Running Flu Clinics: Current Vaccine Features

Top Resources &

Practice Setup

March 2016

Running Flu Clinics

This session will cover:

• Key flu vaccine considerations for the 2016 season

• How to set up the practice for effective and safe patient flow

• Effective patient recruitment strategies

• Medicare versus private billing: the MBS items we can and cannot claim

• The best resources to support flu vaccine efforts in your clinic

2016 Influenza Vaccine

What’s new?

Available from April 2016

Two quadrivalent influenza vaccines (QIVs) will be available free of charge to eligible people under the National Immunisation Program

The Australian Technical Advisory Group on Immunisation (ATAGI) recommends the use of QIVs in preference to Trivalent influenza vaccines (TIVs).

However, TIVs are an acceptable alternative particularly if QIVs are not available.

About the 2016 Flu Vaccine

New composition:

• A (H1N1): an A/California/7/2009 (H1N1) - like virus

• A (H3N2): an A/Hong Kong/4801/2014 (H3N2) - like virus

• B: a B/Brisbane/60/2008 - like virus

Quadrivalent also contains:

•B: a B/Phuket/3073/2013 - like virus

Vaccine brands – free government supply •Sanofi’s FluQuadri® Junior for children under 3 years of age.

•GSK’s Fluarix ® Tetra for people aged 3 years and older.

National Immunisation Program

Patients eligible for free flu vaccine:

• Everyone 65 years of age and over

• All pregnant women at any time during pregnancy

• Aboriginal and Torres Strait Islander children who are six months to less than five years old

• Aboriginal and Torres Strait Islander people aged 15 years and over

• Anyone aged six months and over with a medical condition predisposing them to severe influenza

Medical conditions associated with an increased risk of influenza disease complications

Accessed via: http://www.ncirs.edu.au/assets/provider_resources/fact-­‐sheets/influenza-­‐fact-­‐sheet.pdf

Contraindications

The only absolute contraindications:• Anaphylaxis following a previous dose of any influenza vaccine

• Anaphylaxis following any vaccine component

Precautions for people with known egg allergy:

Risk of vaccination anaphylaxis of egg-allergic patients is very low

Persons with egg allergy, including anaphylaxis, can be safely vaccinated with vaccines that have less than 1 μg of residual egg ovalbumin per dose

There is still a low risk of anaphylaxis

Patients should be vaccinated in facilities with staff able to recognise and treat anaphylaxis

Quadrivalent Vaccines

Accessed via: http://www.ncirs.edu.au/assets/provider_resources/fact-­‐sheets/influenza-­‐fact-­‐sheet.pdf

Accessed via: http://www.ncirs.edu.au/assets/provider_resources/fact-­‐sheets/influenza-­‐fact-­‐sheet.pdf

Trivalent Vaccines

Accessed via: http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/Handbook10-home~handbook10part4~handbook10-4-7

Recommended doses in children & adults

Common reactionsSide effects may include:• Local reactions at the injection site: pain/redness

• Mild fever

• Mild muscle aches

• Tiredness

• In younger patients (6 months - 5yrs):

• Irritability/drowsiness

Anaphylaxis is very rare, but very serious if it occurs

• Adrenaline and a suitably trained provider must always be readily available

• Patients should wait at least 15 minutes at the clinic after their vaccination

Other considerations

Full protection is usually achieved within 10 to 14 days with evidence of increased immunity within a few days

Repeat vaccination every year

The influenza vaccine does NOT give the flu

Contents of the syringe must be shaken thoroughly before use

Report adverse events to TGA: www.tga.gov.au/reporting-problems-1

Adverse Medicines Events Line: 1300 134 237 (for patients)

Flu Clinic Types

Allocate protected days/times for vaccination sessions

More effective patient flow

Practice nurse can coordinate vaccination clinics

Team approach of Nurse + GP

At the practice

Workplace/Corporate vaccinations

Pop-up/Mobile service

Assist with uptake and herd immunity

Challenges of off-site practice (staff, equipment and cold chain logistics)

Community intercept (convenient locations, non-medical environment)

Outreach service

Opportunistic vs Planned approach to flu vaccines

Use clinical software to get a list of eligible patients

Allocate nurse/GP times, sessions or days when flu clinics will run

Decide if the practice will be Bulk billing or Privately billing consults

Inform all staff of flu clinic process (during staff meeting or via memo)

Ensure there’s enough stock to meet demand

Discard stock from the previous season & check expiry dates

Check vaccine fridge temperatures are recorded daily and are within recommended range +2° to +8° C

Ensure there is adequate equipment & staff for anaphylaxis management

For safe & efficient patient flow

Preparing the practice

Recruit patients

Poster in the waiting room to promote flu vaccination

Proactively invite patients (via letter, phone or mobile notification)

Promote influenza vaccination to all patients

Immunise practice staff!!

For safe & efficient patient flow

Preparing the practice

Waiting room poster to promote vaccination

Invitation template (letter/mobile notification)

Patient fact sheet/consent form

Clinical reference:

• The Australian Immunisation Handbook 10th Ed (also available online)

• Age/brand/dosage information for brands you carry

• Anaphylaxis management dose table (Immunisation Handbook)

For safe & efficient patient flow

Essential Resources

Nurses’ scope of practice

Influenza vaccines are Schedule 4 drugs

The vaccine must be initiated/authorised by a GP prior to administration

A GP must be readily available (at the clinic) in case of anaphylaxis

(including until the last patient’s 15min waiting time is up)

The authorising/ordering GP must make an entry in the patient file

RN Div 1 or Med-endrosed EN Div 2

Credentialed Nurse ImmunisersMay initiate influenza vaccines as per the National Immunisation Schedule

GP intervention is not required

Nurse must have CPR and anaphylaxis management skills up to date

Billing considerations

MBS Items:

3 – Brief. Must include a GP consult & entry in patient file

23 - Standard (up to 20min). Must include a GP consult & file entry

10997 – Nurse Monitor/Support. Patient must have a GPMP in place. Consult must include a documented element of monitoring or support of the patient’s chronic illness and not simply “giving the jab”

Bulk billing vs Private billing

Private billing without a Medicare rebate Private fee for nurse consult ($5 - $15+)

Private fee for vaccine if not eligible for government supply ($8 - $25+) Must use private stock if charging for vaccines

Thank you for participating!

Got a question? Email: md@hotdoc.com.au