Immunisation Service Reports...2 the royal children’s hospital immunisation service reports...

Immunisation Service Reports

Immunisation Service

2012–13 and 2013–14

2 the royal children’s hospital immunisation service reports 2012–13 and 2013–14

Index of FiguresPAGE TITLE

9 Figure1:PatientsimmunisedattheDrop-inCentreby12-monthperiod

10 Figure2:PatientsimmunisedattheDrop-inCentreby12-monthperiod:non-outpatientdrop-inpatientsvs.outpatients

11 Figure3:Numberofclinicpatientsbyyear1July2012–30June2014

11 Figure4:Immunisationout-patientclinicpresentingissue,1July2012–18December2012

12 Figure5:ImmunisationadvicecallsattheDrop-inCentreby12-monthperiod

12 Figure6:TelephoneadvicecallsattheDrop-inCentrebycaller1July2012–30June2014

13 Figure7:Inpatientsidentifiedasdue/overdueforimmunisationandvaccinated1September2013–30June2014

13 Figure8:Inpatientsvaccinatedbysite1September2013–30June2014

14 Figure9:MantouxtestsadministeredbytheRCHImmunisationServiceby12-monthperiod

15 Figure10:InfluenzaimmunisationsattheDrop-inCentrebymonthandyear

15 Figure11:Influenzavaccinedosesbyagegroup

16 Figure12:Totalnumberofinfluenzavaccinesbymedicaldepartment(2013-2014)

17 Figure13:NumberofdosesofBCGvaccinefrom1January2011–30June2014

17 Figure14:PostcodesRCHBCGclinicattendeesfromNovember2013–June2014

18 Figure15:NumberofpatientsprovidedmonthlyRSVImmunoglobulinbytheRCHImmunisationService

18 Figure16:NumberofpatientsreceivingeachoftheRSVimmunoglobulindoses2013

18 Figure17:OpportunisticimmunisationsprovidedduringRSVimmunoglobulinvisits(2013)

19 Figure18:RSVvialssavedfromcohortingpatients(2013)

19 Figure19:Numberofdosesrecommendedanddosesadministeredforspecialriskpatientsfrom1January2013–31December2013

21 Figure20:Actualvaccineerrorsfrom1July2012–30June2014

21 Figure21:‘Nearmiss’vaccineerrorsfrom1July2012–30June2014

the royal children’s hospital immunisation service reports 2012–13 and 2013–14 3

AbbreviationsACIR AustralianChildhoodImmunisationRegister

AEFI AdverseEventFollowingImmunisation

BCG BacilleCalmette-Guerin

CVU ClinicalVaccinologyUpdate

DH DepartmentofHealth(Immunisationsection)

FLACC FaceLegsActivityCryConsolability(scaleforpainmeasurement)

FFS Feeforservice

GP GeneralPractitioner

HHE hypotonic-hyporesponsiveepisode

ICU IntensiveCareUnit

ID InfectiousDiseases

MCRI MurdochChildren’sResearchInstitute

MVEC MelbourneVaccineEducationCentre

NCIRS NationalCentreforImmunisationResearchandSurveillance

NIP NationalImmunisationProgram

PAEDS PaediatricActiveEnhancedDiseaseSurveillance

PHAA PublicHealthAssociationofAustralia

RCH RoyalChildren’sHospital

RSV RespiratorySyncytialVirus

SAEFVIC SurveillanceofAdverseEventsFollowingVaccinationIntheCommunity

VHIMS VictorianHealthIncidentMonitoringSystem

VIRGO VaccineandImmunisationResearchGroup

Contents

page

6 section 1: Overview

6 The Immunisation Service at The Royal Children’s Hospital

7 KeyHighlights

8 Staff

page

9 Section 2: Report on Performance

9 (i) Core Service Activity

9 Drop-inCentre

9 Patientsimmunised

10 Outpatientclinics

11 Telehealth

11 Otherimmunisationconsultations

12 TelephoneAdviceLine

12 InpatientImmunisations

14 Electiveadmissions

14 Immunisationsfornewlyarrivedimmigrants

14 InfluenzaVaccine

16 Staffinfluenzavaccine

16 (ii) Additional Immunisation Service Programs

16 BacilleCalmetteGuerin(BCG)vaccineforchildren<12monthsofage

18 RSVImmunoglobulinprophylaxisforcardiacandrespiratorypatients

19 Specialriskpatients

19 Livertransplantaudit

Section 3: Communication and Accountability

20 Melbourne Vaccine Education

20 Immunisation Errors

21 Immunisation Service Monthly Meeting

21 Feedback on the Immunisation Drop-in Centre

22 National Immunisation Teleconference

22 Victorian Immunisation Advisory Committee

22 Surveillance of Adverse Events Following Vaccination In the Community (SAEFVIC)

22 Immunisation Education Provision

22 PHAAImmunisationConference

23 EducationatRCH

24 External Education

25 Staffing

26 Section 4: Clinical Immunisation Research and Publications

26 Publications

27 Conference Abstracts

6 the royal children’s hospital immunisation service reports 2012–13 and 2013-14

Overview1The Immunisation Service at The Royal Children’s HospitalTherearestillmanycountriescurrentlyfacingnumerouschallengesduetopoorroutineimmunisationcoverage,withdeathsofunvaccinatedchildrenduetopreventablediseasesstillcommonplace.Australiahasacomprehensivegovernmentfundedvaccineprogramandasaresultsomediseasesarenolongerseen,orareveryrare.ItisimportanttoensurehighimmunisationcoverageratesinAustraliaandinpatients,outpatientsandvisitorsoftheRoyalChildren’sHospital(RCH)Melbournearenoexception.SinceMarch2001,theImmunisationServiceattheRCHhasoptimisedeveryopportunitytoimmunisepatientsandvisitorstothehospital.ThroughtheestablishmentoftheDrop-inCentre,therehascontinuedtobeanincreaseinservicedelivery,throughtheadministrationofvaccinesaswellasexpertclinicaladvice.Withnumerouschallenges,includingthelaunchofnewvaccinesaswellasoutbreaksofvaccinepreventablediseasessuchaspertussis(whoopingcough),thishasensuredthatthetelephoneadvicelineandwebsitehasbeenwellutilisedbypatients,parents,externalhealthcareprofessionalsaswellasRCHstaff.

TheImmunisationServiceatRCHhascorefundingthroughapartnershipwiththeVictorianDepartmentofHealth–Immunisationsection.TheRCHImmunisationServicealsohasaffiliationswithSurveillanceofAdverseEventsFollowingVaccinationIntheCommunity(SAEFVIC)–basedatMCRI/RCHandMonashHealth.

ThethreecoreservicesprovidedbytheRCHImmunisationServiceremain;

• theDrop-inCentre •Telephoneadviceline

• Immunisationoutpatientclinic(weekly)

Additional services provided by the Immunisation Service;

Immunisationadverseeventmanagement(incollaborationwithSAEFVIC)

ImmunisationofRCHpatientsinspecialriskgroups

Education(onsiteandoffsite)

Immunisationerrormanagement

Clinicalresearch Mediaandpromotionofimmunisations(incollaborationwiththeRCHCorporateCommunicationsteam)

TravelvaccinesincludingaseparateBCGclinic(incollaborationwiththeInfectiousDiseasesteam)

Staffimmunisations(incollaborationwithInfectionControl)

Internationally,theRCHImmunisationserviceisalsohavingimpact.TheBritishColombiaChildren’sHospitalinCanada,wereinspiredtoconsiderahospital-basedimmunisationclinicforchildrenandfamilymembers.TheywereabletogetfundsandspacetoofferinfluenzaimmunisationduringNovember2013toJanuary2014.Itwasaverysuccessfulcampaignandthisexerciseopenedtheeyesofhospitalauthoritiestothefactthatimmunisationshouldbeanongoingpartofthehospital’sservices.

the royal children’s hospital immunisation service reports 2012–13 and 2013–14 7

Key HighlightsProviding Bacille Calmette Guerin (BCG) vaccine for children <12 months of age

TheImmunisationServiceattheRCHhasbeenprovidingBCGvaccineviatheMondayafternoonInfectiousDiseases(ID)clinicsinceNovember1999.Themainindicationforthevaccinewaschildren<5yearstravellingbacktoacountrywithahighincidenceofTuberculosis.Therehadbeenagradualincreaseindemandoverthedecade.DuetochangesinBCGvaccinesupplyin2012,theImmunisationServiceincollaborationwiththeRCHInfectiousDiseasesteamputtogetherabusinesscaseseekingadditionalfundsforadedicatedweeklyBCGvaccineclinic.Additionalclinicswereconductedin2012–13andthen12monthsofpilotfundingwasapprovedandprovidedbytheDepartmentofHealth–ImmunisationsectioninNovember2013.Thisfundingincludednursing,administrationandmedicaltimetorunaweeklyRCHBCGclinic.ThisdedicatedcliniccommencedonTuesday12November2013,alternatingeachweekbetweenImmunisationandInfectiousDiseasesphysicians.TheRCHImmunisationservicecurrentlyadministersbetween80to100BCGvaccinespermonth.

Administering RSV immunoglobulin

Anotherkeyprojectfortheteaminthepast12monthshasinvolvedtakingonresponsibilityforadministeringRespiratorySyncytialVirus(RSV)immunoglobulinforat-riskchildren.RSVisacommonrespiratoryvirusthatcanbefatalinhigh-riskchildren.RSVimmunoglobulinprovidespassiveimmunitywhenadministeredmonthlyinthebronchiolitisseasonfromMaytoSeptember.

InApril2013,thehospitalprovided$44,000offundingtotheImmunisationteamtofacilitateRSVimmunoglobulinforselectedCardiologypatients.PatientsareeitherbookedintotheDrop-inCentreorimmunisedonthewardifcurrent

inpatients.TheImmunisationteamgroupedthepatientappointmentstogether,inanattempttomaximisesharingofvials,whichcost$1500.Theteamalsoensuresthepatientsandtheirfamilieswereprovidedwithimmunisationadviceandopportunisticcatch-upvaccinesduringtheRSVvisit.

In2013,theImmunisationTeamensured93percentofeligiblecardiologypatientsreceivedoneormoredosesoftheRSVimmunoglobulinand39percentofthesepatientswerealsogivenothervaccinesduringthesamevisit.

Thecostsavingsachievedbytheteamthroughsharingofimmunoglobulinvialswasestimatedtobe$64,100.Importantly,noneofthepatientswhoreceivedmonthlyRSVimmunoglobulinwereadmittedtoRCHwithlaboratoryconfirmedRSVinfection.ThisprogramthereforeminimisedtheimpactofRSVassociatedbronchiolitisinthisvulnerablepatientgroup,withcostsavingsinbothwardandintensivecareadmissions.TheprogramisalsoimportantforthefamilieswhomoftenhaveprolongedstaysatRCHandarekeentominimisetheriskofinfections.

Providing opportunistic immunisations for at-risk inpatients

In2011,afterconductingapilotstudylookingatin-patientimmunisations,theImmunisationTeamwasconcernedtolearnthat25percentofthehospital’sin-patientswereoverduefortheirvaccinations.Asaresult,theDepartmentofHealth–Immunisationsectionapprovedfundingtocreateaprogramthatwouldallowthenursestochecktheimmunisationstatusofin-patients.Thiswouldenabletheteamtobeabletoprovideopportunisticvaccinesonthewards,andbringtheAustralianChildhoodImmunisationRegister(ACIR)up-to-date.

OvertheyearstheImmunisationServiceatRCHhasexpandedconsiderablyandthisreportdetailsthevastrangeofworkprovidedbythepassionateandenthusiasticteamofstaffinvolvedinimmunisationatRCH.

Immunisation Service Reports 2012-13 & 2013-14Thisdocumentisaserviceactivityreportovertwoyears[1July2012–30June2014].IthighlightsthecoreserviceactivityaswellasadditionalimmunisationprogramsundertakenbytheRCHImmunisationServiceteam.

8 the royal children’s hospital immunisation service reports 2012–13 and 2013–14

section 1

Theinitialprogrambeganin2012andinvolvedongoingconsultationwithkeystakeholdersincludingthehospitalExecutive,wardstaffandpharmacy,withtheaimofcontinuallyrefiningandstreamliningtheprocessoftrackingandimmunisingthisvulnerablecohortofchildren.

Sincethen,asaresultoftheteam’sproactiveapproachtofindingunvaccinatedinpatientsandfamilies,sinceSeptember2013atotalof42%ofdue/overdueinpatientswerebroughtup-to-date.Thiswaseitherreceivingcatch-upvaccinesorupdatingtheACIRwiththeparent-heldrecordofimmunisation.Ofthepatients,54%werebroughtup-to-dateattheRCH;theotherswereimmunisedwithinamonthofdischargewith33%attheGP,10%throughlocalgovernmentand3%throughotherimmunisationproviders.

Providing Clinical Vaccinology Updates for healthcare professionals

TheinauguralClinicalVaccinologyUpdate(CVU)washeldatTheRoyalChildren’sHospitalon22October2012toaddresstheeducationalneedsofimmunisationprovidersaswellasanopportunitytomeetwithcolleaguesanddiscusstopicalimmunisationissues.Theprogramincludedvaccineupdates,vaccinepreventablediseaseepidemiologyandvaccinesafetyforums.

Duetotheverypositivefeedbackbyattendees,theCVUhascontinuedin2013and2014,withupdatesheldtwiceayearandover250attendeeseachprogram.Thisdemonstratestheimportancethatimmunisationprovidersplaceoncontinuingeducation,asitisessentialtomaintainingimprovementsindiseasepreventionefforts.

Establishing the Melbourne Vaccine Education Centre [MVEC]

InFebruary2014,theRCHImmunisationserviceinconjunctionwithMelbourneChildren’spartnersatSAEFVIC(MCRI)andtheUniversityofMelbourneDepartmentofPaediatrics,launchedtheMelbourneVaccineEducationCentrewebsite(www.mvec.vic.edu.au).TheaimofMVECistoproviderelevantclinicalinformationbasedonthelatestavailableevidence,aswellaspracticaltoolstoassistineducationanddecision-makingaroundnewvaccines.ThiseducationinitiativeisbothforhealthcareprofessionalsandfamiliesandhighlightstheleadershiprolethattheRCHhasinImmunisationeducationatastateandnationallevel.

Staff

Medical

NigelCrawford(Head)

TeresaLazzaro

MargieDanchin

KirstenPerrett

WonieUahwatanasakul

Nursing

SonjaElia(NurseUnitManager)

KateWall

MelanieAddison

RobinCavanagh

MelissaDallinger

KellyBernard

PetaKilsby

RebeccaFeore

MelissaNesbitt

RachaelMcGuire

KirstenMitchell

KerrynWilliams

Administration

JulieBond

JessicaElia

KeyHighlightscontinued

the royal children’s hospital immunisation service reports 2012–13 and 2013-14 9

Report on Performance 2(i) Core Service ActivityDrop-in CentreTheImmunisationDrop-inCentreislocatedontheMainStreetofthehospitalandisinahigh-profilelocationoppositeamaincafé.Itisphysicallyaccessibleandisanintegratedpartofthehospitalcommunity.CollaborationbetweentheDrop-inCentreandthehospitalcommunityensuresopportunitiesforimmunisationaremaximised.

FollowingameetingwithmembersoftheRCHExecutiveaspartofaGreatCareRound,ideastohelpimprovepatientcareandsatisfactionwerediscussed.TheImmunisationTeamidentifiedimprovementopportunitiesintheuseoftheDrop-incentrespace.Currentlytheexitbayisunder-utilisedandwasasuboptimalenvironmentforpatientsandfamilies.AProjectinitiatedrequestformforminorworkstotheexitbaywascompletedtoenabletheroomtobeusedasathirdtreatmentroomwhenrequiredaswellasartdecalsplacedonthewallstomaketheroomlessclinicalinappearance.

Overall Activity

In2012/13,6,695patients,siblingsandparentswereopportunisticallyvaccinatedattheRCHImmunisationDrop-inCentreandin2013/14,7,591opportunisticimmunisationswereprovided.Thisrepresentsanincreaseof14%comparedtothepreviousbiennialreport(2012).Figure1highlightstheserviceactivityoverthelastfewyears.

Figure 1: Patients immunised at the Drop-in Centre by 12-month period

0

2004-05

Overall number of patients

2005-06 2006-07 2007-08 2008-09 2009-10 2010-11 2011-12 2012-13 2013-14

4000

3000

2000

1000

5000

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7000

8000


section 2

PatientseitherpresenttotheDrop-incentrefollowingaspecialistclinicappointmentorhappentobewalkingbytheCentre.Theservicealsoprovidesvaccinesforsiblingsand/orparentsofapatient.InpatientswhoarewellenoughcandropintotheCentreortheImmunisationnursingstaffcanattendthewardandprovideinpatientimmunisations.Figure2demonstratesanoverviewofthesourceofpatientsreceivingimmunisationsattheDrop-inCentre.

Figure 2: Patients immunised at the Drop-in Centre by 12-month period: non-outpatient drop-in patients vs. outpatients

0

2004-05

Drop in

2005-06 2006-07 2007-08 2008-09 2009-10 2010-11 2011-12 2012-13 2013-14

4000

3000

2000

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7000

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Outpatient

Outpatient clinics

TheweeklyImmunisationOutpatientclinicisheldonaTuesdaymorning.ItisacombinedSAEFVICandRCHImmunisationclinic.TheImmunisationServicenursesprovideimmunisationsforpatientsandtheirparentsattendingtheseclinics,includingspecialriskpatients,catch-upimmunisations,vaccinesforfamiliesworriedaboutimmunisationsaswellasimmunisationsforpatientsfollowingapreviousimmunisationadverseevent.In2013,thisclinicwasalsoexpandedwithDHsupporttoincludeBCGvaccinedeliveryforinfant’s<12-months(seeBCGreportpage20).

Therearefivepaediatricianswhohavebeenworkingintheclinicduringthisreportingperiod:NigelCrawford,TeresaLazzaro,WonieUahwatanasakul,KirstenPerrettandMargieDanchin.

Thecliniciswellrecognisedbyinternalandexternalhealthcareprofessionals,withthemajorityofappointmentsbeingnewpatientsforexpertadvice.TheoverallnumberofpatientsseenintheRCHImmunisationclinicisdetailedinFigure3.


Figure 3: Number of Immunisation clinic patients* by year [2012-14]

2012-13 2013-14

Review

New

0

50

100

150

200

250

300

350

400

450

*ExcludesBCGclinicpatients(seeseparatesummary)

A6-monthsnapshotofthewiderangeofcompleximmunisationissuesthatarereferredtotheclinicaredetailedinFigure4.

Figure 4: Immunisation outpatient clinic presenting issue: 1 July 2012 – 18 December 2012

Numberofpatients

Immunisationadverseevent 89

Immunisationconcerns/advice 38

Catch-upimmunisationoptions/plan 21

Specialriskpatients 30

Underlyingcomplexmedicalcondition 14

Drugerror 3

Needlephobia/immunisationsundersedation 3

Eggallergyquestions 2

Reviewappointments 9

TOTAL 209

TeleHealth

InAugust2012,webecameoneofthefirstRCHclinicalservicestoprovideTeleHealth.

UpuntilApril2014,atotalof29patientshavehadaTelehealthimmunisationconsultation,21withtheirlocalGPorPaediatricianinattendance,8intheclient’shome.Thereasonsforconsultationincluded:adversereactionsfollowingimmunisations;specialriskpatientssuchassolidorgantransplantrecipientsandfamilieswithvaccinehesitancyqueries.ThedistanceofVictorianclientsfromParkville,Melbourne,rangedbetween106–729km,with5patientsfrominterstate(NSWandTAS)and1consultationwithanAustralianresidentinBali.AnAustralianChildhoodImmunisationRegisterreviewidentified16patients(<7-yearsofage)whoreceivedvaccinesfromtheirGPfollowingtheTelehealthconsultation.OverallourexperiencewithImmunisationrelatedTelehealthconsultationshasbeenextremelypositiveandanexcellentwaytoprovideaspecialisedservicetoregionalandruralareas.

TheImmunisationserviceacknowledgesthesupportofSusanJuryinestablishingTeleHealthandplanstoexpanduseofthistechnologyinitsclinicalservicesoverthenext12to18months.

Other immunisation consultations

TheImmunisationserviceisaboutmorethanjustadministeringvaccines,withimmunisationnurseexpertsprovidingawiderangeofadvice.ConsultationsforfamilieswhorequirespecialistimmunisationadviceisalsoprovidedattheDrop-inCentre,withtheseconsultationsincluding:

• individualisedimmunisationplaninpatientswithcomplexmedicalproblems-specialriskpatients

•enquiriesaboutnewvaccines(e.g.MeningococcalBvaccine)

•enquiriesaboutnon-scheduledvaccines(eg.influenzavaccine,parentpertussisvaccine)

•parents/medicalstudents/nursingstaffseekingimmunisationresources

• immunisationadverseeventadvice

• incompletevaccinationhistoryrequiringacatch-upimmunisationplan

•overseasbornpatientsrequiringacatch-upimmunisationplan

• incompleteAustralianChildhoodImmunisationRegister(ACIR)datarequiringupdating


section 2

Telephone Advice Line 1300 882 924 (option 2); direct (03) 9345 6599ThetelephoneadvicelineisacriticalelementoftheImmunisationServicedailyactivity.TohelpfacilitateeasieraccesstohospitalbasedservicesweestablishedanImmunisationHotlinein2014.This1300numberisaccessiblethroughoutthestateofVictoriaandhelpedtriagecallsbetweentheRCHImmunisationservice,SAEFVIC,MonashImmunisationandtheDH.

Overthereportingperiodthetelephoneadvicelineusagehasconsistentlyincreased.Themajorityofcallsreceivedarebyparents,followedbyimmunisationproviders,RCHhospitalstaffaswellasothercommunitybasedorganisations.Therewere6,664telephoneadvicecallsdocumentedattheDrop-inCentrein2012/2013and7,581callsrecordedoverthelast12months.Thisreflectsa26%increaseincallscomparedwith2011/2012.

ThetelephoneadvicelineismanagedbytheImmunisationNursingstaff,howeverwhenthereisaparticularlycomplexenquiry,thenursingstaffcanreferthecalltothemedicalstaffforapromptreplytothecaller.Theadvicelineisansweredbetween9am–5pmonworkingweekdaysoftheyear.ThenumberofcallsreceivedbyyearisdetailedinFigure5.ThisdataisanunderestimateofdemandfortheRCHImmunisationtelephoneadviceline,asitisonlyareflectionofcallsanswered.

Figure 5: Immunisation advice calls at the Drop-in Centre by 12-month period

2004-05 2005-06 2006-07 2007-08 2008-09 2009-10 2010-11 2011-12 2012-13 2013-14

0

1000

2000

3000

4000

5000

6000

7000

8000

Number of calls

Overthepast12monthsinformationwascollectedonthetypeofcallertothetelephoneadviceline(figure6).

Figure 6: Telephone advice calls at the Drop-in Centre by caller 1 July 2012 – 30 June 2014

Parent

GP/Practice nurse

RCH paed

RCH RN

MCHN

Other internal

Other external

61%

13%

7%

8%

4%4%3%

Inpatient Immunisations

Achievinghighimmunisationcoverageratesforchildrenwithmedicalconditionsisvitalastheyareathigherriskofmorbidityandmortalityfromvaccinepreventablediseases.WithanincreaseinDHfundinginJune2010toexpandthedeliveryofinpatientimmunisations,thisprojecthascontinuedtoimprovesincethen.Inpatient’sagedbetween6weeksandupto7yearshavetheirimmunisationstatuscheckedusingtheACIR.Thishighlightsthoseinpatient’swhoaredueorarenotup-to-dateaccordingtotheNationalImmunisationProgram(NIP).ThedetailsofchildrenidentifiedasdueoroverdueaccordingtotheACIRissenttothehospitalunitCareManagersforfollow-up.Onemonthfollowingdischarge,theImmunisationnursingstaffrecheckACIRtodetermineifvaccineswereprovided.

SincethepilotandfollowingapresentationfromtheImmunisationServicetotheRCHBoardmembers,fromSeptember2013theImmunisationservicebeganreceivingadailyprintoutofinpatient’sagedbetween6weeksand7yearsofage,byward.Onaverage,50%ofinpatient’sidentifiedasdueoroverdueforvaccinesareimmunisedandpredominantlyatRCH.TheFigure7andFigure8belowdemonstratesthemonthbymonthsuccessoftheprogram.

Therearestillanumberofreasonssomechildrenarenotabletohavetheirimmunisationsbroughtuptodate,andtheseinclude:toounwellontheday;alreadydischarged;unabletoviewchild’sstatusonACIRandifthechildisdeceased.WearecontinuallystrivingtoimprovetheimmunisationstatusofRCHinpatients.


Figure 7: Inpatients identified as due or overdue for immunisation and consequently vaccinated 1 September 2013 – 30 June 2014

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50%

60%

40%

30%

20%

10%

0%

PercentageThose who received vaccinesPatients identified as due/overdue

Jun-14May-14Apr-14Mar-14Feb-14Jan-14Dec-13Nov-13Oct-13Sep-13

Figure 8: Inpatients vaccinated by site 1 September 2013 – 30 June 2014

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Other

Council

GP

RCH

Jun-14May-14Apr-14Mar-14Feb-14Jan-14Dec-13Nov-13Oct-13Sep-13

There were 6,664 telephone advice calls documented at the Drop-in Centre in 2012/2013 and 7,581 calls recorded over the last 12 months


section 2

Elective admissionsNeedlephobiaisamedicalconditionthataffectsatleast10%ofthepopulation.Personswithneedlephobiatypicallyavoidmedicalcare,includingimmunisations.Itcanbemanagedbyreassuranceandeducation,relaxationtechniquesornitrousoxidegasandtopicalanaestheticagents.PatientswhoareneedlephobichaveattendedtheImmunisationclinictodiscussstrategiesforvaccination.SomeofthesepatientsarethenbookedintotheDayMedicalUnittohavetheirvaccineswithsedationandnitrousoxidegas.

Immunisations for newly arrived immigrantsTheImmigranthealthserviceispartoftheDepartmentofGeneralMedicineattheRoyalChildren’sHospital.Childrenandadolescentsofarefugeebackgroundwillhavetypicalpaediatrichealthproblemsandinaddition,mayhavehealthissuesspecifictotheirbackground.Assessmentofnewlyarrivedrefugeechildrenandadolescentsshouldfocuson:

•Parent(orself-identified)concerns

•Excludingacuteillness

• Immunisationstatusandcatch-up

•Tuberculosisscreening

•Otherinfections,includingparasitesmalariaandhepatitis

•Nutritionalstatusandgrowth(includingmicronutrientandvitamindeficiencies)

•Dentalissues

•Concernsaboutdevelopment,visionandhearing.

•Mentalhealthissues

•Previoussevere/chronicchildhoodillnessorphysicaltrauma

•Confirmingthereportedbirthdate

• IssuesarisingfromresettlementinAustralia

Priortothepatient’sclinicappointment,theImmunisationnursesperformanACIRcheckonallimmigranthealthpatientstoassistwithfurthercatch-upvaccinesrequiredandtoreduceimmunisationerrorsatthetimeoftheappointment.TheImmunisationservicecollaboratewiththeImmigrantHealthteamintheregularupdatingofthesecatch-upguidelines[http://www.mvec.vic.edu.au/immunisation-references/refugee-health-catch-up-immunsation-guidelines/].

TheImmunisationnurseshaveprovidedMantouxtestsandsubsequentreadingformanyofthesepatients.Figure9outlinesthetotalnumberofMantouxtestsperformedbytheRCHImmunisationServicenurses.Theimmunisationnursesassistinfacilitatingchestx-rays,medicalreviewandexplanationwiththeinterpreteriftheMantouxtestispositive.

Figure 9: Mantoux tests administered by the RCH Immunisation Service by 12-month period

2008-2009

2009-2010

2010-2011

2011-2012

2012-2013

2013-2014

Mantouxtests

207 289 343 206 207 269

Influenza VaccineMorethan2,900opportunisticinfluenzavaccineswereadministeredattheDrop-inCentrein2013(Figure10),whichisa27%increasecomparedwith2012.Annualinfluenzaimmunisationisnationallyrecommendedforchildrenwithmanyunderlyingmedicalconditionswhoareatincreasedriskofmorbidityandmortalityfrominfluenzadisease.TheRCHImmunisationServiceensuresthatinformationissharedthroughoutthehospitaltohelpfacilitatethespecialriskgrouppatients,tonotmissoutontheannualinfluenzavaccine.

ParentsandsiblingswhoarenoteligibletoreceivefundedinfluenzavaccinecanpurchasethevaccineandhaveitadministeredattheDrop-inCentre.The2013datapresentedinFigure10includespatients,parentsandsiblingsprovidedinfluenzavaccineattheDrop-inCentre.RCHpatientsrepresent55%ofthosereceivingopportunisticinfluenzavaccinesattheDrop-inCentre.Theremaining45%areparentsandsiblingsofRCHpatients.


Figure 10: Influenza immunisations at the Drop-in Centre by month and year

0

100

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600

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800

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1100

DecNovOctSepAugJulJunMayAprMarFeb

2012 2013 2014

Withsurveillancesystemsinplacetomonitoradverseeventsfollowingimmunisationwithinfluenzavaccineinchildrenunder5yearsofage,itisimportantthattheRCHImmunisationservicecapturethenumberofdosesofinfluenzavaccinebyagegroup.Figure11belowdemonstratesthisdata.

Figure 11: Influenza vaccine doses by age group

050

100150

200250300350400450500550600650700750800850900950

1000

Total number of influenza doses given0-5 years

OctSepAugJulJunMayAprMarFeb

TheRCHpatientsimmunisedwithinfluenzavaccinecomefromavarietyofmedicaldepartmentsthroughoutthehospital.Figure11representsthetotalnumberofInfluenzavaccinesaccordingtomedicaldepartmentduringthe2013and2014season.

More than 2,900 opportunistic influenza vaccines were administered at the Drop-in Centre in 2013 which is a 27% increase compared with 2012


section 2

Figure 12: Total number of influenza vaccines (2982) by medical department (2013-14)

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Other

SAEFV

IC

Haem

Adol

Wadja

Metabol

Gen M

ed

Gastro

Renal

Oncol

Resp

Neuro

Dev M

ed

Endo

Cardiol

All/

Imm

unol

2013

2014

Staff Influenza vaccine In2014theRCHexecutiveoutlinedplanstoobtain75%coverageofstaffvaccinatedwiththeseasonalinfluenzavaccine.TheRCHImmunisationservicewasverysupportiveofthis‘GettheJabdone’programledbytheRCHInfectioncontrol.TheInfectioncontrolteamoutlinedthestaffinfluenzaprogramwithajointRCHGrandroundinFebruary2014,coincidingwiththeImmunisationserviceMVEClaunch.

TheRCHImmunisationnursingteamassistedinprovidingstaffforanimmunisationboothontheMainStreetofthehospitalaswellforsomeofthemassvaccinationsessions.Theendresultwas83%ofstaffbeingimmunised,wellabovethe67%levelachievedin2013.

(ii) Additional Immunisation Service ProgramsBacille Calmette Guerin (BCG) vaccine for children <12 months of ageAsdiscussedunderKeyHighlights,theImmunisationServiceincollaborationwiththeRCHInfectiousDiseasesteamputtogetherabusinesscaseseekingadditionalfundsforadedicatedweeklyBCGvaccineclinic.Thiswasacrucialadditiontoourcoreactivity,asthemulti-dosevialsandhealthcareprofessionaltrainingforBCGvaccineadministrationwasmakingdeliveryinVictoriadifficult.ItwasdecidedthatRCHandMonashHealthwouldbetheonlysitesforDHfundedBCGvaccinedelivery.

Additionalclinicswereconductedin2012–13,withongoingfundingapprovedupto30June2015.Thisfundingincludednursing,administrationandmedicaltimetorunaweeklyRCHBCGclinic.ThiscommencedonTuesday12November2013withthe


clinicalternatingeachweekbetweenImmunisationandInfectiousDiseasesphysicians.

ThenumberofBCGvaccinedosesadministeredatRCHoverthereportingperiodisdetailedinFigure13.TherewerenovaccinesadministeredinMayorJune2014duetosupplyissues.AnumberofBCGadverseeventsfollowingimmunisationweredetectedthroughthisclinic,asouradministrationstaffensuredapre-clinicquestionnairewascompletedpriortotheclinicappointmentandthefamilywerealsocontacted6-monthslaterregardinganypossiblereactions.TheBCGvaccineisadministeredtochildrenfromacrossMelbourneandpartsofregionalVictoria(seeFigure14).

Figure 13: Number of doses of BCG vaccine from 1 January 2011 to 30 June 2014

0102030405060708090

100110120130140150

DecNovOctSepAugJulJunMayAprMarFebJan

2011 2012 2013 2014

Figure 14: Postcodes RCH BCG clinic attendees [November 2013- June 2014]


section 2

indicatesthenumberofpatientsreceivingeachofthedosesintheImmunisationDrop-incentre,whichidentifiesthatsomepatientsdidnotreceivealloftherecommendeddoses.

Figure 16: Number of patients receiving each of the recommended RSV immunoglobulin doses 2013

1stdose

2nddose

3rddose

4thdose

5thdose

No.ofpatients

109 68 52 33 24

Atotalof42ofthe109(39%)patientswereprovidedothervaccinesatthetimeofthevisitforRSVimmunoglobulin.SomeofthepatientsmayhavereturnedtotheImmunisationDrop-incentreatanothertimeforroutineimmunisations.Ifparentswerenotimmunised,theywereprovidedwithinformationoninfluenzaandadultpertussisboostervaccine(seeFigure17).

Figure 17: Opportunistic immunisations provided during RSV immunoglobulin visits [2013]

ImmunisationsNo.ofpatients/familymembersimmunised

2month 11

4month 11

6month 5

12month 3

18month 0

Extra13vPCV 1

Patientinfluenzavaccine 11

Parentandsiblinginfluenzavaccine

3

ParentdTpavaccine 1

Total patients/family members administered vaccines at the time of RSV immunoglobulin visits

46

The50mgvialscostabout$800eachandthe100mgvialscostabout$1,500each.ThisyeartheRCHImmunisation

RSV Immunoglobulin prophylaxis for cardiac and respiratory patientsRespiratorySyncytialVirus(RSV)isahighlycontagious,devastatingdisease,especiallyinhigh-riskinfants.RSVinfectiontypicallypresentsasanupperrespiratorytractinfectionandthenmayprogresstothelowerrespiratorytract,causingpneumoniaandbronchiolitis.RSVimmunoglobulinprovidespassiveimmunityagainstRSVinfectionsandhasbeenshowntodecreasetheincidenceofRSVhospitalisationandthenumberofhospitaldays.

In2013theCardiologyCareManagersprovidedthelistof116eligiblepatientsfromtheCardiologydepartment(a33%increasecomparedto2012).Intotal,ofthe116eligible,109patientswereprovidedwithatleastafirstdoseofRSVimmunoglobulin.PatientswerebookedintotheRCHImmunisationDrop-inCentreorwereimmunisedonthewardifacurrentinpatient.

TheImmunisationServicenursingstaffprovidedparentaleducationwithinformationabout:RSVdisease,RSVimmunoglobulin,scheduledimmunisations(2,4,6,and12months),extraimmunisationsrecommendedforspecial-riskpatients(twodosesofinfluenzavaccine,anextraconjugatepneumococcalvaccineat1yearofage),andimmunisationsrecommendedforparentsofinfantswithcardiacproblems.Thepatientsandtheirfamilieswereprovidedimmunisationadviceandcatch-upvaccinesduringRSVvisitsaswellastheRSVImmunoglobulindoses(seeFigure15).

Figure 15: Number of patients provided monthly RSV Immunoglobulin by the RCH Immunisation Service

2007 2008 2009 2010 2011 2012 2013

No.ofpatientsonmonthlyRSVimmuno-globulin

10 45 79 95 72 70 109

Theprogramcommencedon7May2013with2patientsreceivingtheirfirstdoseontheKoalaward.Atotalof286dosesofRSVImmunoglobulinwereadministered,with202dosesgivenattheImmunisationDrop-inCentre.Figure16


Servicesaved31ofthe100mgvialsofRSVproductaswellas22vialsofthe50mgvials.Thetotalcostsavingwasestimatedtobe$64,100asoutlinedinFigure18below.

Figure 18: RSV vials saved from cohorting patients [2013]

Vialswould

haveused

Wouldhavecost

Vialsactually

used

Actuallycost

50mgvials

120 $96,000 98 $78,400

100mgvials

226 $339,000 195 $292,500

Totals $435,000 $370,900

Special risk patients TheRCHImmunisationServiceinconjunctionwithMonashChildren’sHospitalImmunisationservicedevelopedguidelinesforpatientsatspecialriskforvaccinepreventablediseases.TheseguidelineswerepreparedbyaffiliatedimmunisationstaffandendorsedataMonthlyImmunisationmeeting,heldattheRoyalChildren’sHospital.Attendeesatthismeetingincludepaediatricians,infectiousdiseasephysicians,nurseimmunisationspecialists,infectioncontrolteammembersandarepresentativefromtheImmunisationSectionoftheVictorianDepartmentofHealth.TheseguidelinesarebasedonthelatestavailableevidenceandmaybedifferenttotherecommendationsinthelatesteditionoftheAustralianImmunisationHandbook.SomeoftherecommendationsintheseguidelinesareoutsidethescopeoftheNationalImmunisationProgram(NIP).

Thespecialriskguidelineshaveincludedthefollowingconditions;

•SolidOrganTransplantRecipient

•ChemotherapyandPostHaematopoieticStemCellTransplant

•Asplenia/Hyposplenia

TheseguidelineshavebeenplacedonourMelbourneVaccineEducationCentrewebsite[http://www.mvec.vic.edu.au/immunisation-references/special-risk/].TheadditionalrecommendedvaccineshavebeenapprovedandfundedbytheRCHDrugUtilisationCommittee.

Liver Transplant auditIn2013,a12monthauditofalllivertransplantpatientswasundertakenandanimmunisationassessmentmade.From1Januaryto31December2013,theRCHperformed14livertransplantsandinaddition,37patientswerereviewedbytheRCHImmunisationService.Immunisationadvicewasbasedoneachpatient’spreviousvaccinationhistoryandcurrentage,recentvaccinepreventablediseaseserology,recentbloodproductadministrationandcurrentimmunesuppressivemedications.RecommendedvaccineswereadministeredbytheRCHDrop-inCentre,GPpracticesorlocalhospitals.Figure19belowdemonstratestheuptakeofvaccinesfollowingtherecommendationsbasedontheguidelines.

Figure 19: Number of doses recommended and doses administered from 1 January 2013 – 31 December 2013

0

10

20

30

40

50

60

Doses administered to date (03/05/2014)

Doses recommended at assesment

Other

HPV

Varicella

MM

R

Influenza

Pneumovax

23

Prevenar 13

MenA

CW

Y_c

Hepatitis

BHepatitis

A

Immunisation plan


3 Communication and Accountability

Melbourne Vaccine Education Centre

InFebruary2014,theRCHImmunisationserviceinconjunctionwiththeMelbourneChildren’spartnersatSAEFVIC(MCRI)andtheUniversityofMelbourne,DepartmentofPaediatricslaunchedtheMelbourneVaccineEducationCentrewebsite(www.mvec.vic.edu.au).ThissiteishostedbytheRCHEducationResourceCentre.TheaimofMVECistoproviderelevantclinicalinformationbasedonthelatestavailableevidence,aswellaspracticaltoolstoassistineducationanddecision-makingaroundnewvaccines.ThiseducationinitiativeisbothforhealthcareprofessionalsandfamiliesandhighlightstheleadershiprolethatRCHhasinImmunisationeducationatastateandnationallevel.

MVECincludesanAtoZofimmunisationreferences,linkingtoourspecialriskguidelines(detailedintheprevioussection)andotherexpertresourcessuchastheBetterHealthChannel.IthasalsobeenusedasasitetohighlighttheRCHandMonashImmunisationservicepositionstatements,forexampleregardingtheseasonalinfluenzavaccineandthenewMeningococcalBvaccine(Bexsero).

[http://www.mvec.vic.edu.au/immunisation-references/meningococcal-b/]

TheMVECsitealsohighlightsourImmunisationhotlinecontactdetailsandanonlineVictorianImmunisationschedule

[http://www.mikesouth.org.au/immunisation/AUSIMMWELCOME.html].

DevelopedbyMikeSouth,withinputfromtheRCHImmunisationserviceteamandDH,thisAppisupdatedregularly,highlightinganyrecentchangestotheImmunisationschedule.ThisistheplacewedirectRCHstaffregardingourcurrentimmunisationschedule,aimingtominimisetheriskofdrugadministrationerrors.

Immunisation ErrorsAllimmunisationprovidersstrivetoensurethatthe5rightsofmedicationadministrationareperformed.However,errorscanstilloccur.Therearetwotypesoferrors,the‘near-misses’andthe‘actual’errors.TheImmunisationServicereportsallerrorstotheVictorianHealthIncidentManagementSystem‘VHIMS’.ByinvestigatingeachincidentanddiscussingtheseattheMonthlyImmunisationmeeting,wecanunderstandthefactorswhichcontributetovaccineerrorsanddevelopstrategiestofurtherpreventtheerrorsfromre-occurring.Figure20belowdemonstratestheactualvaccineerrorsin2012/14bytypeandFigure21representsthe‘near-miss’errorsbytypeforthesamereportingperiod.


Figure 20: Actual vaccine errors from 1 July 2012 – 30 June 2014 by type

0

2

4

6

8

Wrong dose

Vaccine Contraindicated

Wrong age

Wrong interval

Wrong vaccine

Total actual vaccine errors by type

Figure 21: ‘Near-miss’ vaccine errors from 1 July 2012 – 30 June 2014 by type

0

2

4

6

8

10

12

14

16

18

20

22

24

26

28

30

Expired vaccine

Wrong patient

Wrong interval

Vaccine Contraindicated

Wrong age

Wrong vaccine

Wrong dose

Total ‘near miss’ clinical incidents by type

Ofthetotal40‘near-miss’incidents,halfofthesearerelatedtotheBCGvaccine.SowhenpatientsarepresentingfortheBCGvaccinetotheImmunisationDrop-incentre,theImmunisationnursingstaffarealwaysvigilanttodoublechecktheprescription,theageofthechildandpreviousadministrationofotherparenterallivevaccines.Theseerrorshavealsobeenfedbacktothetreatingmedicalteams,

particularlynewstaffwhomaynotbeawareofthehighratesoferrorsassociatedwithvaccinessuchasBCG.

Immunisation Service Monthly MeetingOnceamonththeRCHImmunisationteammeettoconductdiscussionaboutvariousimmunisationissuesandthisisagreatforumforexchangingideas.ThisgroupincludesrepresentativesfromRCHrelateddepartmentsincluding:SAEFVIC,DepartmentofGeneralMedicineandtheInfectiousDiseasesPaediatriciansandInfectionControl.Therearealsorepresentativesfromexternalimmunisationgroupsincluding:DHImmunisationsection,VaccineandImmunisationResearchGroup(VIRGO)andMonashHealthImmunisationservice.

In2014,theImmunisationservicealsocoordinatedamonthlyinternalbusinessmeeting.Thisallowedustodiscusstopicalissuesandimprovedcommunicationbetweenthemedicalandnursingstaff.Oneimportantoutcomehasbeentoallocatephysiciansandnursestodifferentspecialriskgroups(e.g.Cardiology,Wadja,NeonatesandRespiratoryMedicine).TheaimistoimprovecollaborationbetweenthetreatingteamsandtheImmunisationservice,withoutcomestobemonitoredincludinginpatientvaccineratesandinfluenzavaccinedelivery.

Feedback on the RCH Immunisation Drop-in CentreWhiletheImmunisationServicelovestohearwhenwe’redoingagoodjob,weareawarethattherearetimeswhenpatientsandfamiliesareunhappywiththeirexperienceofhospitalserviceorcare.Itisimportantthatweareinformedofsucheventsastheinformationprovidedenablesustoimproveourservicesandcare.FeedbackformsareavailableintheImmunisationDrop-inCentreandallfeedbackistreatedwiththeutmostconfidentiality.

Overthepasttwoyears,wehavecontinuedtoreceiveagreatdealofinformalpositivefeedbackfromfamilies.OftheformalfeedbackprovidedtotheConsumerLiaisonOfficer,therewerethreecomplaintsandsevencompliments.


section 3

National Immunisation TeleconferenceIn2013,SAEFVICreceivedfundingfromtheCommonwealthDHforacoordinatedvaccinesafetyclinicalnetwork.NigelCrawford,MargieDanchin,KirstenPerrettandJimButteryaremembersoftheAdverseEventsFollowingImmunisation-ClinicalAssessmentNetwork[AEFI-CAN].

ThenetworkalsoincludesrepresentativesfromtheNationalCentreforImmunisationResearchandSurveillance(NCIRS)basedattheWestmeadChildren’sHospital(Sydney),Women’sandChildren’sHospital(Adelaide),PrincessMargaretHospital(Perth)andRoyalChildren’sHospital(Brisbane).Theteleconferencegroupholdsdiscussionseverymonth,initiallyfocusingonHPVvaccine,followingintroductionofmalestotheprogramin2013.Othertopicsdiscussedattheseteleconferencesincludeimmunisationadverseevents,immunisationpolicies,topicsofinterestaswellasadviceoncomplexindividualpatientsseenattheadverseeventclinicsateachsite.

Victorian Immunisation Advisory CommitteeNigelCrawfordandJimButteryareontheVictorianImmunisationAdvisoryCommitteechairedbyRosemaryLester,ChiefMedicalOfficer,DHVictoria.ParticipantsinthecommitteerepresentMaternalChildHealthNurses,GeneralPractitioners,InfectiousDiseasesPediatriciansandothers.ThegroupmeetsquarterlyandprovidesaninvaluablesharingofinformationbetweenDHandtheRCHImmunisationService.Quarterlydataoncasesofvaccinepreventablediseasesprovidesinvaluablelocalinformationandhighlightsareasoftargetimmunisationneeds.Immunisationprogramup-datesprovidedbytheCommunicableDiseaseControlUnitallowtheRCHImmunisationServicetobeawareofensuingchangesorpriorities.

NigelCrawfordwasappointedtotheAustralianTechnicalandAdvisoryGrouponImmunisation(ATAGI)inJune2014.

Surveillance of Adverse Events Following Vaccination In the Community (SAEFVIC)TheRCHImmunisationServicecontinuesacloseworkingrelationshipwithSAEFVIC.TheSAEFVICunitisbasedattheRCHcampusandisapartnershipbetweenDH,RCHDepartmentofGeneralMedicine,RCHImmunisationServiceandtheMurdochChildren’sResearchInstituteandMonashHealth.NigelCrawfordholdsajointpositionasDeputyDirectorofSAEFVIC.TheRCHImmunisationPaediatricians(NigelCrawford,TeresaLazzaro,WonieUahwatanasakul,KirstenPerrettandMargieDanchin)allseeSAEFVICvaccinesafetypatientsaspartoftheweeklyimmunisationclinic.

Therehavebeenover8,000adverseeventsfollowingimmunisationreportedtoSAEFVICfollowingitsformationin2007.Thisequatesto1,000reportsperyearwithapproximately30%or300vaccineesseeninvaccinesafetyclinicsperannum.TheSAEFVICclinicisincorporatedintotheTuesdaymorningRCHImmunisationserviceclinic,withfollow-upvaccinesadministeredintheoutpatienttreatmentroomsorDrop-incentreifrequired.Insomeinstances,patientsareadmittedtotheDayMedicalUnitorovernightintheDolphinshortstaywardforvaccinationasrequired.SAEFVICadministrationandnursingstaffhelpfacilitatetheoutpatientandinpatientfollow-upinclosecollaborationwiththeRCHImmunisationservicenursingteam.

Immunisation Education ProvisionImmunisationeducationisanimportantpartoftheserviceprovidedbytheRCHImmunisationteamofSpecialistNursesandPaediatricians.

PHAA Immunisation Conference [Melbourne June 2014]The2-yearlyPublicHealthAssociationofAustralia(PHAA)ImmunisationconferencewasheldinMelbourneinJune2014.Asthiswasauniqueopportunitytocontributetonationalvaccineeducation,RCHImmunisationhadaprominentpositionattheconference.Wehadaconferencestand,shared


withourMonashImmunisationservicecolleagues.RCHandSAEFVICteammembersstaffedthisstandwithlotsofqueriesfromconferenceattendees.

RCHImmunisationserviceandSAEFVICalsopresentedanumberofpresentationsandpostersatthisconferenceasdetailedinourexternaleducationactivities(seebelow).

Education at RCHWeeklyvaccineeducationsessionscontinueatRCH,beingheldeachTuesdaymorning(8:30–9:00).Thissessionincludesdiscussionofnewvaccines,research,articlesofinterest,vaccinesafetyandprogrammaticissues.Itisalwayswellattendedandgivesallstafftheopportunitytopresentanddiscusstopicsofinterest.ThereisalsoapatientdiscussionforumfollowingtheTuesdayclinic(12:30-13:00).

RCH Nursing and Medical Immunisation Updates

RCH Immunisation Staff Education (48)

FormalweeklyeducationsessionscommencedonTuesdaymorningsin2012asdetailedabove.EachweekanImmunisationstaffmemberpresentsatopicofinterestandshareswiththeteam.Topicscoveredinclude;Rotavirus,Pneumococcal,influenza,varicella,allergies,haemodialysisandHepatitisB,Typhoid,RSVimmunoglobulin,Tuberculosis,SAEFVICreports,Cardiacpatientsandimmunisation,immunologyandadolescentimmunisation.

RCH ward nursing Immunisation Up-dates (18)

•Emergencydepartment(1,SonjaElia)

•CardiacUnit(1,RachaelMcGuire)

•Outpatientdepartment(1,KateWall)

•ShortStayUnit(7,SonjaElia,MelissaDallinger)

•Pharmacydepartment(1,SonjaElia)

•NeurologyandGastrounit(1,KateWall)

•GeneralMedicalUnit(5,RachaelMcGuire)

•NeonatalUnit(1,SonjaElia)

Clinical teaching for Graduate nurses, ward nurses, work experience students (7)

•ThroughouttheyearnursesfromwithinandexternaltoRCHrequesttoattendandobserveattheImmunisationDrop-inCentretolearnaboutgivingvaccinesandobservethetechniquesandcommunicationstyleoftheRCHImmunisationNurses(4)

• ImmunisationupdateforGraduatenurses(3,SonjaElia,RachaelMcGuire)

RCH student immunisation teaching sessions (8)

•PaediatricFoundationProgram(5,SonjaElia,KateWall,MelAddison)

•PostgraduateDiplomainAdvancedPracticeNursing(2,KateWall)

•NeonatalEmergencyTransportServicevideoconferenceonPertussis(1,SonjaElia)

Clinical mentoring of Immunisation Nursing students from LaTrobe University (23)

FollowingsuccessfulcompletionoftheLaTrobeUniversityNurseImmunisercoursesomenursescompletetheirclinicalmentorshipwiththeRCHImmunisationService.LaTrobeUniversityapprovedmentorsatRCHincludeRebeccaFeore,MelAddison,KateWall,KirstenMitchell,SonjaEliaandRachaelMcGuire.

RCH Medical Staff Immunisation Updates •RCHClinicalPracticeReview–‘Medicationsafety:Vaccine

errors,morethanjustabooster’(NigelCrawfordandSonjaElia)

•RCHGrandRound(May2013):Maternalantibodiestorotavirusandtheirpotentialinterferencewithlive,oralrotavirusvaccinesindevelopingcountries(MargieDanchin)

•RCHGrandRound(February2014):LaunchingtheMelbourneVaccineEducationCentre(MVEC)andkeepingRCHFlu-freein2014(NigelCrawford)

•RCHCampusClinicalandPublicHealthResearchSeminars(June2014):ClinicalImmunisationandVaccineSafetyResearchatRCH(NigelCrawfordandSonjaElia)


section 3

Melbourne University Medical Student Teaching at RCH• Immunisationlectureduringtheintroductoryweekofeach

Universityterm(KateWall)

External Education

Victorian Maternal and Child Health Nurses

• Immunisationup-dateheldattheMidwivesandMothersAssociation(SonjaElia)

•MaternalandChildHealthNursetouroftheRCHandtheImmunisationDrop-incentre(SonjaElia)

•What’snewandwhat’sdifferentinimmunisation.AustralianCollegeofChildrenandYoungPeople’snurses,VictorianChaptermeeting,February2013(SonjaElia)

•Choosingnottoimmunise:mythsandmisconceptions.AustralianCollegeofChildrenandYoungPeople’snurses,Conferencemasterclass,Melbourne,August2013(SonjaElia)

•TheImmunisationServiceattheRoyalChildren’sHospital,Melbourne.AustralianCollegeofChildrenandYoungPeople’sNursesConference,Melbourne,August2013(SonjaElia)

• ImportanceofTimelinessinImmunisation.AustralianPracticeNursesAssociation,MoversandShakersConference,Melbourne,October2013(SonjaElia)

General Practitioners and Immunisation Providers

• HypotonicHyporesponsiveEpisodesfollowingimmunisation.14thNationalImmunisationConference,PublicHealthAssociationofAustralia,Melbourne,June2014(NigelCrawford)

• ClinicalevaluationofAdverseEventsFollowingImmunisation:theAustralianexperience(Plenary).14thNationalImmunisationConference,PublicHealthAssociationofAustralia,Melbourne,June2014(NigelCrawford)

• AntibodypersistenceinAustralianadolescentsfollowingmeningococcalCconjugatevaccinationinChildhood.14thNationalImmunisationConference,PublicHealthAssociationofAustralia,Melbourne,June2014(KirstenPerrett)

• NewapproachestotacklingVaccineHesitancyinAustralia:theroleofthepaediatrician.14thNationalImmunisationConference,PublicHealthAssociationofAustralia,Melbourne,June2014(MargieDanchin)

• Gettingthejabsdone:Workingwiththecommunityandparentstoovercomebarrierstoimmunisation–canweimmuniseeveryone?PublicHealthAssociationofAustralia,Melbourne,June2014(MargieDanchin)

• ProvidingopportunisticimmunisationsforinpatientsattheRoyalChildren’sHospital.14thNationalImmunisationConference,PublicHealthAssociationofAustralia,Melbourne,June2014(SonjaElia)

• Immunisationupdate,ClinicalPaediatricUpdate(CPU),RCH,Melbourne,June2014(NigelCrawford)

• ToJabornottojab,VictorianPharmacyAssociationCongress,May2014(NigelCrawford)

• CommunicationwiththeVaccineHesitantparent:newapproaches.ImmunisationNursesSpecialInterestGroupTasmania,March2014(MargieDanchin)

•NewInfluenzavaccines[paneldiscussion]–liveattenuatedvaccine.InfluenzaSpecialistGroup,AnnualScientificMeeting,Melbourne,February2014(NigelCrawford)

• Conjugatepneumococcalvaccinesforchildrenandadults.InfluenzaSpecialistGroup,AnnualScientificMeeting,Melbourne,February2014(MargieDanchin)

• InfluenzaandtheroleofPneumococcalVaccination.InfluenzaSpecialistGroup,AnnualScientificMeeting,Melbourne,February2013(NigelCrawford)

• TheImmunisationServiceattheRCH,ClinicalVaccinologyUpdate(CVU),December2013(SonjaElia)

• What’snewinvaccines?RoyalChildrenHospitalClinicalVaccinologyUpdate(CVU),December2013(MargieDanchin)

• Newapproachestotacklingvaccinehesitancy,ImmunisationLocalCouncilForum,VictorianDepartmentofHealth,November2013(MargieDanchin)

• Impactofmaternalantibodiesonrotavirusvaccineimmunogenicityindevelopingcountries,NationalCentreforImmunisationResearchandSurveillance,TheChildren’sHospitalatWestmead,November2013(MargieDanchin)


• FRACPwrittenexamlectures:Immunisationandvaccinesafety,October2013(NigelCrawford)

• VaccineEducation:Anevidencebasedapproach.ImmunisationAdvisoryCentre,8thImmunisationConferenceandworkshop,NewZealand,September2013(NigelCrawford)

• Preterminfantsimmunisation.ImmunisationAdvisoryCentre,8thImmunisationConferenceandworkshop,NewZealand,September2013(NigelCrawford)

• VaccineSafety:HPVvaccineasacasestudy.ImmunisationAdvisoryCentre,8thImmunisationConferenceandworkshop,NewZealand,September2013(NigelCrawford)

• VaccineSafety,AdverseEventsandWhat’sNew?NestleInfantNutritionandPaediatricUpdate,August2013(MargieDanchin)

• MedicareLocalImmunisationUpdate,BarwonRegion,VaccineSafetyandAdverseEvents,July2013(MargieDanchin)

• MedicareLocalImmunisationUpdate,MacedonRangesandNorth-WesternMelbourne,VaccineSafetyandAdverseEvents,May2013(MargieDanchin)

• OptimisingImmunisationinSpecialRiskGroups,AustralianSocietyofInfectiousDiseases,Plenary,Canberra,April2013(NigelCrawford)

• ImmunisationinChildhoodCancer,AustralianandNewZealandChildren’sHaemotologyOncologyGroup,Plenary,June2013(NigelCrawford)

• MeningococcalVaccines:Fillingthealphabet.ClinicalVaccinologyUpdate(CVU),October2012(KirstenPerrett)

• Pneumococcalvaccines:the7upProject.ClinicalVaccinologyUpdate(CVU),October2012(NigelCrawford)

StaffingMedical StaffingNigelCrawfordhasanappointmentwithRCHImmunisationservice(2sessions)andSAEFVICMCRI(1session).MargieDanchinhasanappointmentfor2medicalsessions,with1sessionbeingmaternityleavecoverforKirstenPerrett(returningtoRCHNovember2014).TeresaLazzarohasanappointmentfor1medicalsessionandaweeklyimmunisationclinicandWonieUahwatanasakuhasaweeklyFeeforService(FFS)immunisationclinic.

Nursing StaffingOverthepast2years,KellyBernardhasmovedonfromtheImmunisationServicetotakeupafulltimeNurseUnitManagerroleonPossumward.TheImmunisationServicehasalsohadsomenewstaffjointheteam,particularlyoverthecourseoftheRSVImmunoglobulinprogram.Wewouldliketoformallythankthemfortheircontributiontothehighqualitycaredeliveredbytheimmunisationteam.Thisincludes:IsabelleLegrigore,MelissaKennedy,KerrynWilliamsandPetaKilsby.

Administrative SupportJessicaEliaandJulieBondhavecontinuedtheirworkwiththeImmunisationServiceinanadministrativeroleandthishasbeenextremelyhelpfultothenursingandmedicalstaffwhohadpreviouslytakenonalloftheadministrativeduties.TheyarebothextremelyknowledgeableaboutImmunisationandonoccasionhavepreventedclinicalimmunisationerrors,throughinitialscreeningofpatientheldimmunisationrecords.ThisadministrationsupporthasalsobeenextremelyhelpfulinestablishingthededicatedBCGclinics.OngoingfundingforadministrativesupportiscrucialtoensurethecontinualefficienciesoftheImmunisationService.


Publications1. HarrisonD,Elia S,RoyleJandManiasE.Painmanagementstrategiesusedduring

earlychildhoodimmunisationinVictoria.Journal of Paediatrics and Child Health2013;49(4):313-318

2. HarrisonD,Elia S,ManiasE,RoyleJ.Sucroseandlollypopstoreduceimmunisationpainintoddlersandyoungchildren:Twopilotrandomisedcontrolledtrials.Neonatal, Paediatric and Child Health Nursing2014;17(1):20-28.

3. GomezR,BarrowmanN,Elia S,ManiasE,RoyleJandHarrisonD.Establishingintra-andinter-rateragreementoftheFace,Legs,Activity,Cry,Consolabilityscaleforevaluatingpainintoddlersduringimmunization.Journal of Pain Research and Management2013;Nov-Dec;18(6):e124-8.

4. DonatoCM,ManuelpillaiNM,CowleyD,Roczo-FarkasS,ButteryJP, Crawford NW,etal.GeneticcharacterizationofanovelG3P[14]rotavirusstraincausinggastroenteritisin12year-oldAustralianchild.Infection, Genetics and Evolution.2014;25(0):97-109.

5 Crawford NW,HuntRW.Rotavirusvaccinetimelinessinspecialcarenurseries.ArchivesofDiseaseinChildhood-Fetal and Neonatal Edition.2014March4,2014:DOI:10.1136/archdischild-2014-306107.

6 Crawford NW,ClothierH,HodgsonK,SelvarajG,EastonML,ButteryJP.Activesurveillanceforadverseeventsfollowingimmunization.Expert Review of Vaccines.2014;13(2):265-76.

7 Crawford NW,BarfieldC,HuntRW,PitcherH,ButteryJP.Improvingpreterminfantsimmunizationstatus:Afollow-upaudit.Journal of Paediatrics and Child Health.2014;50(4):314-8.

8 AkikusaJ,Crawford N.VaccinationinPaediatricRheumatology.Curr Rheumatol Rep.20142014/06/13;16(8):1-7.

9 DoddCN,RomioSA,BlackS,VellozziC,AndrewsN,SturkenboomM,Crawford NWetal.InternationalcollaborationtoassesstheriskofGuillainBarreSyndromefollowingInfluenzaA(H1N1)2009monovalentvaccines.Vaccine.2013;31(30):4448-58.

10 Crawford NW,GrahamSM.EV71vaccine:protectionfromapreviouslyneglecteddisease.The Lancet.2013:http://dx.doi.org/10.1016/S0140-6736(13)61124-1.

11 Crawford NW,ButteryJP.Adverseeventsfollowingimmunizations:factandfiction.Paediatrics and Child Health.2013;23(3):121-4.

12 ClothierHJ,LeeKJ,SundararajanV,ButteryJP,Crawford NW.Humanpapillomavirusvaccineinboys:backgroundratesofpotentialadverseevents.Medical Journal of Australia.2013;198(10):554-8.

13 CampbellS,Crawford NW.Varicellainfectionininfantslessthan12months.Vaccine.2013;31(2):295-6.

14 TranD,ClothierH,ButteryJP,Crawford NW.SurveillanceofadverseeventsfollowingH1N1/09influenzaimmunisationinVictoria,Australia.Nature Science.2012;4(12):1065-73.

15 RichardsS,ChalkiadisG,LakshmanR,ButteryJP,Crawford NW.Complexregionalpainsyndromefollowingimmunisation.Archives of Disease in Childhood.2012;97(10):913-5.

16 DonatoCM,ChôngLS,BonifaceKF,Crawford NW,ButteryJP,LyonM,etal.IdentificationofStrainsofRotavirusVaccineRotaTeqinInfantswithGastroenteritisFollowingRoutineVaccination.Journal of Infectious Diseases.2012;doi:10.1093/infdis/jis361.

Clinical Immunisation Research and Publications 4


17 Crawford NWetal.Guillain-Barrésyndromefollowingpandemic(H1N1)2009influenzaAimmunisationinVictoria:aself-controlledcaseseries.MedicalJournalofAustralia2012;197(10):574-78.

18 Crawford NW.Immunizationsinchildrenwithcancer.Paediatrics and Child Health.2012;22(3):121-2.

19 Crawford NW.TheAustralianImmunisationsystem.Vaccines in Practice.2012;4(4):4-5.

20 ChinLK,Crawford NW,RowlesG,ButteryJP.Authors’reply:Australianimmunisationregisters:establishedfoundationsandopportunitiesforimprovement.[Letter].Euro Surveill.2012;17(21).

21 ChinLK,Crawford NW,RowlesG,ButteryJP.Australianimmunisationregisters:establishedfoundationsandopportunitiesforimprovement.Euro Surveill.2012;17(6).

22 ChengDR,Crawford NW,HaymanM,BuckleyC,ButteryJP.Recurrent6thnervepalsyinachildfollowingdifferentliveattenuatedvaccines:casereport.BMC Infectious Diseases.2012;12(1):105.

23 Danchin M,NolanT.Apositiveapproachtoparentswithconcernsaboutvaccinationforthefamilyphysician.Australian Family Physician,2014.In press.

24 LeaskJ,CheaterF,KinnersleyP,WillabyH,Danchin M.Presumptiveinitiationsinvaccinediscussionswithparents:acquiescencebutatwhatcost?Letterinresponseto:Opeletal.TheArchitectureofProvider-ParentVaccineDiscussions

atHealthSupervisionVisits.Pediatrics2013;132:61037-1046.

25 DunneEM,MarshallJL,BakerCA,ManningJ,GonisG,Danchin MH,etal.DetectionofgroupastreptococcalpharyngitisbyquantitativePCR.BMC infectious diseases.2013;13(1):312.

26 Danchin M,KirkwoodCD,LeeKJ,BishopRF,WattsE,JusticeFA,etal.PhaseItrialofRV3-BBrotavirusvaccine:Ahumanneonatalrotavirusvaccine.Vaccine.2013;31(23):2610-6

Conference Abstracts(i)Immunisationofpreandpostlivertransplantrecipientsat

theRoyalChildren’sHospitalMelbourne(poster).RachaelMcGuire,LaurenHerd,KatheBeyerle,ThaoNguyen,GeorgeAlex,WinitaHardikarandNigelCrawford.14thNationalImmunisationconference(PHAA),Melbourne,June2014

(ii)RespiratorySyncytialVirusImmunoglobulinforCardiologypatientsattheRoyalChildren’sHospital(poster).SonjaElia,NigelCrawford,MaileiKrippner,KateWall,MelissaDallinger,RachaelMcGuire,RobinCavanagh,MelAddison,RebeccaFeore,KirstenMitchell,MelissaNesbitt,KerrynWilliams,PetaKilsby,KellyBernard,AngelaWoodandMichaelCheung.14thNationalImmunisationconference(PHAA),Melbourne,June2014

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Immunisation Service Reports...2 the royal children’s hospital immunisation service reports...

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Transcript of Immunisation Service Reports...2 the royal children’s hospital immunisation service reports...