Covid-19 Vaccination Resources

May 2021: Resources to support second dose planning and recall have been updated so cohort 1-9 patients are recalled 4 weeks earlier in line with recent changes to guidance.  Moderna vaccines are now included in the second dose reports.

April 2021: Astra-Zeneca (AZ) Safety: The COVID-19 vaccination searches have been updated to support AZ safety.  They now include the following features:

1. Searches to identify all patients where AZ is contraindicated (H/o venous sinus thrombosis, thrombophilia, heparin-induced thrombocytopenia)

2. The patients above subdivided into those who haven’t had a first dose and those who are due a second dose of AZ (which will need to be changed to a different brand)

3. Searches to subdivide patients in cohort 1-9 into those who can have AZ (i.e 30+ or with an at risk condition) and those who can’t (i.e. those under 30 without an at risk condition – likely to be carers, healthcare workers or the household contacts of immunosuppressed patients)

4. The second dose searches for AZ now automatically exclude patients from the contraindicated group.

February 2021:We are announcing important updates to the CDRC Precision digital resources for Covid-19 Vaccination Campaign for EMIS and SytsmOne as follows:

– Removal of anaphylaxis and anaphylaxis medication as a contraindication

– Addition of informal carers to cohort 6

– Additional tools to make the screening of invitation lists easier e.g. by highlighting patients with a possible pregnancy, anaphylaxis, learning disability, and dementia.

– A search to identify patients who have been excluded from the invitation lists so these can be checked to ensure no one is inappropriately excluded.All resources are developed following NICE guidelines and are hazard tested and quality assured by NECS. 

In order to access CDRC Precision COVID-19 resources for SystmOne, you will need to join the DCS resource group.

If you are not already signed up to the resources group, we have a guide to help you through the process. You can find the guide here.

To make full use of the DCS Covid19 vaccination system:  

1. You will need to create your own Covid19 patient status alert (icon). This is to allow the PSA to display at your unit for the appropriate cohort of eligible patients. Navigate to the PSAs  

Choose the Imms – Covid19 Vaccination – First PSA and then click Copy. 

Change the trigger report to one of the reports below, depending on progress at your unit. 

2. It is worth setting S1 to carry over vaccine batch numbers – instructions for this can be found here  

3. Add the Covid vaccination templates to your system. This cannot be done centrally. The DCS Covid19 system is currently set up for the Pfizer/Biontec vaccine.   

Go to the vaccination template then click New Template and complete the template as shown below. Spelling, spacing and capitals are important. You might need to tick the Generics box to make the covid vaccines appear in the picking list. 

The following templates will be needed depending on which vaccines you have: 

Template name: Covid19 Pfizer 1 

Vaccine: COVID-19 mRNA Vac BNT162b2 30mcg/0.3ml conc for susp for inj multidose vials (Pfizer-BioNTech) 1 

Part: 1 

Method: intramuscular 

GMS Status: Not under GMS 

Template name: Covid19 Pfizer 2 

Vaccine: COVID-19 mRNA Vac BNT162b2 30mcg/0.3ml conc for susp for inj multidose vials (Pfizer-BioNTech) 1 

Part: 2 

Method: intramuscular 

GMS Status: Not under GMS 

1. If you wish to use the DCS Covid 19 vaccination PSD system you will need to add a local copy of one of the reports – see PSD 

The DCS Covid19 System identifies patients who might be eligible for an influenza vaccination based on the Enhanced Service specification, Green Book JCVI guidance.   

DCS will identify patients who may be eligible for influenza vaccination but it is up to the individual clinician to confirm that they should receive it. 

Patients who might be eligible for their first vaccination will have syringe this patient status alert: 

This flag will appear based on the following rules: 

1. They are in the cohort current set for your PSA (or any of the cohorts above) – see Setup 
2. They have not already had a covid vaccine 
3. They have not declined the vaccine in the last 12 months 
4. They are not pregnant 
5. They are not under 16 
6. They do not have an ‘expiring exception’ in the last 12 months 
7. They have not had any other vaccines in the last 7 days 
8. They have not had covid19 infection in the last 4 weeks 
9. They do not have adrenaline pens on repeat prescription 
10. They do not have a history of anaphylaxis or anaphylactoid reactions 

Housebound Patients 

Housebound patients who are likely to be  

Identifying Why A Patient Is Eligible 

Click on the covid19 icon to open the Covid19 vaccination template. The central panel will display the vaccination cohort the patient is in, any relevant long term conditions and other appropriate warnings such as pregnancy. 

To identify the specific Read code(s) that have triggered eligibility for influenza vaccination, right click on the syringe icon and select Why is this Alert on this Patient?  You can then expand the report 

Identifying All Eligible Patients 

To see all patients who are likely to be currently eligible, use the following reports.  These reports are cumulative i.e. the cohort 3 report will identify patients in cohorts 1,2 and 3. 

Patients can be invited for their covid vaccination in a number of ways. 

Covid19 Vaccination – First Dose 

1. Opportunistic invitation – eligible patients will be identified by a C19 icon below the demographics box, on the home page or on the LTC Master Template.  Clicking on the icon will launch the covid template.  This alert will disappear after vaccination, refusal or addition of other exception code.   

2. Using the invitation searches in the DCS Vaccination>Covid19 report folder 

These reports show non-housebound patients who remain eligible for the first covid 19 vaccination.  Patients will be excluded if: 

• Vaccination declined 
• Vaccination not indicated or contraindicated codes are recorded 
• Patient is pregnant 
• Patient has had an invitation in the last 4 weeks 
• Housebound 
• GSF C/D Palliative care stages 
• Any vaccine in the last 7 days 
• Covid19 infection in the last 4 weeks 
• Adrenaline pens on repeat prescription 
• History of anaphylaxis or anaphylactoid reactions 

Running these searches at monthly intervals will ensure that you invite all the eligible patients until they have been vaccinated or a reason for not vaccinating has been recorded.  As at 3/12/20 the only invitation code available is a SMS text invitation – hopefully more will be added. 

Covid19 Vaccination – Second Dose 

Patients wo are due a second dose will have the following PSA which links to the covid 19 vaccination template 

It is anticipated that an appointment for the second dose will be made at the first dose administration. 

The search called Covid Vaccination – Invitation – Overdue Second Dose # identifies patients who are at least one week overdue their second dose unless they have been coded as declined, not indicated or contraindicated since the first dose. 

To administer the vaccine click on the C19 icon at the top of the screen. The influenza vaccine
template will open and lead you through the process, adding the correct Read codes. 

For patients without the icon, you can launch template from the DCS Master Template or add it to one
of your own templates, toolbars or clinical tree. 

The template features 

Section to code exceptions/adverse reactions/refusal.  Relevant codes already in the record are shown in the adjacent panel.  The far right panel here shows all vaccines administered in recent years 

The next sections covers cohorts, reasons for eligibility and warning such as pregnancy. 

The final section allows you to record the vaccine.  Vaccines that do not appear appropriate will be greyed-out.  You can override this by clicking through to the non-standard vaccine tab. This template has been prepared in anticipation that SystmOne will be able to meet MHRA and NHSD standards, possibly in the new year. Until then practices are reminded that Pinnacle is currently the only approved system for the onsite recording of Covid-19 vaccine administration.

The following checks are run when the vaccine protocol is launched 

All protocols 

• Patient is over 16 
• Patient is not pregnant 
• Patient does not have history of adverse reaction to covid 19 vaccine 
• Patient does not have a record of ‘contraindicated’ or ‘not indicated’ in the past 12 months 
• Patient has had any vaccine in the last 7 days 
• Patient has had covid19 infection in the last 28 days 
• Patient has already completed a course of covid19 vaccination 

First vaccination protocols 

Patient hasn’t already had a first dose 

Second vaccination protocols 

The patient has had the first dose of the same vaccine at the appropriate time period e.g. at least 19 days ago for Pfizer. 

The PSD questionnaire will then be displayed with automatic warnings. 

Once the first vaccination is complete, the user will be prompted to book a second appointment for the second dose.  

The following process can help clinicians add a PSD for the covid19 vaccine.  

Step 1. – Create a local copy of the PSD report. 

As you progress through the vaccination programme you will need to update this report with the current cohort. The initial report is set for cohort 2 stage. 

To move this on remove the report highlighted above and replace it with one of these reports 

Run this report which will identify eligible patients in the relevant cohorts with an upcoming appointment who do not already have a PSD recorded within 7 days of that appointment. To see which appointments are due, use the Breakdown options to select the appointment details. 

Select and highlight the relevant patients.  Deselect any patients who are not suitable for vaccination. Click on the magnifying glass icon to display the selected patients.   

At the next screen, click on the scroll to add the PSD 

…..using this text 

‘This patient is eligible to receive  Covid-19 mRNA Vaccine BNT 162b2 0.3mls Intra-Muscular (IM) Injection   in accordance with Public Health England Immunisation against infectious disease (Green Guide) and JCVI recommendations for the purpose of protection against COVID-19. Dr Xxxxx Xxxxx ‘

This PSD will then be displayed on the covid19 vaccination template for 7 days 

Alternatively, use the PSD tab of the covid 19 vaccination template the add the same information to individual patient records.  There is a preset text option for quick entry. 

Download the search folder:

The searches are contained in the ZIP file below:

Click on the link to start the download and save to a folder on your computer

Extract the searches

Double click on the folder to reveal its contents

Highlight the file COVID19 file and drag it to the desktop

Alternatively, highlight the file and clinic on one of the suggested folders or click the “Extract All” icon

Navigate to reporting in EMIS and create a new folder. In the example here, we have called it “COVID Vaccine Searches”

With the folder open, click on Import

Click on the ellipsis icon at the top right of the box that pops up to navigate to and select the saved covid19 search file

Ensure all searches are ticked (they should be automatically) and click OK. It will take a few minutes to run. It will take a few moments to upload all the searches.

Open the folder named COVID19.

Then run each of the subsearches with the appropriate cohort to identify eligible patients

When using the searches for cohort initial call, use the output of the sub-searches for each cohort. The main search for each cohort simply identifies which patients are eligible; the patient invitation search then excludes anyone who may not be eligible due to prior anaphylaxis, pregnancy and so on: