034E Eligible for Pertussis in pregnancy searches
This folder (v1.1) sits within 034 Eligibility.
The programme for pregnant patients of at least 20 weeks' gestation is designed to protect infants in utero, conferring immunity before they are born to protect their early years. This is expected to be delivered primarily by maternity services (in the form of a Tdap vaccination - previously dTaP/IPV), while GP Practices will opportunistically mop up or vaccinate upon request. Patients are eligible during each pregnancy, as long as they haven't received another dose in the preceding 6 months. In some areas this programme may be primarily managed by midwifery services like the pertussis vaccination programme, although primary care is still expected to keep an eye on patients. See Pregnant patients cohort below for more information.
Primary Care IT strongly recommends that this article is understood before the searches are used in your Practice.
The search and report in the top level folder are designed to support Practices regularly inviting patients for a pertussis vaccination. Other supporting searches carrying information about other currently pregnant patients can be found in Data Admin.
Cohort for pertussis vaccination
The cohort of currently pregnant patients is a refined search to the one usually employed in Enhanced Service (flu) rules. It looks for any patient with a pregnancy related code in the last 9 months, but excludes any patient who has a more recent code indicating delivery, termination or miscarriage. In following this approach, a more precise list of pregnant patients can be used against other search requirements.
In addition to the code patients will be at least 12 years old and their Sex marked as Female.
The search is only as accurate as the coding used in patient records. Patients who have not had their pregnancy episode ended will continue to appear, which carries with it a risk that patients with failed pregnancies may be included.
This search identifies patients who are pregnant but at any stage. This means some patients may only be 12 weeks along, while others may be 36 weeks or have even delivered. There are a number of challenges to creating an accurate register of pregnant patients:
- Not all patients present at a similar time
- Coding pregnancy might take place as early as 6 weeks, but more likely when the patient starts to see the midwife
- Not all GP organisations add the code of Estimated date of delivery - this is one of the few SNOMED codes that can be recorded with a future date!
- Coding for the end of the pregnancy - whether termination, miscarriage, or delivery method - is variable and heavily dependent on when information is sent to the Practice.
A predefined output "Pertussis programme" helps to filter the data before entering records.
This article will refer to such patients as having an 'active pregnancy'.
Review for Pertussis vaccination
This section describes searches found in the top level folder.
No pertussis vaccination during this pregnancy
The search produces a list of all patients with a code suggesting a current pregnancy, but no pertussis vaccination has been recorded in the last 9 months. Patients who have been coded as contraindicated, or who have declined in the past 6 months are not listed, but they can be found in the Data Admin folder. Use the report to review the list to determine which patients are approaching (or beyond) 20 weeks gestation.
If a patient is no longer pregnant, use an appropriate code to end the pregnancy.
Targeted recall
Due to the nature of the pertussis vaccination programme, no targeted recall searches have been created. It is anticipated that the PA-381 report will help users to identify how far along each pregnant patient is, and whether the option for a pertussis vaccination has been presented to them.
Data Admin
Pertussis contraindicated
If patients appear in this search, consider reviewing the patient record to establish when the code was added and if it is appropriate. Patients who have received a vaccination are removed from this search.
Pertussis declined in last 6 months
This search lists all pregnant patients who have declined a pertussis vaccine in the last 6 months.
Patients who have declined remain eligible at any time after 20 weeks and before delivery.
Pregnant and vaccinated
All patients on the currently pregnant register who have received a pertussis vaccination in the last 9 months.
Invited for pertussis vaccination in last 6 months
Eligible unvaccinated patients who have been invited for an pertussis vaccination in the last 6 months.
Pregnancy
The report shows any pregnancy code that is not a review of a problem from the last 9 months. Last Menstrual Period and Estimated Date of Delivery are shown if recorded. Any recent delivery codes, previous vaccination codes, declines or invitations are also displayed.
The report could be used to quickly identify who is most likely to be due by sorting the columns.
- Sort by Estimated date of delivery to identify any dates in the next 20 weeks.
- Sort by LMP to identify dates that were at least 20 weeks ago (where no EDD exists)
- Sort by earliest pregnancy to look at older dates (where no EDD or LMP exists)
DISCLAIMER - For the reasons stated above, always review each record prior to inviting a patient for vaccination. It is important that a clinician establishes how many weeks' pregnant the patient is to avoid any wasted invitations or appointments. Use the report to help identify likely candidates for vaccination, then double check the record.
Coding
Only one active contractual code relating to pertussis vaccination in pregnancy is available:
| SNOMED | Term |
| 956951000000104 | Pertussis vaccination in pregnancy |
Other relevant codes for the pertussis vaccination in pregnancy programme are:
| SNOMED | Term |
| 866641000000105 | Pertussis vaccination in pregnancy declined |
957291000000102 | Pertussis vaccination in pregnancy contraindicated |
865901000000108 | Pertussis vaccination in pregnancy invitation |
866141000000103 | Pertussis vaccination in pregnancy invitation first letter |
866191000000108 | Pertussis vaccination in pregnancy invitation second letter |
866251000000106 | Pertussis vaccination in pregnancy invitation third letter |
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