Managing vaccines in care homes

Care providers must manage vaccines safely and effectively.

Authority to administer

Health and social care providers must be clear who will be responsible for managing the administration of vaccines. For example, this could be the care home, a pharmacy or a GP practice. This is very important for people living in care homes.

The authority to administer the vaccine must be in place before giving it to a person. Vaccines are prescription only medicines (POM). You must only give it under a valid patient specific direction or patient group direction. The most common type of patient specific direction is an FP10 prescription, but there are other types. Vaccines cannot be supplied on a bulk prescription.

Ordering and storing vaccines

Care homes with nursing may order and hold stocks of vaccines to help them vaccinate people in their care.

The Human Medicines Regulations define care homes with nursing as independent hospitals. They're usually registered with CQC for the regulated activity of 'Treatment of disease, disorder or injury'. This means they can hold a stock of prescription only medicines.

The person responsible for the regulated activity can order prescription only medicines. This could be the care home manager. They do not need to be a clinician.

Follow the manufacturer’s instructions for storing vaccines. Take special notice of instructions for COVID vaccines that have been defrosted or after the first dose has been withdrawn from a vial.

Find out more about storing medicines in fridges in care homes.

Administering the vaccine

Nurses working in care homes can administer vaccines to people in their care. They must have a valid patient specific direction. They must be trained and competent to administer vaccines.

Only give the vaccine to people who have given their consent: Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Regulation 11: Need for consent

Follow the principles in the Mental Capacity Act 2005 if a person lacks capacity to make this specific decision.

Before administering the vaccine, be aware of and take all necessary precautions. You must consider any previous reaction to the vaccine, allergy or acute illness.

Flu vaccines

Many healthcare professionals can now give flu vaccines to care staff. This includes registered nurses. It must be part of an NHS or local authority occupational health scheme.

A variety of flu vaccines are on the UK market each year.

Do not give the flu vaccine to people who are allergic to egg without getting advice from the prescriber. There are egg-free flu vaccines available.

Consider the age of the person receiving the flu vaccine when choosing which product to use.

Find out more about flu vaccination in 2022/2023

Flu vaccination guidance for social care and hospice providers

Find out more in The Green Book chapter 19: Influenza

Vaccines for older people

People aged 65 and over are advised to get vaccinated against pneumococcal infections. These are serious as they can lead to pneumonia, blood poisoning (sepsis) and meningitis. Most people only need a single pneumococcal vaccination.

People aged 70 to 79 can get vaccinated against shingles. Only one course of vaccine is needed. The vaccine is not given annually.

Find out more in The Green Book

chapter 25: Pneumococcal

chapter 28a: Shingles

People aged 75 and over are eligible for a COVID-19 spring booster 2023 dose

COVID 19: the green book chapter 14a

Anaphylaxis

Anaphylaxis following vaccination is rare. It occurs in less than one in every million doses for routine vaccines in the UK. The following are useful considerations but are not intended as clinical guidance.

The person administering flu vaccines must have access to emergency equipment and medicines. Care providers must make sure they have this available in line with national guidance.

Anyone can administer an adrenaline intramuscular injection when it is being used as emergency treatment for anaphylaxis.

The Resuscitation Council management of anaphylaxis in the vaccination setting says all vaccination settings:

• must have immediate access to a person with defined minimum knowledge and skills
• should make a local risk assessment, which includes access to emergency services
• carry out a local risk assessment on the need for oxygen availability.

The Green Book has more information on vaccine safety and the management of adverse events.

Record keeping and information sharing

The exact brand of vaccine, batch number and administration site should be recorded in the patient records.

The prescriber must keep clear prescribing records. Care home staff must keep and share records about vaccines they administer. This reduces the risk of giving duplicate doses.

Training and competency assessment

The Royal College of Nursing states:

“Anyone involved in the prescribing or administration of vaccines must be suitably competent and have the knowledge as well as the skills to ensure patient safety, and public trust in immunisation is maintained.”

NICE guidance 'Managing medicines in care homes' states:

“Health professionals working in, or providing services to, care homes should work to standards set by their professional body and ensure that they have the appropriate skills, knowledge and expertise in the safe use of medicines for residents living in care homes’.

All vaccination settings must meet the Resuscitation Council UK minimum training requirements.