Vaccine standing medication orders

In South Australia, a registered nurse/midwife who is authorised can administer vaccines in accordance with the Vaccine Administration Code (the Code) and is no longer required to work under a medical order. Registered nurses administering vaccines without a medical order can only do so if the administration is in accordance with the Code published by the South Australian Department for Health and Ageing and provided that all the other requirements of regulation 18(3) are met. These registered nurses are referred to as authorised registered nurses.

Becoming an authorised registered nurse

To be authorised the registered nurse must have successfully completed an approved training program. Authorised registered nurses must only administer the vaccines:

• Specified in the Code in accordance with specified immunisation schedules for example the National Immunisation Program Schedule and
• as part of a program delivered by an approved organisation.

The Immunisation Section has a HESA accredited online immunisation education program which enables registered nurses to meet the legislated training requirements under the Code.

Nurses not authorised and working under a Standing Medication Order (SMO)

The registered nurse/midwife who is not authorised can only administer vaccines under a medical order. SMOs provide an organisation delivering immunisation programs the mechanism to enable nurses (not authorised) to administer vaccines (Schedule 4 drugs) without an individually prescribed medication order by a medical officer.

It is recommended a vaccine SMO is in place within every organisation that provides an immunisation service where vaccines are administered by nurses who are not authorised.

The registered nurse/midwife who is not authorised and works under SMOs cannot initiate and administer vaccines (Schedule 4 drugs) until each relevant SMO has been endorsed.

Endorsement of vaccine SMOs

The Drug and Therapeutics Committee of the Local Health Network (or equivalent standing medication order committee) is responsible for providing governance for standing medication orders and nurse/midwife initiated medicines.

A vaccine SMO provides a template for a specific medication and indication for use that must be adapted based on local governance processes or procedures to meet the specific needs at specific sites.

Endorsement committees

It is recommended the endorsement committee comprises a:

• medical officer
• senior registered nurse/midwife
• manager (usually the Chief Executive Officer or unit manager).

In some circumstances a pharmacist may also be included; however, the pharmacist cannot replace the medical officer.

Responsibilities of the endorsement committee

Responsibilities of the endorsement committee must include:

• ongoing review and endorsement of all SMOs as required
• processes for implementing SMOs across the organisation.

For the vaccine SMO to be considered valid it must contain the signature, name and title of each member of the endorsement committee.

Implementing a vaccine SMO

SMOs for each vaccine should be specific to the Local Health Network (or equivalent standing medication order committee) and the information contained within these must be adapted from the template (DOC 83KB) of the generic Vaccine Standing Medication Order template provided. Once endorsed the vaccine SMOs must be used in conjunction with the current edition of the Australian Immunisation Handbook and re-authorised regularly or when amended (whichever is sooner) . SMOs not reviewed by the expiry date are considered invalid.