Guidance

Guidance on immunisation training during the COVID-19 pandemic

Published 26 June 2020

UK Health Security Agency (UKHSA) offer the following guidance on immunisation training during the pandemic to support providers for whom immunisation is going to be an on-going routine professional responsibility.

During the global COVID-19 pandemic it is imperative that vaccine uptake remains high and that vaccines continue to be delivered safely by a well-trained and confident workforce. The response to the pandemic has disrupted the provision of face to face, classroom-based immunisation training.

1. The importance of maintaining the immunisation training standards

The National Minimum Standards and Core Curriculum for Immunisation Training for Registered Healthcare Practitioners and the National Minimum Standards and Core Curriculum for Immunisation Training of Healthcare Support Workers describe the minimum training, assessment and supervision that should be provided to those with a role in advising on or delivering immunisations.

The purpose of training is to facilitate safe and effective vaccination whilst acknowledging that providing an effective immunisation programme is more complex than simply administering a vaccine. The standards are not intended to be onerous for immunisers or create an excessive demand on service providers and they should not be seen as a barrier which prevents timely immunisation.

It is recommended that the standards continue to be followed as far as possible during the pandemic.

2. Immunisation training during the pandemic

During the pandemic, it is likely that the opportunity to attend face to face, classroom-based training will continue to be severely limited due to social distancing advice. Immunisers can therefore utilise e-learning, online and virtual training sessions to access foundation and update training rather than the face to face or the mixed delivery learning approaches recommended in the standards documents. Training can be benchmarked against the curriculum detailed in the Core Curriculum documents.

The training required will differ depending on the immuniser’s previous knowledge, experience and background and their role in delivering or advising on immunisation. It is recommended that as far as possible, immunisers undertake foundation training and updates relevant to their specific area of practice and the vaccine(s) that they deliver. They should follow the recommendations in the registered healthcare practitioner standards or the healthcare support worker standards as appropriate.

Where training is well established, it is recommended that immunisers continue to adhere to the current local requirements as closely as possible, albeit using different methods of training than the method usually recommended. Staff may not be able to exactly match the stated requirements at this time (for example, to attend a 2-day course or updates annually) but they should be allowed to continue to vaccinate as long as both they and their employers believe that they are competent and confident to safely do so.

3. Training for those new to immunisation

1. Training needs to be provided prior to new immunisers starting to immunise and not postponed until after the pandemic.
2. E-learning and online training that follows the curriculum detailed in the Core Curriculum documents is considered a reasonable training method when face to face training cannot be delivered.
3. Face to face participatory training is a valuable training medium and therefore it should be reinstated as soon as it is safe and possible to do so within the national guidelines for control of SARS-CoV-2 virus.
4. New immunisers who undertake online foundation immunisation training during the pandemic should be given the opportunity to attend face to face training if they wish to once this is available.

4. Supervision and assessment

In addition to acquiring theoretical knowledge, immunisers need to have time to develop clinical skills in immunisation and apply their knowledge in practice. A period of supervised practice to allow observation of, and development of clinical skills and application of knowledge to practice is essential. Supervision for new immunisers and support for all immunisers is critical to the safe and successful delivery of the immunisation programme and work-based learning is a vital component of all immunisation training.

It is recommended that all new immunisers complete a competency assessment such as the one in the Appendix in the training standards documents (also available on the RCN website) for formal assessment and sign-off of their clinical competency. The competencies required will depend on the individual service area and the specific range of vaccines given by the immuniser but the tool is suitable for use in all areas. Additional competencies, as required by locality or service area, can be added or adapted as necessary.

For new immunisers, theoretical e-learning should be sequenced with their work-based learning so that by the time of assessment of competence, both aspects of training have been completed.

5. Remaining up to date

Immunisers are required to keep up to date. Updating should be seen as a continuous ongoing process rather than purely as a one-off annual event.

The ways immunisers can keep up to date include:

• subscribing to the monthly UKHSA publication, Vaccine update
• reading the ‘Information for Healthcare Practitioner’ documents on GOV.UK
• reading relevant journal articles
• reading any letters and information materials from DHSC, NHS England and Improvement and UKHSA that become available
• reading any recently updated chapters of the Green Book
• undertaking the assessment sections of the immunisation e-learning programme
• self-assessment using the competency assessment tool to identify if there are any areas where they need to update or further their knowledge
• attending online updates such as webinars which have been arranged in some areas (see below)

6. Current available training

A comprehensive immunisation e-learning programme is available on the Health Education England e-Learning for Healthcare website which is free of charge and open access to all. This e-learning programme has been written in line with the recommendations made in the training standards and covers the core areas of immunisation with which healthcare practitioners need to be familiar to deliver immunisations safely. The e-learning programme is relevant to healthcare practitioners with a role in immunisation whatever their background and the setting in which they give or advise on vaccination.

This programme consists of 7 knowledge sessions with accompanying assessments. It is recommended that those new to immunisation complete all 7 sessions. Those with prior knowledge and experience in immunisation can read through the relevant knowledge sessions for refresher training or undertake the assessment sessions to check on their knowledge. Learners may also wish to only undertake the sessions relevant to their role if appropriate.

The UKHSA immunisation webpage provides training slide sets and ‘Information for Healthcare Practitioner’ documents for each vaccine programme which supplement the information provided in the online Green Book. UKHSA will update and add to the training and information resources as required.

The eLfH flu e-learning programme will be updated for the 2020 to 2021 flu season and anyone who gives or advises on flu vaccine can undertake this e-learning programme. New flu immunisers are likely to require additional training (for example, in vaccine administration, storage, legal issues) if they have not administered vaccines before which they can obtain by undertaking the relevant sessions in the general eLfH immunisation elearning programme.

In many areas, training arrangements are well-established and plans have been or are being made to adapt training so that what cannot be delivered as a face-to-face session will be modified to an online meeting or webinar. Any existing training organised at local level should be utilised and those responsible for organising or providing training should consider how training can be delivered effectively within their locality. There are multiple benefits in offering local training where possible as it allows both for any specific local needs or arrangements to be covered and the potential for smaller group interactive online learning which could incorporate a question and answer session.

7. Additional considerations

Immunisers have a personal and professional responsibility to ensure that they have the required knowledge and skills and are able to practice safely within their professional Code and sign and operate under a vaccine patient group direction (PGD). They should inform their employer if they feel they require further training and employers need to be receptive and facilitate this.

It is important that employers allow adequate protected and dedicated study time to those that need to undertake immunisation training. Consideration should be given to the fact that new immunisers will require more time for training than those who are updating their knowledge. In addition, immunisers should be given access to relevant technology to be able to undertake elearning and participate in online training sessions.

8. Expert advice

Although immunisers should try to find the answers to clinical questions for themselves in the first instance (for example from the Green Book and other resources listed above), it is important that they know who to contact should they require additional accurate, expert immunisation advice. This may be their local Screening and Immunisation team, UKHSA Health Protection Team, other locally available immunisation lead, Medicines Management team, Occupational Health lead. Those responsible for commissioning vaccine programmes locally are requested to make relevant contact information available to vaccine providers.

9. Summary

Immunisation remains an essential service and immunisation training should continue to be seen as an important priority during the pandemic. It is vital that immunisers are given the time and opportunity to undertake training and that they are supervised and supported in practice as required. Good quality immunisation training prevents errors and leads to a successful programme. The overall recommendations made in the training standards for immunisation have not changed but while pandemic related restrictions apply, the ways in which immunisers undertake training may need to be adapted.

The comments and suggestions from expert training colleagues in the writing of this statement are very gratefully acknowledged.