1. Children with outstanding immunisations:
Transfer from HV to SN caseload
Leigh Pusey: Immunisation Coordinator, BCUHB
19/04/2018

2. ACKNOWLEDGMENTS
The small army of dedicated immunisers and support staff in north Wales GP practices and BCUHB colleagues who never give up on a child
VPDP, in Public Health Wales for the data
Heart of Birmingham PCT; Working smarter, Improving performance 2006
19/04/2018

3. Presentation overview
Background
Outline of the project
Key actions
Results of the targeted work
Issues identified
Next steps
19/04/2018

4. Background Improve uptake for 5 year olds Cohort 7,956
2nd MMR and 4 in 1 Preschool booster average uptake 92-94%
Avoid an abundance of unvaccinated children entering schools
Reduce risk of an outbreak at younger age
Increase in additions/deductions in the area
19/04/2018

5. ‘Active patient management’ in the Betsi Cadwaladr University Health Board
Background
A phase coined by Heart of Birmingham Teaching Primary Care Trust.
Proactively targeting apparently under immunised children approaching first, second and fifth birthdays
19/04/2018

6. Action taken
If the immunisation is truly outstanding the parents are contacted by phone and encouraged to attend for immunisation by the Health Visitor
Queries about immunisation are discussed with the parent
Some children are home immunised
Some children remain unimmunised
19/04/2018

7. Childhood schedule - to obtain lifelong protection
Very important sequence of events
Get the 1 year olds on target 
Then the 2 year olds
Then the 5 year olds
To stand any chance of getting the Teenage booster and 2nd MMR up to target
- the last safety net before they leave school
19/04/2018

8. Outline of the project There are two key tasks
1.Data cleansing – reconciling data held on the Child Health Information System with the medical record held by the GP practice to ensure COVER report is accurate
2. Proactive follow up of children – Liaising with HV/SN managers to request the Health Visitor follow up each child and facilitating the immunisation.
19/04/2018

9. Parents fall into four categories:
Presume the ‘system’ will pick them up and invite them in.
Do not realise their child is missing an immunisation
Persistently default appointments and may not prioritise immunisation appointments
Do not give consent
19/04/2018

10. Key actions Checking: If the child is still here
If the child has moved in with hand held records
Translate records and move onto UK schedule
Check with GP if vaccines have been given
Review consent status to avoid hanging in the system and not being appointed, avoid deferred ?
Have discussion about egg allergy advice
Focus on children that have had some vaccines
19/04/2018

11. Key actions Facilitating the appointment
Encourage and remind parent of missing vaccines
Make appointments
Support offered to transport to GP appointment
Home vaccinate
19/04/2018

12. Results of the targeted work
East
2016 pre cleanse
2018 post cleanse
% Increase
No. of children
4 in 1
94.4%
96.8%
2.4% 90
2nd MMR
94.2%
96.5%
2.3% 87
Central
No. of children
92.3%
95.8%
3.5% 95
92%
95.5% 96
West
94.7%
1.8% 51
93.9%
2.6% 58
Health Board
Total
92.6%
96.4%
3.8%
236
96.1%
241
19/04/2018

13. Issues identified
Children have moved in from abroad and we were not always made aware
Children were not always transferred onto the incomplete schedule algorithm
Information regarding immunisations was not sent to Child Health Information System
19/04/2018

14. Know how you CHIS works
GP practices reminded about completing immunisation information correctly
Children can’t come for immunisations unless they are invited
Too many deferred consent status
CHIS works well if everyone in the chain knows how to use them
If any part of the system does not understand it uptake rates will suffer
19/04/2018

15. Next steps The scheme was well worth implementing
Repeated for children commencing school 2018
Audit of form filling and training planned
Constant monitoring and awareness raising about treatment queues
Identify schools with lower uptake
19/04/2018