Diseases 2006 page 31). 

Resuscitation Council (UK) 2008 (updated 

Page 30 of 46

time and does not recommend long periods of 

observation. The risk of severe life-threatening 

reactions after immunisation is extremely small. A 

short period of observation (5-10 minutes), whilst 

completing documentation, should be used to detect 

immediate problems. 

2. Patients (and carers) should be provided with verbal or 

written advice on possible local and systemic reactions 

and what to do if they occur. 

3. Inform parent/care to contact GP or NHS direct in the 

event of adverse events or concerns 

4. Inform of timeframe of next vaccines due (if appropriate) 

5. Record the administration of the vaccines to include 

date of administration, name of vaccine, dose, the batch 

number, the site, the route of administration, expiry date 

and manufacturer. 

Enter details in the child’s records and immunisation 

schedule 

Enter on GP electronic patient record in scheduled 

clinics where in operation 

Unscheduled immunisation forms completed and copy 

sent to GP and Information Services 

Write the date and vaccine given in the parent’s red 

book 

6. Inform the child’s GP and named professional (if 

appropriate) 

2008, 2009) 

To offer advice, support and aftercare 

To maintain good standards of record 

keeping and documentation 

To liaise with extended health care teams 

7. Complete data collection for Child Health Information 

system and return to informatics within 24 hours. 

Page 31 of 46

APPENDIX 8 

ANAPHYLAXIS 

Equipment required for the treatment of anaphylaxis 

Practitioners must have attended anaphylaxis training within the last 12 months and be 

competent in the administration of adrenaline. Although adrenaline may be administered in 

anaphylaxis emergencies, practitioners should preferably have a PGD for the administration of 

adrenaline. 

 

 

 

Mobile phone or landline access for emergency calls 

Laerdal or equivalent pocket mask or face shield for adults and children 

Adrenaline kit containing- 

-2 ampoules of Adrenaline (Epinephrine) 1:1000 (1mg/ml) injection 

- 4 x 23G (blue) needle (suitable for all ages). 

-A 21G (green) needle may be needed for obese patients. 

-A 25G 16mm length needle (orange) is suitable for IM injection in pre-term or very 

small infants ONLY. 

-4 x 1ml syringes (calibrated to 0.01ml) 

Adrenaline (epinephrine) dosage 

Adrenaline (epinephrine) 1 : 1000 (1mg/ml) solution 

The appropriate dose of adrenaline should be administered immediately by intramuscular (IM) 

injection (see table below). Treatment should be administered in accordance with advice given 

by the Resuscitation Council, Emergency treatment of anaphylactic reactions. Guidelines for 

Healthcare Providers (January 2008). A PCT Adrenaline PGD is available for practitioners to be 

signed up to use. 

Dose of adrenaline by age 

Child less than 6 years 

AGE 

DOSE OF ADRENALINE 

INTRAMUSCULAR (IM) 

(epinephrine) 1: 1000 (1mg/ml) 

150 micrograms 0.15ml route IM* 

Child 6-12 years 300 micrograms 0.3ml route IM 

Child over 12 years including adults 500 micrograms 0.5ml route IM 

*Use suitable syringe for measuring small volume 

Adrenaline must not be pre drawn 

300 microgram 0.3ml if child is small or 

prepubertal 

Page 32 of 46

APPENDIX 9 

Referral Pathway for Childhood Immunisations in 

Secondary Care 

Rationale: To prevent inappropriate referrals to secondary care 

Please ensure you have prior discussion with an Immunisation Trainer or the Immunisation Co-ordinator 

before referring to secondary care. 

Page 33 of 46

Contraindications to Immunisation 

All vaccines are contraindicated in those who have had: 

A confirmed anaphylactic reaction to a previous dose of a vaccine containing the same 

antigens, or 

A confirmed anaphylactic reaction to another component contained in the relevant 

vaccine, e.g. neomycin, streptomycin or polymixin B (which may be present in trace 

amounts in some vaccines). 

Live vaccines may be temporarily contraindicated in individuals who are: 

Immunosuppressed or Pregnant (see The Green Book) 

The following are NOT contraindications to immunisation 

Family history of any adverse reactions following immunisation 

Previous history of the disease (with the exceptions of BCG for people who have 

evidence of past exposure to tuberculosis) 

Contact with an infectious disease 

Premature birth 

Stable neurological conditions such as cerebral palsy and Down’s syndrome 

Asthma, eczema or hay fever 

Mild self-limiting illness without fever, e.g. runny nose 

Treatment with antibiotics or locally acting (e.g. topical or inhaled) steroids 

Child’s mother or someone in the household being pregnant 

Currently breast-feeding or being breast-fed 

History of jaundice after birth 

Under a certain weight 

Being over the age recommended in the routine childhood immunisation schedule 

Personal history of febrile convulsions or epilepsy 

Close family history (parent or sibling) of febrile convulsions or epilepsy 

Being a sibling or close contact of an immunosuppressed individual 

Recent or imminent elective surgery 

Imminent general anaesthesia 

Unknown or inadequately documented immunisation history 

Egg Allergy 

Individuals with a confirmed anaphylactic reaction to egg should not receive influenza or yellow 

fever vaccines. MMR vaccine can be safely given to most children with a previous history 

of allergy after ingestion of egg or egg-containing food, and vaccination with MMR can 

be performed under normal circumstances. 

For the small number of individuals who have a history of confirmed anaphylactic reaction after 

any egg containing food, specialist advice should be sought with a view to Immunisation under 

controlled conditions. 

Anaphylaxis 

The following statement relating to a definition of anaphylaxis is taken from the ‘Emergency 

treatment of anaphylactic reactions: Guidelines for healthcare providers (January 2008) 

produced by the Resuscitation Council (UK) 

Page 34 of 46

“A precise definition of anaphylaxis is not important for the emergency treatment of an 

anaphylactic reaction. There is no universally agreed definition. The European Academy 

of Allergology and Clinical Immunology Nomenclature Committee proposed the following 

broad definition: ‘Anaphylaxis is a severe, life-threatening, generalised or systemic 

hypersensitivity reaction’. This is characterised by rapidly developing life-threatening 

airway and/or breathing and/or circulation problems usually associated with skin and 

mucosal changes.” 

Ref: 

Department of Health 

2006 Immunisation against infectious disease 

(The Green Book), 

Resuscitation Council UK 2008 Emergency treatment of anaphylactic reactions. 

Guidelines for healthcare providers 

Page 35 of 46

APPENDIX 10 

PROCEDURES FOR MASS IMMUNISATION OF SCHOOL AGE CHILDREN IN 

THE SCHOOL NURSING SERVICE 

These procedures are to be read in conjunction with relevant PCT policies, Childhood 

Immunisation Policy, ‘Maintenance of the Cold Chain Policy’, ‘Mass Vaccination Policy’, 

‘Resuscitation Policy’, ‘Health Records Policy’, ‘Consent Policy’, ‘Standards for Medicine 

Management’ and associated standard operating procedures. 

Procedures 

ACTION RATIONALE PERSON 

RESPONSIBLE 

1. An up to date school year list is to be 

acquired from school. 

2. Parent/ guardians immunisation written 

consent forms to be ordered 

3. An appropriate number of verbal 

consent forms is printed to be used 

when initial consent forms have not 

been returned 

4. The correct amount of immunisation 

leaflets are ordered from DH or Library 

Resource Officer 

5. The immunisation timetable is agreed 

by the school nurse and the school 

health team for the next academic 

year. 

6. Immunisation dates agreed with each 

school’s senior leadership team. 

7. A risk assessment of the environment 

used for immunisation session to be 

completed 

8. An immunisation team is identified for 

each immunisation session. 

PREPARATION 

To identify the accurate cohort of 

pupils who require immunisation. 

To ensure there are an 

appropriate number of consent 

forms. 

To ensure that adequate stocks 

are available 

To ensure there are an 

appropriate number of 

immunisation information leaflets 

to send to young people, 

parents/guardians. 

To ensure that immunisations are 

offered within an optimal 

timescale. 


organised at an appropriate time 

within the school calendar. 


given in a safe environment 

To maintain adequate cover for 

sickness, safeguarding, holidays. 

St Helens - Named 

Immuniser for each 

school 

Halton – Admin 

and Clerical team 

A designated 

person from the 

Admin and Clerical 

team 


team 

Team Co-ordinator 

Team Coordinators 

School Health 

Teams 

Immuniser 

Immuniser 


9. A reserve nurse immuniser is identified To maintain adequate cover in Team Co-ordinator 

Page 36 of 46

for each session. 

10. The names and location of young 

people who are educated ‘otherwise’ 

and require immunisations are 

coordinated by a named nurse. 

11. The availability of an Admin Officer and 

a reserve clerk, is negotiated with the 

clinic clerical staff for each session 

including the sessions in the special 

schools. 

12. Sufficient number of vaccines ordered 

4 weeks prior to a session 

13. Year group and parent education 

sessions agreed with school as 

appropriate. 

14. Immunisation packs to be prepared:- 

HPV 

Information letter 

HPV Consent Form 

Q/A leaflet for parents / carers 

(Year 8) 

Information leaflet for young person 

Pre addressed return envelope 

marked private and confidential 

case of sickness 

To ensure that all school aged 

young people have the opportunity 

to be immunised. 

To ensure each session is 

supported by an Admin Officer. 

To ensure that the required 

amount of vaccine is available for 

each session. 

To ensure that young people and 

parents / guardians can make 

decisions based on informed 

consent. 

To ensure parents / guardians and 

young people have enough 

information to make an informed 

decision before completing and 

returning a signed consent form. 


Immuniser 

Immuniser 

Immuniser 


team 

Td/IPV 

Information letter 

DTP/MMR Consent Form 

Information leaflet 

Pre addressed return envelope 

marked private and confidential 

15. A written action plan is agreed by 

immuniser and the school lead which 

outlines the date that consent forms 

will be delivered and collected. 

16. The appropriate number of information 

packs is taken to school at least 3 

weeks prior to the immunisation 

session 

17. A labelled box file is available in each 

school for returned envelopes 

containing the consent forms. 

18. Returned consent forms will be 

collected from school on a pre- 

To ensure that the consent forms 

are transported by a member of 

the school health team. To avoid 

multiple visits to school to collect 

forms and to avoid loss of forms. 

To ensure that each parent / 

guardian receive a consent form 

and enough information to make 

an informed decision. 

For risk minimisation. 

To allow enough time for the 

consent forms to be processed 

Immuniser 

St Helens - School 

Nurses 

Halton – School 

Health Nursing 

Assistant 

Immuniser 

St Helens - 

Immuniser 

Page 37 of 46

arranged date at least one week before 

the immunisation session 

19. Returned consent forms logged 

against the school’s year list. 

20. Where consent has been refused the 

forms to be identified as a ‘consent 

refusal’ and filed separately. 

21. In the event of a consent form being 

lost, a second consent form is sent to 

the parent/ guardians. This second 

form must state the pupil’s name and 

date of birth and be clearly marked 

DUPLICATE. 

22. A list to be made of the outstanding 

consent forms. 

23. When consent forms are not returned, 

the parent / guardians to be contacted 

by the Immuniser to obtain verbal 

consent in accordance with consent 

guidelines and the Childhood 

Immunisation Policy. 

24. Consent forms checked for parental 

concerns and discrepancies. 

25. The immunisation equipment is cross 

checked with the agreed list and 

prepared for the session 

26. St Helens and Widnes 

The correct number of vaccines 

required for the session is removed 

from the fridge in the clinic setting. The 

temperature of the fridge checked as 

per Cold Chain Policy. 

Runcorn 

The correct number of vaccines is 

collected from North Cheshire Hospital 

(Halton) pharmacy. 

PCT wide 

Vaccines are transported to the school 

in an approved vaccine carrier 

1. Equipment laid out onto each 

immunisation table. 

Adrenalin boxes and packs are to be 

before the immunisation sessions. Halton – School 

Health Nursing 

Assistant 

To identify those young people 

who require immunisation and 

those who do not consent to the 

immunisation being given. 

To minimise risk of immunisation 

without consent. 

To ensure that the correct form is 

issued to the correct pupil. To 

avoid immunisations being given 

twice. 

To enable the Immuniser to 

contact parents / guardians to 

facilitate verbal consent if 

appropriate. 

To facilitate verbal consent safely 

To extract issues / questions 

which need addressing. 

To ensure that the correct 

equipment is taken into school. 

To take the correct amount of 

vaccine to the session at the 

correct 

temperature 

To maintain the cold chain. 

PRE ADMINISTRATION OF VACCINE 

To ensure that each nurse has 

access to everything she needs 

and is adequately prepared should 


team 


team 


team 


team 

Immuniser 

Immuniser 

Immuniser 

Immuniser 

Immuniser 

Page 38 of 46

easily accessible. a young person have an 

anaphylactic reaction. 

2. Pupils present themselves to the clerk, 

who verifies name, date of birth and 

address of the child and the completed 

consent form is given to the child 

3. Children / young people who do not 

have written consent to be seen by an 

Immuniser and be assessed for their 

ability to give verbal consent as per 

consent policy 

4. The Immuniser confirms the correct 

identity with the child 

5. Confirm which vaccine is to be given 

with the child/parent. If there are any 

anomalies in the schedule or history, 

contact the informatics department. 

6. If there are unanswered concerns, 

refer to immunisation coordinator or 

specialist lead immunisation 

coordinator 

7. Check for contra-indication especially 

with regard to pregnancy, illness, 

medication, allergies, fever, previous 

adverse reaction and any recent 

vaccinations. 

8. Ensure the child/parent is aware of 

common adverse reactions and action 

to take if they have any concerns 

9. Explain the procedure, ensuring that 

the child/parent understands about the 

vaccines to be given 

10 Establish current health status to 

assess if child is fit for immunisation 

To ensure that the right person 

receives the right immunisation 

To ensure that all young people 

are given equal opportunity to 

receive their immunisation. 

To establish the correct identity 

and immunisation schedule 

To explain the procedure 

To assess if fit for immunisation 


team 

Immuniser 

Immuniser 

Immuniser 

Immuniser 

ADMINISTRATION OF VACCINE 

1 In the presence of the child/parent, To minimise the risk of drug errors Immuniser 

select the correct vaccine, check 

dosage, expiry date and prepare 

immediately prior to immunising the 

child. Reconstitute if necessary 

according to the manufacturer’s 

instructions 

2 Be aware of the dose of adrenaline 

that may be required for the individual 

child. Adrenaline must not be predrawn 

3 Check the route of administration and To decide on appropriate route 

be familiar with the method of delivery and treatment 

Immuniser 

4 Ensure safe positioning of child and To offer evidence based practice Immuniser 

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administer vaccine at correct site using 

appropriate equipment and technique 

Note 

Medical and nursing staff must give 

routine vaccines by the intra-muscular 

or deep subcutaneous route only. The 

sites which can be used are the middle 

third, upper outer aspect of the thigh or 

arm according to the manufacturers 

recommendations 

5 Each immunisation carried out in 

accordance with the appropriate PGD 

as per PCT Patient Group Direction 

(PGD) Policy 

6 Dispose of equipment as per Infection 

Prevention and Control policy. 

To ensure that each immunisation 

is given correctly and safely in 

accordance with local and national 

guidance. 

Immuniser 

POST ADMINISTRATION OF VACCINE 

1 Record the administration of the 

vaccines to include date of 

administration, name of vaccine, dose, 

the batch number, the site, the route of 

administration, expiry date and 

manufacturer. Immuniser to print and 

sign name and designation. This 

completed consent form to be given to 

the Admin and Clerical team 

2 In the case of HPV, a record card to be 

completed for each pupil after each 

immunisation and given to the pupil 

after dose 3 

3 After the immunisation, each pupil be 

given a post immunisation letter to take 

home 

To maintain good standards of 

record keeping and 

documentation 

To provide each pupil with a 

complete record of their HPV 

immunisation. 

To inform parents / guardians 

that the immunisation has been 

given and to provide them with 

information about possible side 

effects. 

Immuniser 

Immuniser 


team 

Immuniser 


team 

4 Observation of a patient following 

immunisation 

The Department of Health does not 

state a specific time and does not 

recommend long periods of 

observation. The risk of severe lifethreatening 

reactions after 

immunisation is extremely small. A 

short period of observation (5-10 

In the case of HPV the letter will 

tell the young person, parent / 

carer which dose they have 

received and when the next one 

is due. 

(See Immunisation against 

Infectious Diseases 2006 page 

31). 

Resuscitation Council (UK) 2008 

(updated 2008, 2009) 

Page 40 of 46

minutes), whilst completing 

documentation, should be used to 

detect immediate problems. 

5 2 immunisers to remain on school site 

for approximately 30 minutes following 

the last immunisation to support school 

staff 

To ensure that any clinical 

incidents after the immunisation 

session are dealt with 

appropriately 

School nursing team 

AFTER THE SESSION AT BASE 

1 Immunisation data is recorded 

according to local requirements 

HPV consent forms are photocopied 

and sent to informatics after dose 1 

and 2. The original consent form be 

sent after dose 3. 

2 A HPV tally sheet for each year is 

completed after each HPV 

immunisation session 

3. Unused vaccines are returned promptly 

to the fridge as per Cold Chain Policy 

4. A letter is sent to the parents / 

guardians of pupils who did not receive 

their immunisation explaining the 

reasons for non immunisation and what 

action the parent/guardian should now 

take. 

Any pupil who does not receive their 

immunisation in school may be offered 

the immunisation in a future clinic in 

school or the community 

5. Once the consent forms are returned 

from informatics, the consent form is 

filed in each pupil’s records. If any of 

the child health records are unavailable 

follow the records management policy. 

6. All admin and clerical officers will 

check that the same number of 

consent forms that were sent to 

informatics are returned to the clinic. 

7. Following HPV Immunisation Sessions 

consent forms and immunisation 

record cards are stored securely at 

base, between each session. 

To enable data to be entered 

onto the Child Health Computer 

in a timely manner. 

To ensure that the monthly 

returns for HPV are accurate 

and available to the Department 

of Health 

To store vaccines safely 

To ensure that parents / 

guardians are kept informed 

about their child’s immunisation 

needs and to ensure that all 

young people will be given equal 

opportunity to receive their 

immunisation. 

To ensure the PCT holds health 

information for every pupil. 

To enable practitioners to cross 

reference immunisation dates 

with each young person’s 

consent form and to ensure that 

consent forms are appropriately 

filed in each pupil’s records. 

To ensure that the original 

consent form is available for the 

next stage of the programme. 


team 


team 

Immuniser 


team 


team 


team 


team 

8. Young people who are educated To ensure that all young people Team Co-ordinator 

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‘otherwise’ are invited to a community 

session or offered the immunisation at 

home. 

9 If any pupil relocates to another school 

during the immunisation programme, 

their consent form and immunisation 

record card to be included in the child 

health record prior to booking out to 

new clinic/PCT. Transfer out data will 

be recorded. 

are given equal opportunity to 

receive their immunisation. 

To ensure that pupils are 

included in the correct 

immunisation session and thus 

receive their immunisation in a 

timely manner. 


team 

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APPENDIX 11 

HEALTH VISITING TEAM PRE IMMUNISATION CHECK LIST 

Childs Name: 

Yes 

Date of Birth: 

Location: 

No 

Date: 

Checked client details with relevant documentation 

Discussed vaccines to be administered 

Informed verbal consent obtained 

Identify if child is well today 

Has the child had a temperature in last 48 hours 

Are they on any medication 

Did the child have any problems with any previous vaccinations 

Has the child ever had an allergic reaction to anything 

Has the child received another vaccine in last 4 weeks 

If yes document what they are; when & where given. 

Was vaccination deferred 

Has the child had this vaccine(s) anywhere else 

If yes document and inform information services & GP 

Post vaccination advice/ 2009 leaflet given. 

Information services & GP surgery informed of vaccines administered. 

Signed: 

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APPENDIX 12 

Guidelines for Domiciliary Immunisation 

These guidelines are intended to support all staff who administer immunisations, within a 

domiciliary setting. 

These guidelines should be used in conjunction with the current volume 

and updated chapters of Immunisation against Infectious Disease (2006), (The Green 

Book) 

Immunisers must adhere to all process and procedures in the Trust’s Childhood 

Immunisation Policy (2010), 

In the event of a failed visit, one further appointment may be made and the referrer 

notified. 

Action 

Rationale 

Referral received and immunisation status checked 

with GP and information services 

Immuniser to contact the family to arrange an 

appointment 

Immuniser to practice in accordance with the 

Childhood Immunisation Policy 2010 when offering 

immunisations in the home setting 

Vaccines transported according to the Cold Chain 

Policy 

Immuniser and a second staff member to attend visit 

To prevent immunisation 

duplication/drug errors 

To maintain time management 

To ensure evidence based practice is 

followed. 

To maintain the cold chain 

To aid in emergency assistance 

Mobile phone available and accessible during visit 

Childhood Immunisation Procedural Guidelines to be 

followed in the preparation, administration and 

documentation of immunisation 

Unused vaccines returned as per Cold Chain Policy 

To offer evidence based practice 

To maintain the cold chain 

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APPENDIX 13 

Equality Impact Assessment Tool 

To be completed with the corporate document when submitted to the appropriate committee for 

consideration, approval and ratification. 

1. Does the corporate document affect one group 

less or more favourably than another on the basis 

of: 

Yes/No 

Race N 

Ethnic origins (including gypsies and travellers) N 

Nationality N 

Gender N 

Culture N 

Religion or belief N 

 

Sexual orientation including lesbian, gay and 

bisexual people 

Comments 

Age Y Children 0-18 years 

 

Disability - learning disabilities, physical disability, 

sensory impairment and mental health problems 

2. Is there any evidence that some groups are 

affected differently 

3. If you have identified potential discrimination, are 

there any exceptions valid, legal and/or 

justifiable 

4. Is the impact of the policy/guidance likely to be 

negative 

5. If so can the impact be avoided 

6. What alternative are there to achieving the 

policy/guidance without the impact 

7. Can we reduce the impact by taking different 

action 

N 

N 

N 

Y 

N 

As above 

If you have identified a potential discriminatory impact of this corporate document, please refer it 

to [insert name of appropriate person], together with any suggestions as to the action required 

to avoid/reduce this impact. For advice in respect of answering the above questions, please 

contact [insert name of appropriate person and contact details]. 

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APPENDIX 14 

Dissemination and Training Plan 

To be completed with the corporate document when submitted to the appropriate committee for 

consideration, approval and ratification. The status column must be given a Red, Amber or 

Green rating with evidence to demonstrate an action has been completed. 

DISSEMINATION PLAN 

Title of document: 

Childhood Vaccination and Immunisation 

Dissemination Lead: (Print name and 

contact details) 

Proposed action to retrieve out-of-date 

copies of the document: 

Date finalised: 02.11.10 

Previous document already being used no 

If yes, in what format and where Electronic/Intranet 

Withdraw from the internet/intranet/portal 

To be disseminated to: 

Disseminated 

by whom 

Timescale 

(Date) 

Status 

R A G 

Paper 

or 

Electronic 

Comments 

Trust Times 

Team Brief 

Training sessions (Give Details Below) 

Other (Give Details Below) / 

Child Health 

Service leads 

Within 3 

months 

electronic 

IMPLEMENTATION PLAN 

Training Timescale Owner Status 

R A G 

Training Event (Please provide details of available training venues/dates 

to educate staff about this document) 

Training Plan Lead (Please provide details of staff who will be 

responsible for overseeing this training) Team leaders child health 

Within 3 

months 

Service 

leads 

Compliance Monitoring Timescale Owner Status 

R A G 

 

Methodology to be used for monitoring/audit (please include PCT 

Audit Proposal Form) 

12 months Service 

lead 

Responsibilities for conducting monitoring/audit Team 

leaders 

Frequency of monitoring/audit (e.g. annually, 6 monthly etc) annual Team 

leaders 

Process for reviewing/reporting results essential training 

PDR process 

Denotes: Action not yet taken or deadline for action not met. Action plan to address this must be provided. 

Denotes: Action partially implemented. 

Denotes: Action complete. 

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Childhood Immunisation Policy - Halton and St Helens PCT

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