The Child Health Department, COVER and documentation

1. The Child Health Department, COVER and documentation

2. Learning Objectives • Document a vaccination correctly in all relevant records • Explain the importance and purposes of recording information about vaccinations in each system • Describe the role and importance of vaccination coverage data • Describe the role of the Child Health System in record-keeping, calling and re-calling for immunisation. • Report Serious Untoward Events

3. Record Keeping • Registered nurses have a professional and legal duty of care to their patients • Remember! Anything written in your capacity as a nurse could potentially be used in a court of law • Accurate accessible vaccination records are important: • To help to protect you and the welfare of your patient • Assist in monitoring immunisation uptake • Facilitate recall of vaccine recipient if required

4. Record Keeping Good record keeping helps to protect the welfare of children Provides an accurate account of immunisations given to children Better communication and dissemination of information between the clinical team Facilitate recall of vaccine recipient if required Assist in monitoring immunisation uptake

5. What needs to be documented? • When a vaccine is administered, the following information should be accurately recorded • Name of vaccine • Product name • Expiry date - recording this is evidence that it has been checked • Batch number - in case of future problems/recall • Date vaccine is given • Site of injection - including description of which injection was administered in each site • The name and signature of vaccinator

6. Where should it be recorded? • Personal Child Health Record (PCHR) or “Red Book” • Patients/parents should be encouraged to look after their own vaccination records or that of their child’s. • Can be a useful source of reference for other health care professionals who may be involved in episode of care eg: Accident & Emergency visits

7. Medical/GP records • This should contain details of all care given/received in primary care. • Important as parent/patient may consult their GP in the hours or days subsequent to vaccination • May need to ascertain individual vaccine status at a later stage

8. Child Health Information System • Child entered on Child Health Information System at birth • System automatically generates vaccination schedule for child and sends appointments • When child vaccinated practice/clinic practice enters data on system OR returns to the Child Health department on a clinic sheet for entry on system • In theory, system keeps up to date log of child’s immunisation status.

9. Child Health Information System (CHIS) • Produces default list for missed appointments • Maintains a comprehensive record of children in the area • Allows the production of vaccine coverage data (COVER)

10. COVER Cover of vaccination evaluated rapidly

11. Vaccination CoverageCOVER (Cover of Vaccination Evaluated Rapidly) • It is important to know what proportion of any targeted population has received each vaccine • Since 1988 computerised child health registers across the country have held vaccination details for all children resident in the area • Every 3 months, information collected by CfI from each child health computer as to number of children who have completed scheduled vaccine courses at 1,2 & 5y of age • This information used to evaluate and improve immunisation coverage by regular feedback to local areas .Crucial component in the surveillance of vaccine preventable diseases and informing Public Health Policy • Monitors childhood vaccination uptake at local (PCT, StHA), regional and national levels • Quarterly reports produced for percentage of children aged 1, 2 and 5 years completing routine scheduled childhood immunisations in that quarter • Does not include adult vaccination programmes e.g. influenza

12. Objectives of the COVER programme • Detects changes in uptake rapidly to allow early intervention • Investigate reasons for poor performance • Monitors response to interventions and changes in policy • Stimulate local interest • Investigate reasons for poor performance • Look for pockets of poor coverage • Estimate vaccine efficacy • Measure impact and success of a vaccination campaign • Improve vaccination coverage by regular accurate feedback to PCT immunisation leads

13. What does COVER include? • Percentage of children who have received: • 3rd dose of Primary course and Men C and PCV at 12 months and 24 months of age • 4th dose (pre school booster) at 5 years of age • One dose of MMR at 2 and 5 years • Two doses of MMR at 5 years

14. How it works • At any time, system able to calculate what percentage of children in an age cohort/time period have received a particular childhood vaccine • System also keeps records of vaccines given at school but these are not part of COVER programme

15. COVER definitions • Denominator: Total number of children for whom the PCT is responsible on the last day of a defined quarter whose first (second or fifth) birthday falls within that quarter • Numerator: Total number of children who have completed immunisation at any time by their first (second or fifth) birthday

16. PCT responsible population for Cover data • Includes: All children registered with a GP in the PCT whether or not resident within the PCT • All children not registered with a GP but live within the PCT’s boundary • Excludes: Children resident within the PCT boundary but registered with a GP in another PCT

17. Factors influencing COVER • Denominator inflated by: • Children who have moved out of area still on database • “Duplicate” children e.g . Same child but with different name spelling, address or date of birth

18. Factors influencing COVER • Denominator deflated by : • Children moved into area not included on database • Unregistered children

19. Factors influencing COVER • Numerator reduced by: • Lost returns • Delayed returns • Incomplete returns • Unscheduled vaccinations not reported

20. Coverage at 12 Months of Age Immunisation rate for children aged 1 who have been immunised for DTaP/IPV/Hib decreased by -2.41% Uptake for MenC declined by -1.76% Uptake for Pneumococcal also declined by -2.60%

21. Coverage at 24 Months of Age Immunisation rate for children aged 2 who have been immunised for DTaP/IPV/Hib decreased by -0.16% Uptake for MenC remained the same at 96.6% Uptake for Pneumococcal also increased by 2.55% Significant increase of 5.11% for MMR Increase of 0.53% for MenC + Hib (Menitorix)

22. Coverage at 5 years of Age Uptake for children aged 5 who have been immunised with a booster dose of Tetanus, Diphtheria, Polio and Pertussis (Preschool) increased by 4.37% Immunisation rate for MMR 1 and MMR 1st Scheduled Booster both increased by 0.5% and 4.11% respectively Increase of 0.53% for MenC + Hib (Menitorix)

23. Uptake at 12 months Last Qtr: Regional Perspective

27. Coverage rate by practice presented by practice code

28. Performance against National Targets

29. Reporting adverse reactions • Suspected adverse drug reactions (ADRs) to vaccines should be reported to the Committee on Safety of Medicines using the Yellow Card Scheme: • -For established vaccines, only serious ADRs should be reported • -For newly licensed vaccines labelled with an inverted black triangle (▼), serious and non-serious reactions should be reported • -All suspected ADRs occurring in children should be reported

31. Links to Further Information • 1. Guidelines for records and record keeping: • http://www.nmc-uk.org/nmc/main/publications/Guidelinesforrecords.pdf • 2. Child Health Informatics Centrehttp://www.chiconsortium.org.uk/ • 3. Begg NT,Gill ON, White JM. COVER (Cover of vaccination evaluated rapidly): Description of the England and Wales Scheme. Public Health 1989;103:81-9

32. Acknowledgements: • Immunisation Department, • Centre for Infections, • Health Protection Agency • Wilhelmina Abban South East Essex PCT • Rhysian Morgan