BCG patient pathway flowchart: text alternative
Updated 9 December 2021
Applies to England
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Step 1
Bacillus Calmette–Guérin vaccine (BCG) eligibility[footnote 1] identified at booking appointment and recorded in maternal notes.
Step 2
Baby born in hospital in community or home birth.
Step 3
Midwife, neonatal nurse or paediatrician assesses and records BCG eligibility on:
- NIPE S4N
- local maternity IT system
- discharge summary to GP or Health visitor
Step 4
Offer Severe Combined Immunodeficiency (SCID) screening.
If declined:
Notify GP or health visitor (HV) via discharge summary or suitable local alternative, inform Childhood Information System (CHIS).
Discharge – follow local discharge policies.
If accepted – go to step 5.
Step 5
Referral via local systems (includes mother’s medical history, checklist, translation needs).
Go to step 6.
Step 6
Healthcare practitioner assesses eligibility or contraindications (CI) from referral or list.
Go to step 7.
Step 7
Prior to clinic, provider checks SCID screening status of neonate (CHIS):
If SCID suspected go to step 8.
If SCID Screen not offered or SCID not suspected or SCID declined go to step 12.
If SCID Screen offered and result unavailable – reschedule BCG appointment.
Step 8
Provider checks with GP whether Immunology discharge letter received.
Go to step 9.
Step 9
Check if GP confirms baby can receive BCG.
If no go to step 10.
If yes go to step 12.
Step 10
Cancel BCG appointment.
Go to step 11.
Step 11
Record in PCHR red book, local database and inform GP, HV or CHIS.
Discharge – follow local discharge policies.
Step 12
Offer BCG appointment:
If declined go to step 13.
If accepted go to step 15.
Step 13
Provider contacts to discuss decision.
Re-offer BCG appointment.
If declined go to step 14.
If accepted go to step 15.
Step 14
Appointment declined.
Record in PCHR red book, local database and inform GP, HV or CHIS.
Discharge – follow local discharge policies.
Step 15
Attendance:
If not attended – reoffer appointment as per DNA policy.
Go to step 16.
If attended go to step 17.
Step 16
Attendance:
If not attended – follow DNA policy.
Record in PCHR red book, local database and inform GP, HV or CHIS.
Discharge – follow local discharge policies.
If attended go to step 17.
Step 17
BCG vaccination appointment: given or not given or declined.
Record in PCHR red book, local database and inform GP, HV or CHIS.
Discharge – follow local discharge policies.
Glossary
CHIS: Child Health Information System
IT: Information technology
NEMS: National Events Messaging System
SCID: Severe Combined Immunodeficient Syndrome
NIPE S4N: National IT system for the Newborn and Physical Examination screening programme
PCHR: Personal Child Health Record aka ‘Red Book’
BCG: Bacillus Calmette–Guérin vaccine
PMH: Past medical history
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BCG eligibility is described in chapter 32 of the Green Book ↩