Authorised immuniser application guidelines

Introduction

In accordance with Tasmanian legislation a registered health professional other than a medical practitioner or nurse practitioner must be authorised by the Department of Health (DoH) to vaccinate independently in Tasmania.

An Authorised Immuniser (AI) is a registered nurse, registered midwife, or pharmacist who has completed an approved program of study in immunisation, and who:

• Has met the education requirements to become an Authorised Immuniser (AI) in Tasmania, pursuant to Regulation 82(1)(b) of the Poisons Regulations 2018.
• Has been approved by the Secretary, under the Tasmanian Poisons Act 1971, 38 (1) (i) and Poisons Regulations 2018 – Regulation 82 (1)(b) to administer vaccines (as listed in Schedule 4 to the Poisons List) to another person independently of a medical or nurse practitioner.
• Practices in accordance with a vaccination program approved by the Director of Public Health (DPH).

When AIs apply to renew their authorisation, they will reflect on their practice and declare they are competent to practice safely in accordance with their scope and context of practice. 

To maintain safe and effective immunisation practices, AIs will accept responsibility for their personal competence and professional accountability. The requirement for authorisation to practice as an AI and the process for annual authorisation, for registered nurses and midwives are outlined in this document.

This document focuses on the authorisation processes and requirements for Authorised Nurse Immunisers. Pharmacists should refer to the Tasmanian Authorised Pharmacist Immuniser Application Guidelines.

Scope of practice

A registered nurse, midwife, or pharmacist’s scope of professional practice is set by legislation and professional standards such as competency, practice standards, and codes of ethics, as well as public requirements, demands, and expectations. The Tasmanian Immunisation Program Guidelines provide additional information on AI practice scope.

AIs may administer vaccines within their scope of practice, provided they are operating under a DoH approved vaccination program which has policies and procedures in place to provide a safe and effective vaccination service. Vaccine administration must be in accordance with all recommendations for that vaccine as listed in the Australian Immunisation Handbook (AIH), and/or publications from the Australian Technical Advisory Group on Immunisation (ATAGI) and other relevant evidence-based sources.

An AI has expanded skills, experience, and knowledge in assessment, planning, implementation, diagnosis, and evaluation which involves the full spectrum of their role, functions, responsibilities, and decision-making. By accepting the title and role of an AI, the health professional must be competent to practice at this advanced level. 

Immunisation education courses accepted by the Director of Public Health in Tasmania

• From 1 January 2024, all health professionals applying for immunisation authorisation in Tasmania must have completed a training program that has been accredited by Health Education Services Australia (HESA). HESA independently accredits immunisation education programs offered by education providers against the National Immunisation Education Framework for Health Professionals (the ‘Framework’). Assessment against nationally agreed program standards will assist in leading to mutual recognition of immunisation education programs across states and territories.
• A list of recognised, accredited immunisation training programs is available at HESA Accredited Programs. 
• From 1 January 2024, immunisation training programs that are not accredited by HESA will not be accepted in Tasmania. This includes programs completed prior to the HESA accreditation date.

Continuing professional development (CPD)

It is expected that Nurse Immunisers will undertake 8hrs CPD specific to immunisation each year, plus an annual Cardiopulmonary Resuscitation (CPR) update. CPD should cover the following topics:

• Annual CPR theory and practicum, including paediatric and adult CPR.
• Maintaining clinical knowledge of anaphylaxis. This may include attending a CPR course with an anaphylaxis component, completing the on-line ASCIA course, reviewing the relevant sections of the Australian Immunisation Handbook including adverse events following immunisation, the recognition and treatment of anaphylaxis and preparing an anaphylaxis response kit.
• Knowledge and understanding of any legislation which affects immunisation practice.
• Any Commonwealth announcements or changes relating to immunisation, new vaccines introduced onto the schedule and current recommendations.
• Any changes or updates to the Australian Immunisation Handbook or other relevant publications pertaining to the AIs scope of practice.
• Any other identified learning requirement following a self-assessment of competence.

Application process

Applying for authorisation for the first time

Registered nurses and midwifes, who have met the requirements listed in section 2 of these guidelines and wish to apply for authorisation in Tasmania can apply by:

• Completing an initial Authorised Immuniser Application on the Immunisation Provider Portal, or;
• Completing an initial Authorised Immuniser Application form and emailing this to [email protected].

The following documentation is required and must be submitted with the initial authorisation application:

• AHPRA Registration Certificate.
• A certificate of competence in paediatric and adult CPR as per Australian Resuscitation Council (ARC) guidelines attended in the last 12 months.
• A certificate of completion from a HESA accredited immunisation training program, undertaken within the last three (3) years.  If longer than three years, the applicant must have recently been practicing as an Authorised Immuniser in another State administering vaccines, under the National Immunisation Program, to all age groups (infants, children and adults). 
• A Skills Assessment Record – Clinical practicum with evidence of ten (10) individual vaccination encounters if a practicum was not included as part of the immunisation training program completed (requirements outlined in section 4). To request a copy of the Skills Assessment Record please email [email protected].

Annual authorisation process

AIs must complete their annual renewal by:

• Completing an Authorised Immuniser Renewal Application on the Immunisation Provider Portal by 30 June each year, or;
• Completing an Authorised Immuniser Renewal Application form and emailing this to [email protected].

The renewal includes an annual statement and is supported by a declaration. AIs must ensure they are compliant with the CPD requirements in section 1.2.

• Confirmation of authorisation to practice will be available before 1 August each year. The confirmation letter will be available for download from the portal. 
• Automated reminder emails for expiring authorisation will be sent where renewal has not been completed. 

Applicants are encouraged to keep their details up to date to ensure they receive important communication updates from the DoH Immunisation Team and to retain access to their account.

Skills assessment (Practicum)

Health Professions must undertake a supervised clinical practicum to become an AI in Tasmania. The nurse is required to conduct ten (10) individual encounters under the supervision of a preceptor. 

A preceptor must be a Medical Practitioner, Nurse Practitioner, or an Authorised Nurse Immuniser (ANI) who has a minimum of two years recent and regular experience administering NIP vaccines, to all age groups (infants, children, and adults).  

Preceptors will assess the nurse’s clinical performance in accordance with the Australian Immunisation Handbook recommendations and the relevant National and State Immunisation Schedules.The assessment and judgement of competence in the clinical practice setting will include clinical observation, questioning, and review of documentation to assess skills, knowledge and attitudes. Preceptors will observe and assess the nurse, provide appropriate feedback, and complete the Skills Assessment Record (to request a copy please email [email protected]). The preceptor will indicate if the nurse demonstrates overall competence in the provision of vaccinations according to the performance criteria in the Essential Immunisation Practice Standards, or whether they require additional practice to further develop their clinical knowledge and skills. 

The key areas include:

• availability of an in-date Anaphylaxis Response Kit before each immunisation session
• knowledge and maintenance of cold chain requirements during the immunisation sessions
• completion of the pre-vaccination assessment and ensuring valid consent
• selection of the appropriate vaccine(s)
• following occupational health and safety guidelines for hygiene to minimise the risk of needle stick injury
• correct administration of the vaccine(s)
• providing immediate after care
• knowledge of common Adverse Events Following Immunisation (AEFI) and the process for documentation and reporting an AEFI in Tasmania
• documentation including reporting of vaccinations to the Australian Immunisation Register (AIR).

The Crown carries no liability in respect of AIs carrying out vaccinations; it is the AIs obligation and responsibility to ensure they have their own appropriate professional, public and other indemnity coverage.

Audit process

Audits of random samples of AIs will occur periodically throughout the year. They help to ensure that AIs are meeting mandatory authorisation requirements, providing important assurance to the DoH and the Tasmanian community.

Each time you apply to renew your authorisation, you make a declaration that you have met the mandatory requirements to continue to practice as an AI in Tasmania. 

If you are selected for audit, you will receive a notification via email from the DoH. You will be requested to provide evidence, within 28 days, that you have met the mandatory requirements.

AIs must maintain a comprehensive portfolio containing sufficient evidence from the previous 12 months to demonstrate continuing competence in immunisation for their current context of practice.

Grievance procedure

If an applicant has a grievance because authorisation to practice has not been granted, the AI Grievance Procedure will be implemented.

The applicant must consider the feedback provided and if wanting to continue with a grievance, lodge a formal appeal to the DPH (or delegate) within 14 days from receipt of the initial contact made with the Communicable Diseases Prevention Unit (CDPU).

The formal appeal against the decision must be made to:

The Director of Public Health
GPO BOX 125
Hobart  TAS  7001

detailing all necessary information and documentation, including contact details.

The applicant will be informed in writing of the DPH’s decision within 14 days of the receipt of the application.

Lapsed authorisation policy

An AIs authority to practice lapses if they fail to complete their annual authorisation renewal application through the online portal.

While the health professional will be notified in writing that their authorisation has lapsed and that they are no longer authorised to practice as an AI in Tasmania, it should be noted that health professionals who practice without current authorisation will be operating outside the legal framework. 

AIs found to be practicing without authorisation will be reported to the Australian Health Practitioner Regulation Agency (AHPRA).

If an AI’s authority to practice has lapsed for a period of greater than three (3) years, they will be required to provide further educational evidence before being re-authorised. Please contact CDPU for further information.

Information support

Providers are encouraged to contact the Immunisation Unit, CDPU for immunisation support or for any queries relating to the authorisation process on 1800 671 738 or via email at [email protected].

More information

The following resources will provide guidance and points of reference to assist the AIs to meet the standards of competency required for renewal of authorisation to practice.

• Australian Resuscitation Council Website
• ASCIA e-training for health professionals
• Australian Government, Department of Health, Immunise Australia Program
• Australian Immunisation Handbook, Australian Government Department of Health, Canberra, 2018 
• Australian Technical Advisory Group on Immunisation (ATAGI)
• Centre for Disease and Control
• National Vaccine Storage Guidelines ‘Strive for 5’ | Australian Government Department of Health and Aged Care, Third Edition. Commonwealth of Australia 2013
• National Centre for Immunisation Research and Surveillance | NCIRS 
• World Health Organization

Resources

• Skills Assessment Record (practicum): to request a copy of the Skills Assessment Record please email [email protected].