Guidance

Training recommendations for COVID-19 vaccinators

Updated 20 October 2022

The importance of training for COVID-19 vaccinators

The authorisation of several different vaccines against coronavirus (COVID-19) and the need to vaccinate millions of people with these as rapidly as possible has required, and continues to require, a substantial workforce to give the vaccine safely and effectively.

The number of vaccinators required has exceeded the number of trained and experienced vaccinators who were giving vaccines prior to the pandemic and many of those who were already giving vaccines have been required to maintain the national routine immunisation schedule. It has therefore been necessary to rapidly train healthcare workers who have not vaccinated for some time or who have not previously given a vaccine in order to maximise vaccine uptake in a short time period.

It is of vital importance that the COVID-19 vaccinator workforce receives comprehensive training and competency assessment, in order that COVID-19 vaccines are administered safely and effectively. This is so that those who receive these vaccines are protected and public confidence in the COVID-19 vaccination programme is established and maintained.

This document sets out the recommendations for training a workforce who are knowledgeable and able to confidently, competently and safely deliver the COVID-19 vaccine programme at pace. These recommendations are intended to complement the recommendations made for training the COVID-19 vaccinator workforce by NHS England.

These training recommendations should in no way undermine the recommendations made in the UK Health Security Agency (UKHSA) national minimum standards for immunisation training. The training standards still apply to all other vaccines and in all other situations. This COVID-19 vaccinator training guidance has been written to meet a very specific need in an emergency pandemic situation. The intention is to maximise delivery whilst ensuring that COVID-19 vaccines are given safely and effectively.

These recommendations were reviewed in October 2022 when minor updates were made to wording and document links.

Who needs to be trained

People who need to be trained include:

  • experienced and competent vaccinators (both registered healthcare practitioners (RHCPs) and unregistered healthcare support workers (HCSWs)) who have vaccinated within the past 12 months
  • RHCPs who are either new to, or returning to vaccination after a prolonged period
  • vaccination support workers (unregistered healthcare workers new to immunisation with a specific role in vaccine administration)
  • administrative support staff

Training requirements for COVID-19 vaccinators

These requirements are detailed below and summarised in Appendix A

Experienced and competent vaccinators (both registered HCPs and unregistered HCSWs) who have vaccinated within the past 12 months

This group will require training specifically about the COVID-19 vaccines including:

  • vaccine specifics – for example, how it is made, how it works, what it contains
  • who the vaccine should be given to
  • contraindications and precautions
  • legal issues including obtaining consent and legal framework to supply/administer the vaccine (Patient Group Direction (PGD); Patient Specific Direction (PSD); protocol; patient specific prescription)
  • how the vaccine should be stored
  • how to prepare the vaccine
  • how and at which anatomical site to administer the vaccine
  • how to recognise and respond to an adverse reaction following immunisation
  • how to dispose of vaccine equipment
  • what to expect after vaccination and other information to give those who have been vaccinated
  • where to record that COVID-19 vaccine has been given and what to record
  • supervision and delegation responsibilities
  • how to put on and take off any personal protective equipment (PPE) required for immunisation
  • infection prevention and control measures

Basic life support (BLS), adult and/or paediatric as required, and anaphylaxis training should have been undertaken within the last year. Update training for this should be undertaken now if it has not. It is recommended that this group should also undertake the administration, storage and legal aspects of e-learning sessions available in the immunisation e-learning programme if they have not received any vaccine update training in the past year.

Registered Healthcare Practitioners who are either new to, or returning to, vaccination after a prolonged period

This group will require specific training about the COVID-19 vaccine as listed above and it is recommended that they should also undertake the administration, storage and legal aspects of e-learning sessions available in the immunisation e-learning programme if they cannot attend any face-to-face training which covers this.

Work-based practical training, supervision until confident and assessment of competency using the COVID-19 vaccinator competency assessment tool will also be required. BLS and anaphylaxis training should have been undertaken within the last year. Update training should be undertaken now if it has not.

Vaccination support workers (unregistered healthcare workers new to immunisation with a specific role in vaccine administration)

The new immunisation workforce required to deliver the vaccine may come from various backgrounds and not all may have worked directly in healthcare delivery previously. However, as it is envisaged that this particular group in the workforce will only be responsible for a specific role in vaccine administration, with assessment of suitability to vaccinate an individual and obtaining consent carried out by an experienced healthcare professional, the main focus of their training should be very specific to their role.

This group will require training specifically about the COVID-19 vaccine including:

  • vaccine specifics – for example, how it is made, how it works, what it contains
  • how the vaccine should be stored
  • how to prepare the vaccine
  • how and at which anatomical site to administer it
  • legal aspects including accountability and the legal framework by which they can administer the vaccine
  • what to do following vaccine administration
  • how to recognise and respond to an adverse reaction following immunisation
  • how to put on and take off any PPE required for immunisation
  • infection prevention and control measures
  • an understanding of their role and its limitations and action to take if unsure

Work-based practical training (for example. how to give an intramuscular (IM) injection, BLS skills), supervision until confident and assessment of competency using the COVID-19 vaccinator competency assessment tool will also be required.

New vaccinators should be supervised and supported by experienced, competent and knowledgeable vaccinators (see section below). Consideration should be given as to whether there are any particular groups who would be more appropriately vaccinated by experienced vaccinators.

Administrative support staff

Training for this group of staff depends on the role assigned to them. If they are responsible for vaccine storage, they could undertake the vaccine storage e-learning session available from e-LfH. They may also require specific training in areas such as information governance, infection prevention and control and/or BLS.

Training provision

Consideration needs to be given as to how comprehensive training can be most safely and effectively provided. Current guidance on measures to take to reduce the risk of COVID-19 spreading should be followed.

Both theoretical and practical training will be required.

Theoretical training

A number of resources have been made available to support theoretical training including:

E-learning programme

A COVID-19 vaccination e-learning programme that covers the topics listed in the bullet-pointed section above, has been written by UKHSA and developed by Health Education England eLearning for Healthcare (eLfH). The programme consists of a Core Knowledge session and an assessment session and vaccine-specific sessions together with accompanying assessments for each of the COVID-19 vaccines currently in use. More vaccine-specific sessions are added as and when any new COVID-19 vaccines become available. All of the sessions are regularly and rapidly updated as new information becomes available and any changes to the programme are made.

The COVID-19 vaccination e-learning programme takes between 60 to 90 minutes to complete. The amount of time it takes depends on the previous knowledge and experience of the vaccinator, with those familiar with giving and advising on immunisation being able to complete it more quickly than those who are new to immunisation. Time taken to complete it also depends on the role of the vaccinator as those responsible for assessing suitability for vaccination and taking consent may spend longer on these aspects than those who are responsible for administration only.

Additional existing e-learning sessions on administration, storage and legal aspects of vaccination can be undertaken depending on role, previous training and experience. These are available as part of the e-LfH Immunisation programme.

Training slide set

A core training slide set for immunisation trainers is available on the UKHSA COVID-19 vaccination programme webpage. This slide set covers all the key aspects of the COVID-19 vaccine programme. Trainers should select the slides required depending on the background and experience of the health care workers they are training and according to the role they will have in delivering the COVID-19 vaccine programme. These can be used for locally-run training sessions.

Face-to-face training

Face-to-face training is particularly valuable for new vaccinators as practical elements such as BLS and IM injection practice may be possible at these sessions and it enables them to ask questions and gain peer support through meeting other new vaccinators. It is strongly recommended that interactive training (in person or through webinars) which provides the opportunity to ask questions is made available to all vaccinators where possible.

Information for healthcare practitioners about the COVID-19 vaccine programme guidance has been developed to answer questions from vaccinators and is regularly updated to include issues that are arising as the programme is being delivered.

Practical skills

In addition to acquiring theoretical knowledge, it is essential that new vaccinators develop clinical skills, competency and confidence in immunisation. Consideration should be given as to how this training can most effectively take place. The importance and benefits of work-based training and experience should not be underestimated – see section below for further explanation.

Supervision and assessment of competency

A period of supervised practice to allow observation of, and development of skills in vaccine administration and application of knowledge to practice is required. Supervision for new vaccinators and support for all vaccinators is critical to the safe and successful delivery of the COVID-19 immunisation programme. The supervisor must be a registered, appropriately trained, experienced and knowledgeable practitioner in immunisation.

All new vaccinators, and those returning to immunisation after a prolonged interval, should complete a competency assessment for formal assessment and sign-off of their clinical competency. They should be supervised administering the vaccine until both they, and their supervisor or trainer, feel confident that they have the necessary knowledge and skills to administer vaccines safely and competently.

Experienced vaccinators should use the competency tool to self-assess that they are able to meet all the competencies listed and confirm that they have the knowledge and skills necessary to administer COVID-19 vaccine. This is required to work to the COVID-19 PGDs and protocols.

The time required to gain competence and confidence will vary from person to person and ultimately attainment needs to be agreed by both supervisor and vaccinator. Those with a clinical background who have given IM injections before are likely to feel confident and competent more quickly than those who have not.

Additional training

Training such as additional sessions on BLS, management of anaphylaxis, safeguarding (adults and/or children as required), infection control, information governance, will be required in addition to immunisation specific training. This should either be provided by the employer or the employer should indicate where and how the training should be undertaken. Specific training requirements for those involved in delivering the COVID-19 vaccine programme are set out by NHS England.

Remaining up to date

Given the rapidly evolving and constantly changing nature of the COVID-19 programme, it is essential that COVID-19 vaccinators ensure they remain up to date with the latest relevant information available about the COVID-19 vaccination programme.

They should check that they have read the most recent versions of the following publications:

Updating should be seen as a continuous process rather than purely as an annual one-off requirement. However, it is recommended that vaccinators do take the opportunity, annually, to review what training updates are required (including statutory and mandatory training). If they have not undertaken the COVID-19 vaccination e-learning sessions since first completing them, vaccinators may wish to revisit these to refresh their knowledge and undertake any additional reading/training required to assure themselves that they are familiar with the latest information and resources and feel confident in their practice.

They may also wish to self-assess against the competency tool and confirm that they are confident in all of the areas assessed. Vaccinators should ensure they meet Care Quality Commission (CQC) regulation requirements for training and updating and any continuing professional development requirements as set by their professional regulator (where applicable).

Managers should confirm with vaccinators that they are able to access the relevant resources in a timely manner and check that they are given the opportunity to update themselves.

It is important that an effective method of regular and ongoing updating of all those involved in giving the COVID-19 vaccine is identified and utilised. This may include, for example, daily briefings and safety huddles. Local cascade systems for vaccinators should be used (or developed if not currently in place) to rapidly alert vaccinators of any key changes to vaccine recommendations or updated guidance.

Summary

With an ongoing pandemic that continues to cause millions of infections and over 6 million deaths across the world, it is crucial that COVID-19 vaccines are safely and effectively delivered to as many of those eligible as possible. This requires knowledgeable, confident and competent vaccinators. It is therefore vital that anyone administering the vaccine is given the time and opportunity to undertake the comprehensive training and ongoing updating they need and that they are supervised and supported in practice as required.

The contributions from expert training colleagues in the writing of these recommendations are very gratefully acknowledged.