Out of Schedule Vaccination Template - Adult
Introduction
The Out of Schedule Vaccination - Adult template is a structured clinical template designed to support clinicians in recording vaccinations for adult patients aged 18 years and over who require out-of-schedule following immunosuppressive treatment. This includes patients who have undergone haematopoietic stem cell transplantation (HSCT), CART-T cell therapy, solid organ transplantation, or who are receiving biological therapies or standard-dose chemotherapy.
Patients undergoing HSCT and CAR-T therapy are generally treated as clinically never vaccinated and require a comprehensive re-vaccination programme over a period of up to three years. Other immunosuppressed patients, including those receiving biological therapies, solid organ transplantation or standard-dose chemotherapy, may require selected out-of-schedule vaccinations in accordance with specialist recommendations rather than a full re-vaccination programme.
The template is built in accordance with the Oxford BMT/ACT programme Immunisation Schedule B.2.13 v10.0 (September 2024) as the primary clinical authority, supported by the SWBMT Adult Post-transplant Immunisation Protocol PRO-CLIN-10 v7.0 (September 2023) and relevant national guidance where applicable.
A separate template is available for paediatric patient under 18 years - see Out of Schedule Vaccination - Child.
What Does it Actually Do
The template provides a complete clinical workflow for out of schedule vaccination in adult post-transplant and immnosuppressed patients across five sections
Section 1: Safety Screen
The Safety Screen section must be completed before any vaccination is recorded. The nurse records the treatment type, the date of transplant or end of treatment, and the source specialist document. A seven-item general safety checklist must be completed before proceeding. This covers fitness for immunisation, written specialist authorisation, absence of anaphylaxis history, Prednisolone threshold, IVIg interval, COVID-19 vaccination status, and maintenance chemotherapy status. The specialist team determines when the vaccination programme should commence. The template should only be used where appropriate specialist advice or written authorisation has been received.
Section 2: Hepatitis B
This section provides a dedicated standalone Hepatitis B pathway for patients who require HepB vaccination outside the full HSCT re-vaccination schedule. This includes solid organ transplant recipients, biological therapy patients, patients with poor response to a previous primary vaccination course. Note that HepB is already included within Infanrix Hexa and Vaxelis at the 6, 7, 8 and 18-month scheduled time points for full HSCT patients — the standalone tab should not be used for those patients at those time points. A separate Live Vaccine Gate section must be completed on visits where MMR is being given.
Section 3: Other vaccinations
This section covers all other scheduled post transplant vaccines and seasonal influenza. The clinician selects the appropriate time point since transplant or treatment from a single drop-down. Quick reference schedules are available on the Reference tabs, while the button on this page opens the full Oxford BMT/ACT immunisation guidance.
Four vaccine recording rows allow multiple vaccines to be recorded at a single visit. Each row has its own next vaccination due drop-down to accommodate vaccines with different follow-up intervals at the same visit.
Section 4 and 5 - Vaccine Schedule Reference
Two static reference tabs provide quick reference tables summarising the Oxford BMT/ACT and SWBMT vaccination schedules. These pages are intended as a clinical reference only and represent the typical vaccination schedule. Where patients have an individual vaccination plan from their specialist team, this should always take precedence.. Section 5 covers greater than 10 months. Each table has three columns: time since transplant, disease protected against, and vaccine choice and brand name. Live vaccine rows are highlighted in red. Clinical decision rows requiring a GvHD check before selecting a vaccine are highlighted in amber. Navigation links on each tab allow movement between pages without using the tab bar.
How to use this template
Use the template in the following order:
1. Complete the Safety Screen first. This confirms the patient's treatment pathway and checks whether vaccination can safely proceed.
2. Navigate to the relevant vaccination page (Hepatitis B or Other Vaccinations) to record vaccines administered during the consultation.
3. Use the Reference pages for guidance only. They reproduce the typical vaccination schedules. If the patient has a personalised vaccination plan from their specialist or consultant team, this should always take precedence over the standard schedule.
What does it look like
Where to find it
Clinicians can search for this template at the bottom left of SystmOne screen or using F12 by searching for 'Out of Schedule..'. or access the link from the main vaccination and immunisation template.
System Dependencies
The template does not require additional SystmOne modules or permissions. It is important that users are aware that the template exists.
Fitting your practice
There are no system-level dependencies that require configuration before use.
Clinical governance responsibility rests with the GP practice. Practices should ensure that all clinical staff who may use this template are familiar with the out of schedule vaccination pathway, pre-vaccination safety screen and know how to retrieve the template using F12 search. Staff should confirm that written authorisation from the specialist team is present on the patient record before proceeding with any vaccination.
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