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PSDs and flus
cloe

425 Posts

Posted:  18-Sep-2012 08:13
Hello

The HCA's have their clinic list signed each morning to act as a PSD for adminitering flu vaccine to anyone who attends their clinic that day. how do others manage add-ons after the list has been signed e.g. an extra blood test or ECG slotted in mid morning, that is also entitled to the flu vaccine.

Thank you

Cloe

Essex Girl

50 Posts

Posted:  18-Sep-2012 09:38
Hi Cloe,

the patient would have to re-book for their flu vaccine unless one of us were free to pop in and give it at the time... ..  don`t know if anybody else has any suggestions ??

Chivers

65 Posts

Posted:  18-Sep-2012 16:09
We do individual PSD''s rather than a list of names. They are a bit more time consuming, but can then be scanned into the pt records rather than having to be stored for years on end. They also are a lot more flexible that a list.

Cookies

423 Posts

Posted:  18-Sep-2012 17:52
I thought a PSD was an instruction for flu jab to be given on an individual named basis and had to be recorded in patients records therefore as long as a prescriber records something in patients records then any extras could be vaccinated where appropriate.
I'm not sure signing a clinic list would be classed as a PSD - maybe I'm wrong ,but how does the prescriber enter their request to vaccinate in the individual patients records?
Does somebody check the HCAs clinic prior to signing her clinic list to check that the patients on her  list  require a flu jab?
Signing a clinic list seems more like a PGD which a HCA cannot use inorder to vaccinate.

Our HCA has a separate PSD for each patient which is completed prior to her clinic and scanned into the individual patient records prior to her seeing the patient -  all her patients are booked in advance which allows a prescriber to complete a PSD prior to her seeing the patient. Any extras booked in on the day that may need a flu jab Eg diabetic attending for bloods who needs a flu jab , she sends a screen message to a prescriber who then enters written instruction onto patients computer records which then allows HCA to vaccinate patient there and then. Flu drop in flu clinics are only done by registered nurses who use a PGD if not a prescriber.
This is on recommendations of our PCT  although I'm sure this may be different elsewhere in the country.
Fluff

1208 Posts

Posted:  18-Sep-2012 21:17 Log in to like this post
Agree with Cookies: signing a clinic list is not classed as a PSD as surely it will include patients who are not eligible?
We do have a list of patients on a PSD but they have been checked beforehand.
If our HCA has an extra e.g. ECG who is eligible for flu vac, she will ask the person referring if the flu vac can be given and put a new PSD under that persons nose and ask them to sign it there and then. If that can't be done, the patient is rebooked or another nurse is asked if they can come in quickly and do it.
I do a session on the course and it is amazing how different practices run their HCA clinics. Even though the HCA and their mentors are given all the legal information, some GPs still insist on doing their own thing. Some practices run a list of all eligible patients (sometimes as many as 3000 or more) and put all patients on one PSD so that the HCA can vaccinate any of them. Not sure it would stand up in a court of law but some HCAs are fightened to say anything to their GP or PM.
Maybe I go the other way as I'm very protective over my HCAs but I want us all to be able to stand with heads held high and justify what we are doing. I wouldn't be without them but need to protect both them and myself

Fluff
anon-i-mouse

312 Posts

Posted:  19-Sep-2012 08:09
I''m interested to read this thread, our HCA''s are about to start doing flu''s after having had PCT training, I know if our GPs thought they could get away with it would sign a sheet as suggested here, and I dont think its right either, I suggested they enter the read code ''flu jab recommended in surgery'' to each of the notes, but as yet the training hasnt been given so im not sure what they will be told, I have asked the trainer if she can provide the training materials to me before the HCA''s go so that I can be aware of what they will be taught, but as the training is at a cost she wont share the slides - I suspect incase I then decide to use them as a training aid and not send the ladies on their course!.

Is it a case of unless they are fit and well and state that the HCA''s wont be able to give - ie if a pt says they are unwell then as nurses we question to what extent they are unwell (ie they have a bit of a sniffle vs they have a rip roaring infection and are on antibiotics)... and give or delay accordinging ... can the HCA''s make that judgement or is it as I say a case of send them away.

The training ought to have been arranged earlier but as with everything with this PCT its all last minute, by then time they are trained and i have time to go through what needs to be in place and clinics on and booked (reminding reception that I suspect the HCA''s cant do pneumo) it will be the end of the flu season!


munchkin

238 Posts

Posted:  19-Sep-2012 09:11
I''m not saying I agree with what happens at our practice but......
HCA does flu clinics unsupervised by a nurse without any PSD or anything else!!!
I hope she wouldn''t vaccinate any one that she has any concerns about and won''t vaccinate children.
Obviously I disagree but over ruled by GP''s who say they are happy she is capable of jabbing! Always a GP on site when clinics happen. Not sure where she stands legally with no registration, insurance or qualifications!

Munch
Cookies

423 Posts

Posted:  19-Sep-2012 10:23
Munchkin
Not sure if you already have BUT I would strongly advise you to seek advise re this.
In her job description ,who does it say she is accountable to? If its you, then in my opinion you need something in writing to protect you  incase anything happens as I'm sure technically it could be you in serious trouble if she makes a mistake.....

Does the HCA have any form of medical defence cover ? - When our HCA started doing flu jabs I had to complete all sorts of paperwork for her  MD  as they requested copies of practice protocol and  PSD etc that she would be using....They even requested a copy of her updated job description.

munchkin

238 Posts

Posted:  19-Sep-2012 10:50
Cookies
Thanks for your advice. I will have a word with the PM tomorrow! I have verbally said that I have not personally delegated this or any other role to our HCA who has been given lots. Of responsibility ( that she is very happy to do).

I''m on an immunisation update tomorrow and will ask for advice! Maybe something in writing would be good to formalise my position and cover myself!

I don''t think her contract would have much more on it than Phlebotomy! OMG where would that leave her! Could it be argued she is giving imams without permission?

I do frequently raise concerns over this issue but no one seems to worry but me!

Munch
Cookies

423 Posts

Posted:  19-Sep-2012 11:23
Munchkins
Perhaps worth having a quiet word with the HCA re your concerns  as she may not actually be aware of the potential problems she could land herself in -especially if nothing in her contract about her doing immunisations !
Has she actually completed a recognised training programme to allow her to give injections. Our PCT do training courses for HCAs re flu,pneumo and B12 BUT they can only access this if have NVQ level 3.
All the theory given on this course and then HCA needs to be supervised in practice giving injections until signed off as competent.

munchkin

238 Posts

Posted:  19-Sep-2012 14:15
Cookies

The course was done! It was provided by a company who were not concerned re lack of any NVQ. I was asked to supervise B12 injections but have not done so.
I thought if the HCA were to be required to do these injections then she should have insurance cover but this was not available as she has no formal training.
I have spoken to our HCA re my concerns but she doesn''t seem to understand. She feels confident to jab and the GP''s are happy so fails to see my point!




Munch
Cookies

423 Posts

Posted:  19-Sep-2012 15:04
Hi Munchkins
Not sure what else to suggest -sorry.
Although ....maybe  worth contacting your PN lead , MDU or union for further advise ?

munchkin

238 Posts

Posted:  19-Sep-2012 15:23
Will ask at update tomorrow!

Munch
cloe

425 Posts

Posted:  20-Sep-2012 19:31
Well, what a minefield. The more i look into it all, the more i realise how we are not doing it as it should be done. Both out HCAs have done the 2 day training and looking at their handbooks, all the advice is in there on how to use PSDs properly and, the need for protocols for any vaccines/b12s they give. But neither of them has said anything and just got on and done it the old way!!
So i need to get on and write some protocols and try and get their clinics running with PSDs used properly.

Cloe

Buckos

138 Posts

Posted:  09-Oct-2014 12:42
I did the course recently and was taught that you don't need a separate prescription for each patient, this has been checked with the rcn, mps and the local CCG.

A list of names is not a PGD, a PGD is completely different, HCA's aren't allowed to use a PGD.

In my surgery I copy and paste my clinic list in to the PSD template and the prescriber signs it.

The PSD has to be used in line with the policy.

My PSD is on headed paper and basically worded as follows:

"The Following list of patients are to be administered:

Seasonal Influenza vaccination (split virion) 0.5mls by intramuscular injection

by Health Care Assistant name here

List of patients names and date of births

Prescriber signature......................
Date of signature...........................
Valid until.......................................

"

I'm allowed to give anyone who is eligible over the age of 16 the flu vaccine. But not pregnant women, and have to ask the relevant questions first such as have you had it before and are you well. Any problems I am too refer them to Gp or nurse.

Printing a clinic list and turning it in to a PSD is perfectly legal, a prescription is a written instruction from a prescriber.

On the course I was told if you had an extra that wasn't on the list then you could add them and get the Gp to sign it, or could quickly write up a new PSD.

Della

1697 Posts

Posted:  09-Oct-2014 20:45
Yep, Buckos is right, a list is perfectly acceptable using the wording (or very similar) to what she has - this is a fairly standard PSD.

That list should only include the names of people who are eligible for the flu vaccine, and at my surgery every name must be written or typed on the list, it cannot just be a print-out of the people attending that morning (not sure if that's true, or just what my surgery does - I'm not arguing with it as it's taken a while to get them to come round to the idea of PSD's!).

And any HCA giving any injection should have a PSD of some kind, whether a list like Buckos, an individual script or a PSD read code (eg "has authorisation to give xxxx under PSD") as long as it has been entered by a GP.

At my surgery, anyone else attending (eg for a routine nurse appt or slotted in as an extra) has an individual PSD recorded by the GP before administration of flu vaccine, and if that can't happen for whatever reason, they must book in for another time.







 
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