Vaccine standing drug 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 Drug Order (SDO)

The registered nurse/midwife who is not authorised can only administer vaccines under a medical order. SDOs 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 SDO 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 SDOs cannot initiate and administer vaccines (Schedule 4 drugs) until each relevant SDO has been endorsed.

Endorsement of vaccine SDOs

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 SDO 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 SDOs as required
• processes for implementing SDOs across the organisation.

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

Implementing a vaccine SDO

SDOs 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 80KB) of the generic Vaccine Standing Drug Order template provided. Once endorsed the SDOs must be used in conjunction with the current edition of the Australian Immunisation Handbook.