Questions and Answers from Stakeholder Webinar_14 June_to share externally

Questions and Answers Stakeholder Webinar (14 June 2022) Implementing changes to the Medicines Regulations 1984. Vaccinating Health Worker role.

Please send questions to vaccinationsauthorisatons@health.govt.nz Please find below the link to the next webinar • Ref# 1-1406

Tuesday 28 June 12pm – 1pm Question

Response

Vaccination Workforce How will the nursing profession feel valued and respected, with the It is important to recognise the critically important role that nurses play in the introduction of the Vaccinating Health Worker (VHW) role? delivery of immunisations in Aotearoa.

The VHW role is intended to support the role of nurses, not replace them. This is in the context of immense pressure on nurses with all of the tasks they are required to perform – particularly across general practice. The Programme is aware of people within organisations performing supporting roles (such as kaimahi or health navigator roles) who could be further supporting general practice by taking some of the vaccination load – for example during flu season when practices are running large clinics.

There is additional training to support nurses who will take on supervisor roles. We recommend that they undertake this training.

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Who will keep the register of authorised VHW? Are their plans to change full vaccinator authorisation as this seems to be a now unnecessary process for medical officers of health.

The VHW role may be a bridging step for some people – to give them the confidence to go on and train in nursing. This could have positive impacts for equity within the nursing workforce.

There is no register.

The Medical Officers of Health (MOoH) leaders’ group and the Acting Director of Public Health were consulted on the VHW role. They raised this question and asked if there is a way of synchronising and standardising this process and adding coherency, including the possibility of a register.

Until an improved and standardised process is agreed then the current authorisation remains unchanged ie, there is no register.

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What is the utility of the local MOoH to be involved?

Why are MOoH involved in this but were not involved in CVWUS - this is potentially a significant increase in their workload - what kinds on volumes are anticipated.

Refer to 2-1406 The Programme employs MOoH who authorise CVWUS and provisional vaccinators. These MOoH will also make authorisation decisions about VHWs, rather than MOoH in the regions.

Currently there are approximately 460 authorised CVWUS. It is difficult to anticipate how many of these will transition to the VHW role.

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What information been shared with MOoH about the expansion of their role and their responsibilities and the new processes? Haven't received anything yet from the NPHS

At some point in the future, iHNZ may explore sharing information about authorised VHW, CVWUS and provisional vaccinators with local MOoH. The programme has met with representatives from various Public Health Units around the motu and have shared information on the VHW role. It has been communicated that there is no expectation of the role and responsibilities of local MOoH expanding, as VHW authorisation is centrally managed by the Programme.

Please see 4-1406.

VHW training pathway Will the Programme consider a VHW to have an Annual Practicing Annual Practicing Certificates are issued by responsible authorities in relation to Certificate or come under a regulator body? health practitioners regulated under the Health Practitioners Competence Assurance Act 2003 (HPCA Act).

Do these vaccinators have to complete all the modules to complete the training, or can they stop at the influenza training if that is all they will be delivering?

Can you become a VHW without having been an authorised CVWUS?

The VHW role is expected to draw from people with a wide variety of backgrounds, including some who may be from a regulated profession. The VHW role itself will not be regulated under the HPCA Act. There are many health worker roles in our health system that are not regulated under the HPCA Act with systems and processes in place to ensure safe practice. More information can be found here.

The training modules will be grouped, e.g. for Stage 1 there is COVID-19 and influenza as one module and Boostrix and Gardasil as another. There is no need to complete, for example, the Boostrix/Gardasil module to be authorised to administer influenza and COVID-19.

However, vaccinators will need to complete all VHW Stage 1 training and authorised before being eligible to become a VHW Stage 2.

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Is there an option for community kaimahi workers who didn't become CVWUS certified to do some direct entry into becoming a VHW?

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What is the training pathway and time period for someone to complete Stage 1 training, for those who have not completed CVWUS training previously but have suitable healthcare experience

The priority is supporting authorised CVWUS to bridge to authorised VHW. Phase 2 of the programme will look at bringing on board 'other people' as new entrants i.e. those not authorised CVWUS into the role. It is anticipated the entry point training will be rolled out from August.

The time period for completing the training will vary by individual, as the pathway has a blended learning model including online, face to face and supervised practice components.

Employers will be able to nominate people for this role – they know their teams and are best placed to determine if they are well suited to become a VHW and whether there are appropriate clinical supervisor provisions in place.

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Will people be able to access the VHW training and micro-qualification without being supported by an employer?

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Are courses/modules free?

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What if the nurse doesn’t want to be a supervisor?

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What is the definition of "supervised" immunisation?

Please see 8-1406 An employer needs to support a person to become a VHW,

Please see 9-1406 It’s free for the participant; there is no cost to access the bridging stage 1 modules such as influenza, and the clinical supervisor training modules.

Supervision The programme recommends that workers and employers identify VHW clinical supervision role. The clinical supervision module is optional and is open to all authorised vaccinators. You know your strengths and experience to inform your professional development goals and training needs.

Note also that we are talking about VHW clinical supervision, rather than line management.

VHW would administer a vaccine that has been being prepared by someone else.

They ensure that the vaccinator’s training has been undertaken, and right vaccines are administered by the right person and in the right way at the right time.

Supervision means that the clinical supervisor is available on premises within easy calling distance of the VHW. 3|Page

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Can it be recommended that for the VHW, this it is not peer review for sign off as with registered nurses and pharmacists

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Why is training for supervisors not mandatory? This is an important skill when it comes to communication and direction.

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Will there be criteria for the supervisor as to level of experience - ie fully authorised, so many years, proof of practice etc?

A VHW will not be able to clinically assess another VHW. It will be the responsibility of their clinical supervisor or another authorised vaccinator.

Some authorised vaccinators have existing clinical supervision skills and experience, as such mandatory supervisor training doesn't apply to them. The course is open for authorised vaccinators to self-select their participation.

This was covered at the Webinar on 31 May 2022. Please refer to the slide below, which covers supervision requirements.

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Clinical assessment of RN /Pharmacist fully authorised vaccinator requires an approved assessor (who has done assessor training) to assess them. Why is this not the same for a VHW?

Fully authorised and pharmacist vaccinators can administer any vaccine without supervision, potentially to all age groups including infants. The clinical assessment requirements reflect this additional level of complexity and risk.

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Will there be guidelines as to what is expected for these VHWs to maintain their competency?

VHW are working under clinical supervision and direction to a narrower age range.

Guidance Yes, the Immunisation Handbook is being updated to reflect these expectations for VHWs. A key point of difference from the CVWUS role (which will lapse in June 2023) is that the VHW role is enduring. There are expectations around maintaining knowledge and competency – this will be in the Immunisation Handbook.

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Will there be guidance to school-based programmes for this role?

School based vaccination providers will adhere to Ministry of Education informed National Health NZ guidelines will ensure consistency and transparency consent policy. for both the workers and the kids/parents. consent form will need to reflect who is vaccinating the kids.

Vaccination records Recording/documenting the vaccines - will there be an effort to integrate There is a GP notifications process whereby new vaccinations added via CIR (for this into PMS systems for General Practice/community Outreach teams in Covid and for Flu) are sent via Healthlink to General Practice PMS systems. This the future? occurs 24 hours after the vaccinations were documented.

How often does the CIR numbers/data get sent to PMS systems? Just to Please see 20-1406 have a good handle on vaccination numbers of flu vaccines for targets Can primary care currently see flu vax status for their patients whose Please see 20-1406 data was submitted to CIR by eg a pharmacy?

Other questions Please can you manage the application on a National level?

Yes, this is the intention, as has happened with CVWUS and provisional vaccinators.

Please see 4-1406 A registered health professional obtains the consent from the consumer. The VHW may participate in screening questions and must check that consent has been given and is still active at the time of vaccination.

Employers/providers agree the salary for their employees and in accordance with sector employment agreements.

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Is taking consent going to become part of this role at some point?

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Is there an expectation that VHW will have fair salary matrix?

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Will there be full time work opportunities available for this?

While the VHW is a role it its own right, the expectation is that in practice a VHW will have additional skills to perform other functions such as health navigator, blood pressure checks, oral health guidance, throat swabbing – rheumatic fever, cold chain support, Hep C screening. It will depend on the needs of the employer, their preparation /qualification and workplace setting.

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So can VHW complete and administer all covid vaccines going forward?

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Will VHW be NZQA accredited?

A VHW Stage 2 will be able to prepare and administer COVI-19 (all brands) to ages 5+ once they have been authorised to do so.

VHW Stage 1 will be anticipated NZQA equivalent – Level 3 VHW Stage 4 will be anticipated NZQA equivalent – Level 4

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