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Healthcare assistants

Healthcare assistantsIn this alert Julie Price, MPS’s Clinical Risk Programme Manager, highlights the risk of healthcare assistants performing immunisations

Our team has identified the use of Healthcare Assistants (HCAs) undertaking immunisations in general practice as a risk area. There is no definitive list of tasks that an HCA can undertake. Whatever task is delegated to an HCA, the healthcare professional or registered clinician must ensure that the HCA is trained and has the necessary knowledge, skills and competence to undertake the tasks delegated to him/her, and that accountability is clear.

The Nursing and Midwifery Council states that: “The delegation of nursing or midwifery care must be appropriate, safe and in the best interests of the person in the care of a nurse or midwife. The decision to delegate would be judged against what could be reasonably expected from someone with their knowledge, skills and abilities when placed in those particular circumstances.”1 In many practices GPs delegate the task of administering certain injections to HCAs – for example, flu and pneumococcal vaccinations and vitamin B injections. Some HCAs are now being asked to administer pertussis vaccination for pregnant women.2

During our CRSAs (Clinical Risk Self Assessments) we identified that this is being undertaken on occasions by the HCAs without the HCA having Patient Specific Directions (PSDs) in place. The Nursing and Midwifery Council states that: “A Patient Specific Direction (PSD) is a written instruction from a qualified and registered prescriber for a medicine including the dose, route and frequency or appliance to be supplied or administered to a named patient.”3

Prior to administration of any vaccine by an HCA to a patient, the HCA must obtain a signed authorisation (such as, patient list signed by GP or independent prescriber) to administer the vaccine and complete the vaccination record sheet that details the patient name, date of birth, vaccine given, dose, batch number and expiry. This is a legal requirement under the Medicines Act (1968). Where an HCA is unsure about any aspect he/she must refer to a clinician for advice before administering the vaccine.

Education CRSAsThe PSD must:

  • state the name of the patient
  • state the name and dose of the prescription only medicine to be administered
  • show evidence to confirm that the patient has been considered as an individual.

The use of a template may assist for this purpose, for example:

A PSD for vitamin B injections could state: name, DOB, medication, dose, frequency of administration, review date, and be signed by the independent prescriber/GP and HCA, then scanned into the record.

The flu vaccinations could have a PSD attached to the list of patients signed by the independent prescriber and the HCA. For pertussis vaccination there should be a signed PSD for each patient. Patient Group Directions (PGDs) that were introduced in August 2000 constitute a legal framework which allows certain healthcare professionals, eg, practice nurses, to supply and administer medicines to groups of patients that fit the criteria laid out in the PGD.

HCAs cannot and should not vaccinate or administer immunisations on the basis of a PGDs, PGDs are only to be used by qualified healthcare professionals. Within general practice, HCAs are required to work in situations where constant close supervision is not always possible. This means that HCAs need to be able to share the responsibility for working safely and correctly.

Education, training and assessment will help to give them the confidence to do this successfully. Employing GP partners are vicariously liable for the acts and omissions of the HCA. All HCAs should have adequate indemnity arrangements in place for the task they undertake. It is essential that practices inform MPS of tasks that the HCA is undertaking to ensure that adequate indemnity arrangements are in place.

Percentage of practices who identified the risk

  1. Communication 99%
  2. Confidentiality & Caldicott 96%
  3. Prescribing 96%
  4. Record keeping and visits 96%
  5. Health and safety issues 94%
  6. Test results 88%

NB. This data analyses the results of more than 120 CRSAs conducted during 2012.

References
  1. Nursing and Midwifery Council, The Code: Standards of Conduct, Performance and Ethics for Nurses and Midwives (2009)
  2. Health Protection Agency, Pertussis vaccination programme for pregnant women (2013) 
  3. Nursing and Midwifery Council, Standards for medicines management (2010)
Useful links
  • BMA, Patient Group Directions and Patient Specific Directions in General Practice (2010)
  • Hand T, Influenza Vaccinations by Healthcare Assistants in Primary Health Care (2009)
  • RCN, Healthcare Assistants and Assistant Practitioners
  • Health Protection Agency, National Minimum Standards and Core Curriculum for Immunisation Training of Healthcare Support Workers (2012)
27 comments
  • By Alice on 08 February 2017 08:50 Thanks for your post Jane. If you a member of Medical Protection, please feel free to contact us for specific advice. Many thanks, The Web Team
  • By Jane on 08 February 2017 06:56 Can a HCA administer child immunisations where there is a PSD and in the presence of a nurse?
  • By Alice on 16 November 2016 04:06 Thanks for your post, Angelina. I think your question is covered by a previous reply on this thread. If you are a member of Medical Protection, please do not hesitate to contact us directly for specific advice in your situation. With best wishes, The Web Team
  • By Angelina on 10 November 2016 03:43 can HCA provide Meningococcal C vaccine under PSD and doctor supervision?
  • By Nicole on 31 October 2016 02:09 Can an HCA give a vaccine or B12 injection by sub cutaneous injection if the patient has a bleeding disorder?
  • By Alice on 26 September 2016 12:11

    Thanks for your post Rachael. In the experience of our medicolegal team, the administration of vaccinations to housebound and care homes patients is usually undertaken by the registered nurse. Although there is no defined list of tasks that a HCA can undertake, it is prudent for the practice to consider the  points in the GMC's Good Medical Practice Guide (2013), paragraph 45 here http://www.gmc-uk.org/guidance/good_medical_practice.asp.

    I hope this is helpful. With best wishes, The Web Team

  • By Rachael joy on 20 September 2016 03:39

    HI 

    ARE HCA able if trained and competent to go to housebound patients and care homes and administer flu injections? Thank you 

  • By Alice on 18 August 2016 04:08

    Thanks for your most, Michelle. I've checked with a professional colleague who tells me that a Patient Specific Direction (PSD) is an instruction from a doctor, or non-medical prescriber for medicines to be supplied and/or administered to a named patient after the prescriber has assessed the patient on an individual basis. There is no set protocol for PSDs written into the Legislation. As long as the prescriber (prescribing doctor) has considered that the individual patient and has, as a consequence, given an instruction to supply or administer a drug to that patient the PSD is sound.

    We would advice that the healthcare professional delegating the task must ensure the HCA is trained and has the necessary knowledge, skills and competence to undertake the tasks delegated to him/ her, and that accountability is clear and the HCA should not be asked to make clinical judgements. I hope this is helpful. With best wishes, The Web Team.

  • By Alice on 18 August 2016 04:07 Thanks for your comment, J Tomkinson. I've checked with a professional colleague here, and she informs me that The Medicines Act does not allow HCAs to administer POMs under a PGD, as they are not included in the list of ‘authorised‘ persons. An authorised person is one who is professionally regulated, ie, a registered nurse. HCAs therefore have to use a PSD or signed prescription as authority. I hope this is helpful, With best wishes, The Web Team
  • By MIchelle on 29 July 2016 10:44 Hi, can anyone tell me if a HCA can administer travel vaccines under a PSD following the patient having a travel consultation with the doctor?
  • By J Tomkinson on 22 July 2016 07:53

    Hi 

    The link to CQC PSD's page states ' Healthcare assistants cannot administer/supply medicines under a PGD.'

    Can you clarify this please

  • By Alice on 11 July 2016 09:42 Thanks for your post, Sue.  The information provided in the article March 2012 Unsung Heroes or Hidden Risk, still stands. There is no definitive list of tasks that an HCA can undertake. Medical Protection advice is such that whatever task you delegate to an HCA, you must ensure that the HCA is trained and competent to undertake the tasks delegated to him/her, and that accountability is clear, as stated by the GMC in Good Medical Practice. He/she should be supervised and work to practice protocols. Members are invited to contact Medical Protection for further advice. I hope this is helpful. With best wishes, The Web Team
  • By Jacko on 07 July 2016 04:31

    Hi Paul,

    In response to your question, a nursing assistant may ask a registered nurse for medication for a patient. However, as the nursing assistant is not qualified to assess a patient, it is the RNs responsibility to assess the situation and act accordingly. The RN is bound by the NMC Code:  

    “You assess need and deliver or advise on treatment, or give help (including preventative or rehabilitative care) without too much delay and to the best of your abilities, on the basis of the best evidence available and best practice”. https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf

    Hope this helps,

    The Web Team

  • By Sue Hansliw on 06 July 2016 09:20 Hi can HCAs give depos under a psd please
  • By Paul on 04 July 2016 10:49 is there anything Wrong with a nursing assistant asking a RN for medication for a patient. for example in a mental health ward and the patient is being in a prone restraint, can the NA ask a RN arriving at the scene to get medication?
  • By Alice on 14 June 2016 09:04 Thanks for your post, Claire. The information provided in the article March 2012 Unsung Heroes or Hidden Risk, still stands. There is no definitive list of tasks that an HCA can undertake. Medical Protection advice is such that whatever task you delegate to an HCA, you must ensure that the HCA is trained and competent to undertake the tasks delegated to him/her, and that accountability is clear, as stated by the GMC in Good Medical Practice. He/she should be supervised and work to practice protocols. Members are invited to contact Medical Protection for further advice. I hope this is helpful. With best wishes, The Web Team
  • By Clare on 05 May 2016 03:19

    The Medical Protection Society Article from March 2012 entitled "Unsung heroes or hidden risk?" talks about a number of different roles that are carried out by HealthCare Assistants- one of these roles includes INR clinics and warfarin dosing. The MPS published advice concerning the delegation to HCA's for dosing Warfarin and if this is to take place the MPS suggested rigid guidelines should be followed. As this article was written over 4 years ago I just wanted to get some updated guidance concerning this issue. What guidance does the MPS currently suggest regarding HCA's running INR clinics and dosing warfarin using clincial decision support software?

  • By W B on 14 March 2016 07:50 I am a pharmacist and i work for a company that delivers nurse and HCA training for vaccinations, PSD's PGD's amongst other things. We can provide templates if required.
  • By Rachel on 29 September 2015 02:33

    Hi Ann

    Yes, suitably trained HCAs can provide vaccinations under patient specific directions (PSD)s, but ultimately the responsibility lies with the prescriber. As long as individuals are named and assessed for provision of this service and with the governance emphasis on training and competency of HCAs

    Thank you 

    MPS Web Team

  • By Ann on 29 September 2015 07:28

    Hi

    Can HCAs give shingles vacs?

  • By Gillian Bailey on 08 September 2015 09:12

    Hi

    My name is gillian bailey, i'm a HCA.  I did a training course on injection technique and administering B12 and Flu's.

    Does this cover me for administering Pneumoccocal vaccine.

    Kind Regards

    Gill

  • By Alice Gorecki on 22 July 2015 01:16

    Thanks for your comment. We don’t have examples of PSDs as such but MPS would advise the practice to develop their own following the guidance set out in the article. Practices could also contact their Medicines Optimisation Team within the CCG for advice and support. I hope this is helpful.

    Regards, the MPS Web Team

  • By P Harris on 13 July 2015 04:19

    Hi

    i've just been on a vac's update for hca and the course leader says we can't go out and do housebound flu's on our own but the gp says we can 

    is this right 

  • By Jack on 25 February 2015 12:12

    Hi Katrina,

    Thank you for your feedback and interest in our training courses. In this instance please could you email your query to the editor of Practice Matters sara.dawson@mps.org.uk

    MPS Web Team

  • By Katrina on 13 February 2015 05:21

    Hi Can HCA's be trained to give Hepatitis B Vaccinations, under the direction of a qualified nurse. I work in Occupational Health and all our Officers get vaccinated against Hep B as standard.

    if so are there any training courses?

     
  • By Rachel on 05 February 2015 05:28

    Hi Margaret

    Thank you for your enquiry. I'm afraid we don't have the PSDs available to download from our website as they can be written in various ways (ie. "an instruction in the patient's notes or a note sent to a treatment room for the administration of a medicine or a course of medicine" - more information is available here).

    Our advice would be to contact the Medicines Optimisation team at your local CCG as they may be able to provide further guidance on how you should format your PSDs.

    Julie Price, who authored the above article, has also suggested that the following resources might help you find out more about PSDs:

    I hope you find that useful. Please get in touch if there's anything else we can do to help.

    MPS Web Team

  • By margaret on 04 February 2015 03:47

      
    Please can you help trying to download the PSD for healthcare assistants on pneumo vaccines and b12.

    Please either send these down email to me or send information on where to get these.

    Thank you

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