Delivery of the HINI Vaccination Programme within the Southern Health and Social Care Trust

A reflection

Glynis Henry

Assistant Director of Nursing for workforce Development and Training

Glynis Henry

Assistant Director of Nursing for workforce Development and Training

ContentsContents

Context Background Working structure and arrangements Activity Learning through reflection

ContextContext Late April 2009 – WHO announced emergence of

a novel influenza virus From a health and social care system perspective

spring 2009 was characterised by planning to prepare for a potential pandemic influenza

11th June 2009 the World Health Organisation had announced a move to pandemic alert 6, the intensity of preparedness planning intensified.

Vaccination development was underway

Pandemic Influenza (H1N1) Vaccination Programme Pandemic Influenza (H1N1) Vaccination Programme

1st July 2009 HSS (MD) 28/2009:Vaccine availability, timeframe, licensing, number of doses, storage and presentation, initial priority groups, resources, training, information materials and data collection

14th August 2009 HSS (MD)37/2009Increased clarity re supply, prioritisation and that the seasonal influenza programme would continue as normal

Pandemic Influenza (H1N1) Vaccination ProgrammePandemic Influenza (H1N1) Vaccination Programme 6th October HSS (MD) 44/2009

Covered specific issues including vaccines, supply, distribution, storage, priority groups, Trust arrangements, primary care arrangements, university health service, monitoring uptake and information.

15th October HSS (MD) 47/2009Provision of final details of the programme and Launch date for programme

Pandemic Influenza (H1N1) Vaccination ProgrammePandemic Influenza (H1N1) Vaccination Programme

Further updates followed including HSS (MD)49/2009, HSS (MD)58/2009 24th November which announced phase two of the programme, through to end of the financial year and beyond, HSS (MD) 9/2010.

Structure and arrangementsStructure and arrangements Regional Pandemic Vaccination work-stream

Comprising a number of stakeholders including for example, PHA, BSO, HSCB, DHSSPS HSC Trusts and universities and was multidisciplinary in make up.Met frequently and communication was via a range of modes.

SHSCT pandemic vaccination work-streamIncluded PHA, HSCB and Trust staff. Multidisciplinary initially with a relatively small membership which expanded as information about the programme increased. Meetings scheduled to follow regional meetings.

SHSCT pandemic vaccination work-streamSHSCT pandemic vaccination work-stream

Purpose: Prepare plan to deliver pandemic vaccination programme and deliver that plan

Plan included a number of elements:

Model, supplies of vaccine(s), workforce, training, information and communication, system for data collection, monitoring and reporting

Programme streamsProgramme streams

All pregnant women Those within clinical risk groups 6 months - 65

years Household contacts of immunocompromised

individuals People aged 65 and over in the current seasonal

flu vaccine clinical at risk groups Frontline health and social care workers (extended

to all)

Pandemic Influenza (H1N1) Vaccination ProgrammePandemic Influenza (H1N1) Vaccination Programme

Special schools Inpatients within clinical risk groups with hospital

stay of more than 7 days Egg and constituent allergy vaccination clinic Domiciliary/housebound community (supporting

primary care) Children 6 months – 5 years

The Trust had to ensure arrangements were in place for it deliver vaccination to all these streams

ActivityActivity H1N1 Swine Flu vaccination programme activity: Number of staff vaccinated 3895 (as at 1st January 2010) Number of pregnant women vaccinated 2358 (as at week ending 16th April 2010) Egg and constituent allergy vaccinations 116 dose 1 and 102 dose 2 (as at week ending 16th April 2010) Total number of ‘at risk inpatients’ vaccinated 209 (as at 31st March 2010) Number of Children >6 months and < 5years vaccinated 2669 (week end 12th March 2010)

ActivityActivityPandemic (Swine) Flu Vaccination Programme in Special Schools

23rd October 2009 - SHSCT

SPECIAL SCHOOL No. Eligible No. Immunised Dose 1

No. requiring 2 doses

No. Immunised Dose 2

Lisanally

99

76

20

16

Sperrin View

84

64

30

25

Donard

55

43

24

15

Ceara

95

71

19

14

Rathore

113

94

55

38

Total

446

348

148

108

Activity Activity Patients vaccinated in domiciliary setting Dec 2009/ Jan 2010 Total no. patient vaccinated

Total no. of no access visits

Number of vaccines declined

Number of vaccines deferred

1493 44 141 106 H1N1 flu vaccinations – Nursing home numbers Newry & Mourne 270 Armagh 148 Portadown 64 Dungannon 38 Banbridge 170 Lurgan 164 Total 854

The reflective cycle (Gibbs 1988)

Gibbs reflective cycleGibbs reflective cycle

Description: what happenedFluid dynamic situation

Feeling: what we were thinking and feelingDynamic, changing, trying to keep pace, communication

Evaluation: what was good and badGood-Regional and local groups, team work, support, commitment of staff, training, responsiveness of all involved, expertise of colleagues. Regional group approach to learning the lessons Challenge- Trying to keep everyone informed in a fluid situation

Gibbs reflective cycleGibbs reflective cycleAnalysis: What sense we could make of it

Recognise need to strike the right balance between regional direction and local delivery model. The approach based on prioritisation worked well. Sound decision making at critical points. Support the creative thinking of staff.

Conclusion: what else could we have done

Encouraged more engagement with areas where public health is not as embedded. Continued focus through the ongoing programme

Action plan: If it arose again what would we doFeel better prepared in light of the experience We think the focus on priority groups encouraged uptake and lessened the impact of surge on the acute hospital system

ConclusionConclusion

Don’t judge each day by the harvest you reap, but by the seeds you plant.

(Robert L Stevenson)

A final word:

Thank you, colleagues from Regional Agencies and Education Providers who supported us.

Thanks to the Trust’s Vaccination Group, the vaccinators and to all those staff and managers who contributed and supported this work.

Thank you all for listening.

Glynis Henry