This guide explains how to deal with mixed consents for the DTP/MenACWY vaccination programme. In particular it explains he various scenarios that can be encountered, and how best to deal with them, to ensure that children can be outcome appropriately.
This covers both steps in triage workflow, as well as how to outcome using both the spreadsheet and the iPad.
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There are two mixed consent situations that a parent can create
- Yes consent for DTP; No consent for MenACWY
- No consent for DTP; yes consent for MenACWY
In either case the No consent could be for a number of reasons, that the parent can select:
- Personal choice
- Vaccination being given elsewhere, e.g. GP
- [DTP] Vaccination already received (5 doses in total)
- [MenACWY] Vaccination already received after age 10 years
- Child not eligible due to medical reasons
- Concern about safety of immunisation
(Note that not all of these are used by every provider.)
In this situation, the referral would be sent to the spreadsheet or iPad for outcome processing. The no consent would be highlighted as ‘parent declined’.
This means that the clinicians can review the referral, see that the child is due one of the vaccinations, but not the other, and outcome the child appropriately.
In this scenario, the parent has confirmed yes consent for both DTP and MenACWY, however the clinicians have decided that one of the vaccinations should not be given. Typically this would happen where the parent has stated that their child has had one of the vaccinations in the past 5 years or since the age of 10.
When the clinician changes one of the yes consents to no consent, they would typically select ‘declined clinically, or by service’. If they do this, then the whole referral will not come down to the spreadsheet or iPad. This means that the child would not be able to receive the one vaccination that they can receive (either DTP or MenACWY).
The way to resolve this, is for the clinician to select ‘consent not given’ when they change the consent status for the affected vaccination. By doing this, it provides the same status as when the parent declines consent on the econsent form - ‘parent declined’.
By doing this, it means that the referral will appear on the spreadsheet or iPad, and the child can receive the relevant vaccination and be outcome appropriately.
If the parent has declined one of the vaccinations, then the referral will still come through to the spreadsheet of iPad, so that the child can have the vaccination they have been consented for.
If both vaccinations have been consented but the clinicians decide not to give one of them, then this section explains what needs to happen within RIVIAM workflow.
Why would a clinician decline one of the vaccinations?
This would typically be because either the child has already had the vaccination or there are some medical history which means they should not have it. This will be flagged up within RIVIAM workflow as clinical triage, based on what was on the econsent form.
The clinician selects the relevant referral, and then clicks on the imms tab in the left hand menu
- For the relevant vaccination, the clinician clicks on the ‘Action’ button, next to the relevant vaccination, and selects ‘update consent status’ from the dropdown.
- A new window opens and they then need to select ‘Consent not Given’ and NOT ‘declined clinically or by service’.
- In the ‘select the step to allocate to’ dropdown, they should select ‘Parent declined consent’.
- Finally they should type in relevant notes to explain what is happening.
Clicking on confirm will update the record:
This record will now appear on the clinic spreadsheet or iPad clinic, and allow the remaining vaccination to be outcomed.
To outcome records on the spreadsheet, start by downloading a clinic spreadsheet. Once you have that you should see entries as follows:
The first entry is the one we have processed in the example above. The MenACWY vaccine has been declined, but the DTP vaccine can still be given.
The second entry is in clinical triage, and can be given if the nurse is happy, based on the history information provided.
In order to outcome, the information in the top left needs to be filled out fully. This is different to Flu or Covid, as two entries need to be made in each cell for Batch number and expiry date:
The final step is to fill in the outcomes for each of the vaccinations for each referral:
Then the file can be saved and uploaded back into RIVIAM, as normal.
This section describes how to outcome mixed consents on theRIVIAM iPad app.
The patient Alpha Testlr has a yes consent to DTP and a No consent to MenACWY.
- Select the child Alpha TestLR.
- Complete the outcome for Alpha Testlr.
- Select Save and confirm.
- The patient will move to the Seen List
The patient Alpha Testlr will appear in the Clinic but only in the SEEN List.
- Open the Alpha TestLR referral.
- Clinicians can see that the DTP vaccine has been given.
- Clinicians can see that the parent has not given consent for MenACWY so will not give the vaccine.
- If the parent changes their mind and wishes the child to be vaccinated. Clinicians will not be able to change the NO to YES on the iPad. First, they must go to the Immunisations tab and update the vaccination status on RIVIAM to consent given and complete the outcome using either the spreadsheet or generate another clinic.