The ACT Government has made changes in 2020 to permit registered nurses and midwives that have successfully completed a training course that meets the National Immunisation Education Framework for Health Professionals (December 2017) (National Education Framework) to administer certain vaccines without a prescription or standing order.
The changes commence under the Medicines, Poisons and Therapeutic Goods Regulation 2008 from 21 August 2020. New ACT Registered Nurse and Midwife Vaccination Standards (the Standards) have been established to set conditions for the administration of vaccines by authorised nurse and midwife immunisers.
Health Education Services Australia (HESA) is currently working to establish a list of accredited training courses that meet the National Education Framework. While this work is being undertaken, a list of training courses that ACT Health will accept as meeting the National Education Framework is described in the Standards. Recognised courses include:
- University of Melbourne – Nurse Immunisation Program
- La Trobe University – Nurse Immuniser Program
- University of Tasmania – Immunisation Education for Registered Nurses
- Australian College of Nursing – Immunisation for Health Practitioners
- SA Health – Understanding Vaccines & the National Immunisation Program
- QLD Health/Cunningham Centre – Registered Nurse Health (Drugs and Poisons) Regulation 1996 course
Specific refresher training is not required under the arrangements. However, an authorised registered nurse or midwife must ensure that they have the necessary knowledge, experience and commitment to continuous self-education to ensure their professional competence to practise as an immunisation service provider. This may be, but is not limited to, attendance at updates or seminars on current practices or annually reviewing best practice policy for immunisation.
Employers should establish clinical governance structures, documented policies and procedures to ensure authorised nurses or midwives they employ are able to provide vaccination services in accordance with the ACT regulatory requirements.
This includes, but is not limited to:
- processes for checking registration and qualifications of employed nurses and midwives,
- patient assessment and post vaccination monitoring,
- anaphylaxis management,
- vaccine cold chain management,
- record keeping and reporting of adverse events,
- provision and maintenance of equipment, and
- checking professional indemnity cover for employees.
Under the new arrangements, authorised nurse and midwife immunisers may administer any Australian registered vaccine without a prescription or standing order included in the Australian Register of Therapeutic Goods; with the exception of:
- Immunisation for tetanus prophylaxis related to wound management.
- Immunisation for travel purposes.
- Immunisation of contacts of a case with a notifiable condition, unless directed by the Chief Health Officer (CHO) or their delegate.
- Immunoglobulin preparations, unless directed by the CHO or their delegate.
- Immunisation for Tuberculosis
- Immunisation for Q fever (Coxiella burnetii)
- Immunisation for Rabies and other Lyssaviruses
- Immunisation for Japanese Encephalitis
The Standards enable a suitably qualified nurse or midwife immuniser to administer the COVID-19 vaccine when it becomes registered and available in Australia.
An authorised nurse or midwife immuniser must meet the following conditions when administering a vaccine without a prescription or standing order:
- Conduct vaccinations in accordance with the Australian Immunisation Handbook (current online version);
- Store vaccines in accordance with the current version of the National vaccine storage guidelines: Strive for 5;
- Maintain appropriate records of each vaccination event. Each vaccination event should be recorded on the Australian Immunisation Register;
- Ensure a complete and in-date anaphylaxis response kit is readily available at the premises at which the vaccine is given;
- Report any adverse events following immunisation (AEFI) to the ACT Health Protection Service. Note: AEFIs are Notifiable Conditions under the ACT Public Health Act 1997 and must be reported to the Health Protection Service Immunisation Unit;
- Hold a current certificate for the Australasian Society of Clinical Immunology and Allergy (ASCIA) anaphylaxis e-training for health professionals or equivalent issued;
- Have successfully obtained a statement of proficiency in cardio-pulmonary resuscitation (such as Provide cardiopulmonary resuscitation - HLTAID001 or equivalent) within the last 12 months; and
- Be covered by appropriate professional indemnity insurance for providing vaccinations (generally this insurance will be held by the employer).
Nurse and midwife registration status
These changes relate to registered nurses and midwives only and do not permit an enrolled nurse to administer a vaccine without a prescription.
These changes do not affect the current authorisations for nurses, midwives and enrolled nurses who may administer vaccines with a prescription. The changes also do not affect the ability for nurse practitioners and endorsed midwives to administer vaccines without a prescription.
Existing authorising mechanisms for nurse and midwife immunisers are not being repealed.
Nurses and midwives working for Canberra Health Services (CHS) who administer vaccines under CHS Standing Orders, will continue to be authorised unless these expire or are revoked by CHS.
Nurses and midwives working for CHS Maternal and Child Health Services who administer vaccines under Chief Health Officer Standing Orders, will continue to be authorised via this mechanism until these expire on 31 December 2021.
Nurses and midwives working for private vaccination service providers who administer vaccines will continue to be authorised under their employer’s First Aid Kit licence, until these expire. ACT Health will not be will not be issuing any new First Aid Kit licences and will not be renewing any existing licences beyond 13 October 2021.
All currently practicing nurse and midwife immunisers will need to meet the training requirements of the new Standards from the date that their current authorising mechanism ends. Some nurse and midwife immunisers may need to retrain where they have not already undertaken a recognised course.
There are no pre-existing authorising mechanisms for nurses and midwives working for general practices. From 21 August 2020 qualified nurses and midwives working in general practice may administer vaccines without first obtaining a written or oral prescription from a doctor, where they have undertaken recognised training under the Standards.