diff --git a/app/_components/screenshots/_screenshots.scss b/app/_components/screenshots/_screenshots.scss index f205afb45..dc828ac2a 100644 --- a/app/_components/screenshots/_screenshots.scss +++ b/app/_components/screenshots/_screenshots.scss @@ -1,6 +1,6 @@ .app-screenshots__contents, .app-screenshots__screenshot { - margin-bottom: govuk-spacing(9); + margin-bottom: govuk-spacing(9) !important; } @include govuk-media-query($media-type: print) { diff --git a/app/_components/screenshots/template.njk b/app/_components/screenshots/template.njk index 43fb540e4..8c7e60a71 100644 --- a/app/_components/screenshots/template.njk +++ b/app/_components/screenshots/template.njk @@ -19,10 +19,10 @@ {%- set itemId = item.id or (itemTitle | slugify) -%} {%- set file = item.src or (itemId + ".png") -%} {%- set alt = item.alt or ("Screenshot of " + itemTitle) -%} + + {{ itemTitle }} +
- - {{ itemTitle }} - {{ alt }} {%- if item.caption %}
{{ item.caption | markdown | safe }}
{% endif %}
diff --git a/app/_layouts/product.njk b/app/_layouts/product.njk index 3a27a956b..5fa0c056b 100644 --- a/app/_layouts/product.njk +++ b/app/_layouts/product.njk @@ -41,6 +41,7 @@ ] }, { title: "Vaccinations", services: [ "Book a vaccination", + "Manage vaccinations in schools", "Manage your appointments", "Record a vaccination", "Select people for invitation" diff --git a/app/images/manage-vaccinations-in-schools/2022/10/check-a-vaccination-record/australian-record-not-up-to-date-example.png b/app/images/manage-vaccinations-in-schools/2022/10/check-a-vaccination-record/australian-record-not-up-to-date-example.png new file mode 100644 index 000000000..ac6adabc2 Binary files /dev/null and b/app/images/manage-vaccinations-in-schools/2022/10/check-a-vaccination-record/australian-record-not-up-to-date-example.png differ diff --git a/app/images/manage-vaccinations-in-schools/2022/10/check-a-vaccination-record/australian-record-up-to-date-example.png 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Use the password `mavis` to access. +related: + items: + - text: Prototype code repository + href: https://github.com/nhsuk/manage-vaccinations-in-schools-prototype + - text: Service guidance + href: https://guide.manage-vaccinations-in-schools.nhs.uk +permalink: "manage-vaccinations-in-schools/{% if pagination.pageNumber > 0 %}page/{{ pagination.pageNumber + 1 }}{% endif %}/" +--- diff --git a/app/posts/manage-vaccinations-in-schools/2022/10/check-a-vaccination-record.md b/app/posts/manage-vaccinations-in-schools/2022/10/check-a-vaccination-record.md new file mode 100644 index 000000000..af0639fcd --- /dev/null +++ b/app/posts/manage-vaccinations-in-schools/2022/10/check-a-vaccination-record.md @@ -0,0 +1,83 @@ +--- +title: Check a vaccination record +date: 2022-10-17 +related: + items: + - text: Service design ideas for a measles outbreak + href: https://app.mural.co/invitation/mural/nhsdigital8118/1665477929936?sender=u4f2227392499e7dce8f43480&key=6d3efeb2-b59f-4bd1-be39-88a01bbc0db8 +screenshots: + items: + - Start page + - Vaccination record + - Expanded vaccination + - Routine vaccinations + - Full record for a 20 year old + - Australian record – up to date example + - Australian record – not up to date example + - NHS app – vaccinations showing in medicines + - NHS covid pass – COVID-19 vaccinations +--- + +When we were [mapping service design ideas for a measles outbreak](https://app.mural.co/invitation/mural/nhsdigital8118/1665477929936?sender=u4f2227392499e7dce8f43480&key=6d3efeb2-b59f-4bd1-be39-88a01bbc0db8) in Mural, we identified a need for viewing a vaccination record. + +## Measles scenario + +Consider the scenario: + +- there is a measles outbreak in your child’s school +- you’ve received information from the school about the outbreak + +One of the first things a parent needs to do is: + +- check if their child has had their vaccinations +- book an appointment for any catch-up + +> As a parent +> I need to see if my child has had all of their MMR vaccinations +> So that I can understand their vulnerability if they get measles +> And so that I can book a vaccination appointment + +Current options for checking your child’s vaccination record: + +- the red book +- calling your GP +- the NHS app, if dependants have been added and if vaccinations will be shown there. (This is inconsistent, presumably based on GP IT. Sometimes it is shown under immunisations, at other times under medicines, and often only as far back as 2010ish.) + +## What a vaccination record service might look like + +With this need, we wanted to create a hypothetical vaccination record service, to explore if it could meet the right needs. + +2 pages: + +- a start page to describe the service +- a record page to show what vaccinations someone has had + +### Record not history + +We chose to use ‘vaccination record’ instead of ‘vaccination history‘ because we know some people’s records will be incomplete, and ‘history’ suggests a comprehensive list. + +### Assumptions + +The record would include travel vaccinations, users would expect to see all vaccinations. + +You can check other people’s vaccination records, if you have proxy access (for example children and people you care for). ‘Check a vaccination record’, not ‘Check your vaccination record’. + +### Findings through experimentation + +What vaccinations were routine will be based on someone’s age. Any logic that considers missed vaccinations needs to know about when routines changed. A recent example – the HPV vaccine is now offered to both boys and girls. + +The importance of missed vaccinations will vary based on the vaccine, person and clinical factors. Consider the vaccine itself, the person’s age, time since missed vaccination, immunosuppression, etc. For example, a BCG vaccination is rarely given to anyone over the age of 16 because there is little evidence it works very well in adults. + +It seemed helpful in the initial design to indicate that a vaccination was routine by noting the schedule (for example 8 weeks, 12 weeks). + +As part of this experiment we identified the common vaccination brands given for routine vaccinations. + +### Questions + +- Do we show an overall status, for example ‘up to date’? +- Do we include contraindications? +- How do we add callouts for upcoming routine vaccinations? +- How do we add callouts for upcoming missed vaccinations? +- How do we indicate the difference between routine, travel and outbreak vaccinations? Do we need to? +- Can people add missing vaccinations themselves? +- How do we indicate vaccinations that are in the record but were not via the primary source, for example when someone tells a doctor they’ve had a vaccination already? diff --git a/app/posts/manage-vaccinations-in-schools/2022/10/cinnamon-consent-flu.md b/app/posts/manage-vaccinations-in-schools/2022/10/cinnamon-consent-flu.md new file mode 100644 index 000000000..0a7c12f44 --- /dev/null +++ b/app/posts/manage-vaccinations-in-schools/2022/10/cinnamon-consent-flu.md @@ -0,0 +1,91 @@ +--- +title: School-aged consent for a flu vaccine using Cinnamon +date: 2022-10-07 +screenshots: + items: + - Start page + - Student details + - Consent + - More fields after consent + - No consent + - Medical answers yes + - Success +--- + +Cinnamon is a digital [‘Immunisation e-Consent’ tool](https://www.cinnamondigitalapplications.co.uk/eConsent). + +Screenshots show the journey parents take through Cinnamon when they are giving consent for their school-aged child to have a flu vaccine. + + + +## Letter sent via school + +Parents enter the website from a link emailed to them in a PDF, sent by the school. + +There was no clear call to action in the email itself. + +The formatting of the PDF letter made it difficult to read. + +A second guidance PDF tries to give help on how to use the service, but its distorted screenshots and red arrows make the process look more complicated than it is. + +The PDF letter had the following text: + +> The Influenza nasal spray vaccination is offered annually as part of the national programme for vaccination of children and young people. This academic year the vaccine will be offered to children in all year groups from Reception through to Year 6. +> +> The nasal spray flu vaccine is safe and effective in helping to protect children against flu. +> +> Flu is caused by the influenza virus, which children can catch and spread easily. It can be a very unpleasant illness for children, which can lead to serious problems, such as bronchitis and pneumonia. +> +> Vaccinating them also protects others who are vulnerable to flu, such as babies and older people. +> +> The vaccination is given as a simple, quick and painless spray into each nostril. +> +> Contained within this letter are some frequently asked questions and useful information about the vaccine, and the virus it protects against. +> +> Further information is also available on the NHS Choices website www.nhs.uk. +> +> Please take this opportunity to check that your child’s routine vaccinations are up to date. You can check this with your GP Practice. If you have any questions, you can also contact the Immunisation Service or your School Nurse. + +## Lists of options + +### Reasons for not giving consent + +- Asthma (severe) +- Vaccine already given at GP Surgery +- Vaccine already given at Pharmacy +- Other +- Egg allergy +- Vaccine contents (porcine gelatine) +- Intending to take to GP +- Immunosuppression (child) +- Immunosuppression (adult) +- Previous allergic reaction to flu vaccine +- Salicylate oral therapy +- Another live vaccine due + +### Gender + +- Male +- Female +- Prefer not to say + +### Ethnicity + +- White British +- White Irish +- Any other White background +- White and Black Caribbean +- White and Black African +- White and Asian +- Any other mixed background +- Indian +- Pakistani +- Bangladeshi +- Any other Asian background +- Caribbean +- African +- Any other Black background +- Chinese +- Any other ethnic group +- Prefer not to say +- Unknown diff --git a/app/posts/manage-vaccinations-in-schools/2022/10/nhs-login-journey.md b/app/posts/manage-vaccinations-in-schools/2022/10/nhs-login-journey.md new file mode 100644 index 000000000..400bc0793 --- /dev/null +++ b/app/posts/manage-vaccinations-in-schools/2022/10/nhs-login-journey.md @@ -0,0 +1,14 @@ +--- +title: NHS login journey +date: 2022-10-17 +screenshots: + items: + - Login + - Enter email + - Found login + - Enter password + - Check your mobile phone + - Signed in patient +--- + +Screenshots showing the NHS Login journey on a new device. diff --git a/app/posts/manage-vaccinations-in-schools/2022/10/riviam-consent.md b/app/posts/manage-vaccinations-in-schools/2022/10/riviam-consent.md new file mode 100644 index 000000000..7c8179940 --- /dev/null +++ b/app/posts/manage-vaccinations-in-schools/2022/10/riviam-consent.md @@ -0,0 +1,19 @@ +--- +title: School-aged consent for a flu vaccine using Riviam +date: 2022-10-28 +screenshots: + items: + - Start page + - General FAQ expanded + - Flu FAQ expanded + - Technical FAQ expanded + - School selection + - School selection, postcode search + - Student details + - Parent/Guardian details + - Consent + - No consent given + - Health questions + - Confirmation + - Email confirmation +--- diff --git a/app/posts/manage-vaccinations-in-schools/2022/11/alternative-consent-requests.md b/app/posts/manage-vaccinations-in-schools/2022/11/alternative-consent-requests.md new file mode 100644 index 000000000..a88b529ab --- /dev/null +++ b/app/posts/manage-vaccinations-in-schools/2022/11/alternative-consent-requests.md @@ -0,0 +1,54 @@ +--- +title: Asking for consent in many ways +date: 2022-11-10 +related: + items: + - text: Consent study + href: https://research-information.bris.ac.uk/en/publications/implementing-new-consent-procedures-for-the-schools-based-hpv-vac +--- + +Consent needs to be inclusive, and must avoid digital exclusion. + +It doesn’t have to be done only by email. + +## Paper consent + +Some SAIS teams have not started using digital yet, presumably this means their consent is all done by paper. + +Many teams also use digital consent alongside paper consent – whether by choice, or because digital uptake is too low. This is creating an extra burden for teams when triaging consent. This doesn’t mean paper is a bad option – it means we might need to somehow do the hard work to make paper efficient. + +We haven’t seen any examples of paper consent forms. We assume that these are forms sent home with children. + +We should explore, ‘What would a good paper consent process look like?’ + +## Telephone consent + +[A study by Bristol University](https://research-information.bris.ac.uk/en/publications/implementing-new-consent-procedures-for-the-schools-based-hpv-vac) has shown that telephone requests for consent for HPV vaccines were successful. In the study they had school children call their parents, from school, just before their vaccination, to get consent. + +> Expanding the consent procedures for the schools-based HPV vaccination programme to include parental telephone consent was broadly welcomed by the immunisation nurses, parents, and young women in our study. + +We should consider how we could incorporate something like this. + +- Could a school share phone numbers with us? +- Could a phone number be given to parents for them to call and give consent? + +Ideas include: + +- Direct calls from SAIS team to parents +- An automated phone call service, using numeric options +- Sending requests by text message + +## Self consent (Gillick competence) + +- People aged 16 or over are entitled to consent to their own treatment +- Children under the age of 16 can consent to their own treatment if they have enough intelligence, competence and understanding to know what’s involved in their treatment. This is known as being Gillick competent. + +[More about children and consent on NHS.UK](https://www.nhs.uk/conditions/consent-to-treatment/children/) + +We need to establish if there is a user need to empower young people to give consent themselves. What happens when a parent does not give consent, but a child under 16 wants to? + +### Self consent and HPV + +The [Bristol University study](https://research-information.bris.ac.uk/en/publications/implementing-new-consent-procedures-for-the-schools-based-hpv-vac) found that self-consent was rare for young women aged 12-13 years: + +> The requirement for young women to confirm that they had discussed vaccination with their parents, and that vaccination would not cause difficulties at home, meant adolescent self-consent was rare in this age-group. diff --git a/app/posts/manage-vaccinations-in-schools/2022/11/cinnamon-consent-hpv.md b/app/posts/manage-vaccinations-in-schools/2022/11/cinnamon-consent-hpv.md new file mode 100644 index 000000000..8a0bfcb3c --- /dev/null +++ b/app/posts/manage-vaccinations-in-schools/2022/11/cinnamon-consent-hpv.md @@ -0,0 +1,66 @@ +--- +title: School-aged consent for an HPV, 3-in-1 and MenACWY using Cinnamon +date: 2022-11-17 +related: + items: + - text: Screening checklist for contraindications to HPV + href: https://www.immunize.org/catg.d/p4062.pdf +screenshots: + items: + - Student details + - Medical history + - Medical history (expanded) + - Consent + - Consent not given + - Consent for MMR given + - Consent for 3-in-1 and MenACWY + - Asking for type of relationship to child +--- + +There are three separate consent journeys for school-aged immunisations. + +1. [Flu vaccine](https://www.nhs.uk/conditions/vaccinations/child-flu-vaccine/) +2. [HPV vaccine](https://www.nhs.uk/conditions/vaccinations/hpv-human-papillomavirus-vaccine/) +3. Combined [3 in 1 teenage booster or Td/IPV](https://www.nhs.uk/conditions/vaccinations/3-in-1-teenage-booster/) with [MenACWY](https://www.nhs.uk/conditions/meningitis/vaccination/) + +The HPV and Td/IPV with MenACWY journeys both also prompt for MMRs if they’ve been missed. + +The first pages of the Cinnamon HPV consent journey are the same for flu, HPV and 3 in 1 with MenACWY. See the [flu journey for screenshots](/manage-vaccinations-in-schools/2022/10/cinnamon-consent-flu/#start-page). + +The journey for ‘HPV’ and ‘3-in-1 with MenACWY’ are identical, except for different vaccines being asked for on the consent page. + +## Student details + +Parents are asked for their child’s ‘Sex’, but in the flu journey it was ‘Gender’. + +Year groups and date of birth years are limited to those eligible for the vaccines. + +There is no validation on the address, NHS number or parent telephone number. You can enter anything. + +## Medical history + +The questions being asked are more generic than with flu. Where flu asked for egg allergies, aspirin medication and asthma, here parents are asked for existing conditions and regular medication, and ‘anything else you should know’, which might cover pregnancy. + +## Consent model + +Parents give consent for the full vaccination course (initial dose and booster dose) for HPV. Presumably this means no consent is requested 6 months later, when boosters are due. + +On the consent page, the options for relationship to child include ‘Self-consent’: + +- Mother +- Father +- Legal Guardian +- Self-consent +- Other (a text field asks for details) + +Self-consent is kind of hidden here. It’s not clear from this journey that a student could be completing this themselves. + +## MMR catch-up + +In the medical history, parents are asked: + +> Has the child named on this form received two doses of the MMR vaccine since the age of one? + +If the answer is No, then the parent is asked to give consent for an MMR vaccination. + +MMR vaccines are not given in school, instead parents will be invited to catch-up clinics. diff --git a/app/posts/manage-vaccinations-in-schools/2022/11/consent-requests.md b/app/posts/manage-vaccinations-in-schools/2022/11/consent-requests.md new file mode 100644 index 000000000..c3b97ef7b --- /dev/null +++ b/app/posts/manage-vaccinations-in-schools/2022/11/consent-requests.md @@ -0,0 +1,36 @@ +--- +title: Making consent requests consistent and effective +date: 2022-11-10 +screenshots: + items: + - Consent message + - Reminder message + - A consent request email from a school + - The letter attached to the email + - The FAQ attached to the email + - Another consent request letter from a school +--- + +Current requests for consent from schools can be really bad. They can be waffly with no call to action, meaning they are not effective in gathering consent from parents. + +Details are often in a PDF attached to an email. + +Quality is really variable. + +Our hypothesis is that if we can manage consent requests centrally, we can make them consistent and effective. + +We also need to consider [how to ask for consent in ways other than email](/manage-vaccinations-in-schools/2022/11/alternative-consent-requests/). + +## An alternative consent request + +We drafted a consent request email and a consent reminder for a flu vaccination. + +We aimed to keep this email as simple as possible. + +We give details about when and where vaccinations are taking place, and there is a clear call to action to give or refuse consent. + +This is followed by extra information about the flu vaccine and contact details for the SAIS team. + +## An email from the NHS + +Our hypothesis is also that this email will carry more weight if it comes from the NHS, rather than a school, amidst all the other usual school communications. diff --git a/app/posts/manage-vaccinations-in-schools/2022/11/give-or-refuse-flu-vaccination-strawperson.md b/app/posts/manage-vaccinations-in-schools/2022/11/give-or-refuse-flu-vaccination-strawperson.md new file mode 100644 index 000000000..dd029c1e5 --- /dev/null +++ b/app/posts/manage-vaccinations-in-schools/2022/11/give-or-refuse-flu-vaccination-strawperson.md @@ -0,0 +1,147 @@ +--- +title: Parent consent journey, straw-person design +date: 2022-11-04 +screenshots: + items: + - Start page + - Confirm school + - About you + - About your child + - Child’s date of birth + - Are they registered with a GP? + - Do you know their NHS number? + - Do you agree to them having a flu vaccine? + - No consent given + - Consent given health questions + - "Health question: Immune system" + - "Health question: Household immune system" + - "Health question: Asthma" + - "Health question: Allergy" + - "Health question: Aspirin" + - Check your answers + - Consent confirmation +--- + +Based on an analysis of existing consent tools we determined parents and guardians would need to: + +- tell us, or otherwise confirm, which school their child was at +- give details about their child or children +- give details about themselves, including contact details and their relationship to the child +- record consent, and if no consent is given, give a reason +- answer medical questions specific to the vaccine to make sure it is safe for the child to receive the vaccine at school +- confirm their choice and information given +- be easily able to tell the health team if anything changes (for example they get the vaccine elsewhere) +- have details about when and where the vaccination will happen + +This service will need to be used by parents of homeschooled children. This is not currently designed. + +## Service name + +We started with: + +> Give consent for a vaccination + +This became vaccine specific: + +> Give consent for a flu vaccination + +If you do not intend to give consent, there isn’t a reason to visit a ‘Give consent’ service. We want to encourage people who do not give consent to tell us and tell us why. We made this choice more explicit in the service name: + +> Give or refuse consent for a flu vaccination + +## Confirming their child’s school + +We saw that current consent tools have tricky ways of confirming which school a child is at. They used: + +- a postcode or name lookup (postcode being the school’s postcode, not where you live) +- a code, emailed separately, to identify the school + +We suggest that the link each parent receives will be unique to their school. It might also be unique to them and their child. This means the parent need only confirm the school shown – they don’t need to find it or find and copy a code. + +## Adult details + +We ask for: + +- name +- relationship to child +- telephone number +- email address + +We might want to confirm their email address somehow. + +### Relationship to child + +We’ve gone with: + +- Parent +- Guardian +- Carer +- Other + +We need to validate this list. + +Given different rules around parental consent for mother and father, we might need to explicitly ask which they are. + +## Child details + +We ask for: + +- name +- preferred name +- date of birth +- sex (not gender) +- GP they are registered with +- NHS number + +### Preferred name + +A child may go by a middle name or abbreviated name, or something else. We expect there is a need for this information to help nurses build a rapport with each child during the vaccination event. + +### Sex and gender + +We don’t know what the need is for this information, we have assumed that sex is the appropriate thing to ask for in a medical scenario. + +We need to find out: + +- if this question can be removed +- if it’s vaccine specific and only needed in certain cases +- whether we ask for gender or sex, if required + +### GP they are registered with + +Not all consent tools ask for this. We need to confirm the need. + +It’s not clear how easy it will be for people to find their GP surgery. + +It’s also not clear what data we would use, and how we’d structure that list. + +We also include two options to help the user: + +1. let them continue if they don’t know +2. tell us if they are not registered at all + +### NHS number + +Not all consent tools ask for this. We need to confirm the need. + +It’s not clear how easy it will be for people to give an NHS number. + +It might be the case that with the child’s information we can look up and match a child’s details without needing their NHS number. If we do not find a match, we might ask for an NHS number in that situation. + +## Vaccine specific journey + +Each vaccine journey will need to be specific. + +The start page needs to give detail about the vaccine and specific links to more information. + +The medical health questions will vary depending on the vaccine. + +## Available in other languages + +The service must be translatable to other languages, to make it easier for all parents and guardians to give consent. + +We need to research which languages would be most helpful. + +## NHS App + +If consent was somehow made available through the app, we might get some information for free. This might include parent and child details. This could simplify the consent journey, if people can sign in hassle free. diff --git a/app/posts/manage-vaccinations-in-schools/2022/11/learning-from-real-child-vaccination-records.md b/app/posts/manage-vaccinations-in-schools/2022/11/learning-from-real-child-vaccination-records.md new file mode 100644 index 000000000..938d8161b --- /dev/null +++ b/app/posts/manage-vaccinations-in-schools/2022/11/learning-from-real-child-vaccination-records.md @@ -0,0 +1,186 @@ +--- +title: Learning from real vaccination records of 3 kids +date: 2022-11-29 +screenshots: + items: + - The red book + - Das Impfbuch (German vaccinations book) + - Data extract from a CHIS system (CarePlus) + - Data extract from a GP practice system (EMIS) + - GP practice vaccinations record in the NHS app + - A snippet from the consolidated record +--- + +## How vaccinations are recorded + +Children’s vaccinations are recorded and duplicated in multiple places, such as: + +- records kept by the parents/guardians (e.g. [the red book](#the-red-book) or [the German equivalent](#das-impfbuch-german-vaccinations-book)) +- GP practice systems +- the IT systems of child health information services (CHIS) + +The GP vaccination records are commonly available to patients via the NHS app. + +We wanted to better understand: + +- how well data is being shared between GP practices and the local CHIS +- how well data is being shared between between school aged immunisation services (SAIS) and CHIS +- how a child’s vaccination data follows them when they move around the country + +## Designing with data + +[To design effectively, we needed a deep understanding of real service data](https://www.gov.uk/service-manual/design/designing-with-data-an-introduction). We looked at getting analytical access to anonymous versions of GP and CHIS vaccination records, but realised that getting that access would be a lengthy process. + +To allow us to learn while the access to anonymous mass data was being sorted out, we decided to look at (anonymous) records belonging to team members and their children. + +## Looking at individual records + +One team member with 3 kids (2 primary school age, 1 secondary school age): + +- obtained copies of their kids’ vaccinations records from their GP and their local CHIS +- dug out their own paper-based records (several red books, and having lived abroad, a German ‘Impfbuch’) +- donated anonymised versions of the source data to the team +- reconciled everything to create a single, master vaccination record for each child + +To avoid medical jargon and acronyms, the reconciled vaccination record included [the vaccine names from NHS.UK](https://www.nhs.uk/conditions/vaccinations/nhs-vaccinations-and-when-to-have-them/) alongside the record entries from the GP, CHIS and red book records records. + +[The reconciled record looked like this](#a-snippet-from-the-consolidated-record). + +### How to request CHIS records + +1. Find out who your local CHIS is, from your GP or local school aged immunisation team +2. Find a contact for them +3. Submit a written request for the data +4. Verify your identity + +## Covered scenarios + +The vaccination records included: + +- vaccinations given in many settings + - at GP practices + - in school by SAIS teams + - in hospital by hospital teams + - at home by hospital teams + - at community pharmacies + - at vaccination centres +- vaccinations done abroad and then digitised in England +- vaccination data moving between regions and different GP practices +- NHS-funded and privately funded vaccinations +- vaccinations given for a variety of reasons + - routine + - travel vaccinations + - extra vaccines for at-risk children + - early doses and boosters given as part of outbreak response + - as part of clinical trials + +## Findings + +### Statistics + +According to the records, the 3 children had collectively received 67 vaccinations to date. + +| Source | Present & accurate | Incomplete or with errors | Missing | Total | +| --------- | ------------------ | ------------------------- | --------------- |-------| +| Red book | 62 (93%) | 0 (0%) | 5 (7%) | 67 | +| GP record | 53 (79%) | 5 (7%) | 9 (13%) | 67 | +| CHIS | 57 (85%) | 5 (7%) | 5 (7%) | 67 | + +### Missing records + +#### From the red book + +The 5 vaccinations missing from the red books were all seasonal flu given in school, when the parents (and the red books) weren’t present. + +For 2 chickenpox vaccinations, (easily lost) vaccination slips were tucked into the books, instead of being handwritten in. + +#### From GP records + +9 vaccinations were missing from the GP records: + +- 3 flu vaccinations given in school (although these were present in the CHIS records) +- 2 chickenpox vaccinations given privately at a community pharmacy (Boots) +- 2 extra polio doses given at a vaccination centre several days before the GP records were pulled. They were present within the CHIS records, so it is possible that either the CHIS hadn’t yet shared the data with the GP practice, or the GP practice hadn’t imported them yet. +- 2 vaccines that were given as part of a medical trial. The trial was double blind with one placebo given for every two vaccinations, so the children could have received placebos. These vaccinations were only recorded in the red book. Unless the parents ever contact the study authors, they may never find out what was administered. + +#### From CHIS records + +5 vaccinations were missing from the CHIS records: + +- 1 tick-borne encephalitis travel vaccination given at the GP practice +- 2 chickenpox vaccinations given at a community pharmacy (see above) +- 2 vaccines that were given as part of a medical trial (see above) + +### Errors or incomplete records + +#### In the GP records + +5 records contained errors: + +- 2 6-in-1 vaccinations were recorded as 5-in-1 vaccinations, so the HepB part wasn’t captured. +- 1 chickenpox 2nd dose was incorrectly coded as 1st dose +- 2 doses of the tick-borne encephalitis (TBE) travel vaccine were incorrectly recorded as Japanese encephalitis, so despite the same vaccine brand being given 3 times, the digital record looked like this: + - 1st dose of Japanese encephalitis vaccine + - 2nd dose of tick-borne encephalitis vaccine + - 3rd dose of Japanese encephalitis vaccine + +It was possible to catch and investigate these discrepancies because the vaccine brand name was recorded in the red book. + +Such errors in recording will make it much harder to automate answering questions like + +- am I up to date with my vaccinations? +- what level of protection do I have against this disease right now? + +#### In the CHIS records + +CHIS records inherited the same 5 errors from the GP records (see above). + +The CHIS’s ‘venue’ field was wrongly showing as the GP in many cases: + +- for a COVID-19 vaccination that happened at a vaccination centre +- for vaccinations that happened abroad or at an out-of-area GP. This may have been caused by manual re-keying of that information at the children’s current GP practice +- for some SAIS vaccines, despite them being given in school +- for routine vaccinations that were administered in the home by hospital nurses (it’s unclear how the records would have been reported to the GP) + +#### Vaccine product name not appearing on GP and CHIS printouts + +The red book records the vaccine product names (e.g. ‘Infanrix hexa’). The GP and CHIS printouts, and the NHS app, didn’t show the vaccine product name (but perhaps this information is still stored in the source systems). + +Without the vaccine product name, it would have been impossible to spot some of the mistakes in the digital recording, nor be in a position to correct them. + +#### Vaccine metadata often missing + +All GP records contained the date and vaccine type, but some additionally included: + +- manufacturer +- batch number +- injection site +- expiry date + +There wasn’t an obvious pattern for this information being present or absent, although newer records were more likely to have this metadata. + +CHIS recorded batch numbers for only a handful of vaccinations. + +### What was confusing or unexpected + +#### Jargon-heavy language + +The vaccine names in the GP records (e.g. ‘1st dipht tet acell pertus, haem influ b, inactiv polio vacc’) were cryptic and full of medical jargon. They required Googling to recognise and understand. Mapping the GP names across to [much the simpler language used on NHS.UK](https://www.nhs.uk/conditions/vaccinations/nhs-vaccinations-and-when-to-have-them/) helped enormously with the analysis. + +#### Vaccinations recorded across multiple CHIS and GP entries + +A single 6-in-1 vaccine injection appears to be recorded as: + +- three entries in CHIS records +- two entries in the GP records. + +#### Phantom red book records + +The red books had 2 ‘phantom’ flu jab recorded on days when a SAIS team was supposed to come to the child’s school, but those jabs were absent from the GP and CHIS records. It’s unclear whether: + +- the red book entries were wrong (perhaps if there was confusion as to whether the child was actually vaccinated on that day or not, or some other miscommunication between the parents and the school), or +- the digital records had gone missing for some reason. + +#### Understanding deviations from routine schedules + +The records showed the 2nd MMR dose being given ahead of schedule at 2 years, instead of at 3 years 4 months. After lots of Googling and reflection, the parents eventually remembered that the deviation happened in response to a local measles outbreak. This explanation wasn’t captured anywhere, and would eventually be lost in the mists of time. diff --git a/app/posts/manage-vaccinations-in-schools/2022/11/poc-flu-campaign.md b/app/posts/manage-vaccinations-in-schools/2022/11/poc-flu-campaign.md new file mode 100644 index 000000000..2a7ec32c1 --- /dev/null +++ b/app/posts/manage-vaccinations-in-schools/2022/11/poc-flu-campaign.md @@ -0,0 +1,94 @@ +--- +title: "Point of care: Record a flu vaccination" +date: 2022-11-23 +screenshots: + items: + - Flu campaign + - Child details + - Record flu vaccination + - Has the vaccine been given? + - Check and confirm + - "If vaccine not given: Why not given?" + - Confirm the vaccine was not given + - Record saved + - Child details after vaccination + - Child details after vaccination refused + - Updated flu campaign page +--- + +We started with a flu point of care (POC) journey because we: + +- have seen examples of flu POC systems +- had a strong starting point with the consent designs + +In this design we have assumed the user: + +- has access to good internet +- has a pre-populated list of people to vaccinate + +We know that many POC users will not have reliable internet, and we need to think about how to support them. + +## List of children + +The designs show an MVP list of students who’ve been approved for vaccination. We believe this list is created during a SAIS triage of answers to health questions – but we need to do research to confirm this. + +We expect users to need to: + +- filter the list +- see lists of children that have not yet been seen, and those that have been seen already +- use pagination for long lists +- have the list broken down by class or year group +- get details for children not approved for vaccination + +All students have the screening status ‘Approved’. We do not know what the alternatives would be, for example someone with severe allergies or someone who has asthma. + +When a child has been seen, their status will change to ‘Vaccinated’ or ‘Vaccine not given’. + +## Child details + +We play back the information given during the consent process (child and parent or guardian details). + +We need to validate what SAIS teams need to see at point of care. + +We show a summary of the screening process, with a link to see all the answers to the screening questions, as answered in the consent journey, and checked by triage. We do not know if there’s a clinical need to see the full questions and answers at point of care. + +The vaccinator might need to see the screening questions when answers contain important details. + +After a vaccination has been recorded or not given, we show the details of the event, which can be changed. + +## Recording the flu vaccination + +### A default vaccine + +The vaccine details have been predetermined by the campaign and by the answers given [when the SAIS nurse signs in for the day](/manage-vaccinations-in-schools/2022/11/poc-prepare-the-day/). + +We’re using sensible defaults as decided by the user, but also giving the option to change them. We believe there might be a need to change these details – for example if a child is having a flu injection rather than a nasal spray. + +### Vaccination site is known + +We only need to ask for the vaccination site if the child has had an injected vaccine. + +When we ask if the flu vaccination has been given, we default to the nasal spray. We know that it must be given nasally. We do not need to ask for the vaccination site. + +### When the vaccination is not given + +Users still need to record that the vaccine was not given, and why. + +Reasons include: + +- the vaccination was refused +- they were too unwell +- they had contraindications + +We’ve seen these reasons in other POCs, but our list might not be exhaustive. + +### Check and confirm + +After telling us if the child has had the vaccine, we ask users to check and confirm their answers. + +On this screen we include a number of defaults to minimise what they need to fill in: + +- date defaults to today +- time defaults to now +- vaccinator defaults to the name given by the user when they signed in +- location defaults to the campaign location diff --git a/app/posts/manage-vaccinations-in-schools/2022/11/poc-hpv-campaign.md b/app/posts/manage-vaccinations-in-schools/2022/11/poc-hpv-campaign.md new file mode 100644 index 000000000..a00b19a24 --- /dev/null +++ b/app/posts/manage-vaccinations-in-schools/2022/11/poc-hpv-campaign.md @@ -0,0 +1,38 @@ +--- +title: "Point of care: Record an HPV vaccination" +date: 2022-11-23 +screenshots: + items: + - HPV campaign + - Student details + - Record HPV vaccination + - Given vaccine + - Check and confirm + - Student details after vaccination +--- + +The journey for recording an HPV vaccination is very similar to the [flu journey](/manage-vaccinations-in-schools/2022/11/poc-flu-campaign/). + +In the HPV case we might want to refer to students rather than children, given their ages. + +Students may not have been given consent by their parents, but given their ages, Gillick consent is an option. We know this, but have purposefully left self-consent to later. + +## HPV has multiple doses + +HPV is a vaccine with two doses, the second coming 6 to 24 months after the first. + +We do not know how the point of care system would know about previous HPV vaccinations, but we have assumed that it would. + +From this assumption, we can tell the users if the student needs to have their first or second dose. + +We play back the current dose: + +- on the student details page +- on the vaccine details page +- on the check and confirm answers page + +At the moment the prototype defaults to the first dose for everyone. + +## HPV vaccine is an injection + +We must ask for the vaccination site when someone is vaccinated. We’ve put the most common sites at the top – right arm and left arm. diff --git a/app/posts/manage-vaccinations-in-schools/2022/11/poc-prepare-the-day.md b/app/posts/manage-vaccinations-in-schools/2022/11/poc-prepare-the-day.md new file mode 100644 index 000000000..337e66239 --- /dev/null +++ b/app/posts/manage-vaccinations-in-schools/2022/11/poc-prepare-the-day.md @@ -0,0 +1,62 @@ +--- +title: "Point of care: What are you doing today?" +date: 2022-11-23 +screenshots: + items: + - Start page + - Sign in + - You’re signed in + - What are you doing today? + - Are you the vaccinator? + - Which flu vaccines are you using? + - Which batches? + - Check and confirm + - Flu campaign +--- + +We want to simplify the data users enter at the point of vaccination. Repeating their own name, location, vaccine used and vaccination site is laborious. They do this hundreds of times. + +Our hypothesis is that we can: + +- use sensible defaults +- allow users to choose their defaults when they sign in +- infer further defaults from those choices + +In this design we show what defaults a user might choose when they sign in, for example at the beginning of a campaign or clinic. + +## A worked example + +Consider you’re a SAIS nurse at a primary school, and you’re there to administer flu vaccines. + +If the system knows about the SAIS team schedule, where they are going and when, and what vaccinations they are giving, then we can present the most likely list of things they will be doing today. + +For example, we know that on 22 November this SAIS nurse is in a SAIS organisation that is going to these schools and running these clinics: + +- St Mary’s Primary School Flu campaign, 22 November +- Hele’s Secondary School HPV campaign, 22 November +- Catch-up clinic, 22 November + +From the campaign they select, we will know that we need to ask which Flu vaccines they will be using, and which batches of those vaccines. + +If the system knows what vaccines are in stock, and what batches are available, these choices can be simplified. + +By making these choices at the start, the user can reuse them for each vaccine they administer. + +## We need to know more + +Is this worked example a realistic one? + +We need to know more about the vaccines teams take to campaigns – is it always or usually the same batch of the same vaccine. What changes? Do different team members administer different vaccines? + +We need to validate our assumptions through research. + +## Clinics and change of plans + +We don’t know: + +- what happens at a clinic – are clinics usually for one vaccine type? All vaccines? +- what happens if plans change + +We’ve assumed that the knowledge of what’s happening comes from somewhere, this information will need to be kept up to date. + +We don’t expect to design a clinic and campaign scheduling system. diff --git a/app/posts/manage-vaccinations-in-schools/2022/11/school-consent-strawperson.md b/app/posts/manage-vaccinations-in-schools/2022/11/school-consent-strawperson.md new file mode 100644 index 000000000..dd81c29f3 --- /dev/null +++ b/app/posts/manage-vaccinations-in-schools/2022/11/school-consent-strawperson.md @@ -0,0 +1,32 @@ +--- +title: School consent journey, straw-person design +date: 2022-11-10 +screenshots: + items: + - Start page + - Campaigns + - Send flu consent requests + - Preview consent message + - Preview reminder message + - Existing consent message +--- + +Following the [parental consent journey](/manage-vaccinations-in-schools/2022/11/give-or-refuse-flu-vaccination-strawperson/), we: + +- explored what features a school might see +- drafted consent request email +- drafted consent reminder + +The largest questions we had when designing these pages related to the upload of contacts and the sending of requests. + +Questions include: + +- How do we refer to a vaccination ‘campaign’? We think campaign is right, but we need to check. +- Who should be responsible for sending the consent request? The school or SAIS? +- How far in advance should the consent requests be sent? Cinnamon consent was requested 1 month in advance. +- How long should we wait until sending a reminder? +- Who decides which children are eligible for the vaccine? – Sometimes a CHIS will send a list of children who are eligible to the SAIS provider +- What information would the school upload to the NHS service? +- What information can they share under GDPR? +- Would reminder requests be sent automatically? +- How do we accommodate [alternatives to requesting consent by email](/manage-vaccinations-in-schools/2022/11/alternative-consent-requests/)? diff --git a/app/posts/manage-vaccinations-in-schools/2022/12/flu-consent-iteration.md b/app/posts/manage-vaccinations-in-schools/2022/12/flu-consent-iteration.md new file mode 100644 index 000000000..99477a1e9 --- /dev/null +++ b/app/posts/manage-vaccinations-in-schools/2022/12/flu-consent-iteration.md @@ -0,0 +1,94 @@ +--- +title: Iteration to parent consent journey for flu +date: 2022-12-13 +related: + items: + - text: SAIS interviews round 1 + href: https://www.notion.so/SAIS-interviews-round-1-f2dd1af58c8040f7a8c5c34a35d6b70b + - text: Prototype changes + href: https://github.com/nhsuk-archive/consent-for-vaccinations-prototype/commit/ce8ad48e24c79cfcffb483c17b0aba6b82f8352f +screenshots: + items: + - What is your child’s name? + - Child’s date of birth + - Confirm child’s school + - About you + - Nasal consent + - No nasal consent given + - Injection consent + - Registered GP + - Household immunosuppressed + - Asthma steroids + - Egg allergy + - Anything else? +--- + +Following research with 4 SAIS team leads, we iterated our initial flu consent journey for parents to incorporate our findings. + +## Nasal vs injection + +A SAIS team lead told us that it wasn’t clear what flu vaccine a parent was giving consent for. Is it nasal spray or injection? Our only reference to the nasal spray was on the start page. + +They told us that without the intra-muscular (IM) option, they’d lose 5% of their flu vaccinations. + +We have changed the journey so that: + +- we explicitly ask for consent for the nasal spray, and highlight the pork gelatine content of the vaccine +- if they do not agree, in our list of reasons, pork gelatine is now at the top +- if a user gives any reason other than ‘vaccine received already’ or ‘will be given elsewhere’, we now ask if they want to give consent for an injected vaccine instead +- if consent for an injection is given, we ask fewer clinical questions as the contraindications relating to the nasal spray do not apply + +## Parental responsibility + +We’ve changed the list of options for ‘relationship to child’ – we’ve added ‘Other’ and removed ‘Carer’. + +If ‘Other’ is selected, we give guidance that they must have parental responsibility to give consent. + +A good example is a step-parent. + +[About parental responsibility](https://www.gov.uk/parental-rights-responsibilities) + +## Parents can give information for the wrong person + +SAIS team leads told us that parents frequently enter information wrong. + +Examples include: + +- giving their child’s name instead of their own +- giving their own date of birth instead of their child’s + +It needs to be clear when we are asking about the child vs the person with parental responsibility. + +We made some content changes to clarify this, but we’d typically identify and iterate these sorts of issues based on how frequently they occur in a live system. + +## Asking for their child’s name + +We have refined the questions to ask for: + +- official name first (for example on a birth certificate), rather than just ‘name’ +- ‘are they known by another name’ rather than ‘preferred name’ + +It may not be the child’s preferred name, but it’s what they’re known as. + +## Asking for sex or gender + +We have been told there is no biological need to know sex information. SAIS users couldn’t point to specific needs for this information. We have removed the question. + +We might want to put it back in some form within the HPV journey, where uptake amongst male and female is important to know. + +## NHS number + +We have removed the page asking for an NHS number. + +Some teams ask for it, others do not. When it is asked for most parents do not give the number. It is not frequently used. We do not expect to need to use the NHS number, so have removed for now. + +## Refined clinical questions + +Our health questions are still not clinically assured, but we have iterated them based on feedback in research. + +We: + +- made it clear that only severe egg allergies that have led to admission to intensive care are relevant (as per the green book) +- given an example of someone in a household who is immunosuppressed, using the example of a bone marrow transplant from the green book (anecdotally, parents confuse this question with shielding for COVID) +- added a question about oral steroids if a child has been diagnosed with asthma – the dose and type of steroid is relevant to contraindications +- added an ‘anything else?’ question at the end, to capture anything that does not fit into the standard questions – for example when a child has a fear of needles. This is now in line with other vaccine journeys diff --git a/app/posts/manage-vaccinations-in-schools/2023/01/adding-a-session.md b/app/posts/manage-vaccinations-in-schools/2023/01/adding-a-session.md new file mode 100644 index 000000000..7a9ed1234 --- /dev/null +++ b/app/posts/manage-vaccinations-in-schools/2023/01/adding-a-session.md @@ -0,0 +1,60 @@ +--- +title: Adding a session +date: 2023-01-24 +related: + items: + - text: Prototype pull request + href: https://github.com/nhsuk-archive/manage-childrens-vaccinations-prototype/pull/28 +screenshots: + items: + - Add session from dashboard + - What type of session? + - Which school is it at? + - Which routine vaccine is being given? + - When is the session? + - Check and confirm details + - Session created + - Session page without any children +--- + +These are first pass designs for creating a school-based routine vaccination session. + +We have assumed that users will want to create sessions within the service. Alternatively they might want to upload a calendar or spreadsheet from a separate system. + +When creating a session we ask: + +- what type of session (routine, clinic or mop-up) +- where is it (which school) +- what type of vaccine +- when is it (date and time) + + + +## Session times + +We do not know how important start and end times are for users. We currently ask if it’s a morning, afternoon or all day session. Users might need to specify actual times. + +## Other types of sessions + +We need to do more user research to understand the needs around catch-up clinics and mop-up school sessions. + +## Adding children + +How lists of children will end up in our service is still one of the biggest unknowns. + +For now, all sessions are created without any children. + +## Permissions + +We haven’t considered who would have permission to add and edit sessions. + +For example, we might not want bank staff to do this. + +## Design notes + +When selecting a school, it should use a school autocomplete. + +We’ve purposefully left out: + +- situations where other types of vaccine might be given (for example MMR) +- any situation that is not a school session or clinic (for example home visits) diff --git a/app/posts/manage-vaccinations-in-schools/2023/01/faster-vaccination-recording.md b/app/posts/manage-vaccinations-in-schools/2023/01/faster-vaccination-recording.md new file mode 100644 index 000000000..423924d8a --- /dev/null +++ b/app/posts/manage-vaccinations-in-schools/2023/01/faster-vaccination-recording.md @@ -0,0 +1,39 @@ +--- +title: Recording vaccinations faster +date: 2023-01-23 +related: + items: + - text: Prototype pull request + href: https://github.com/nhsuk-archive/manage-childrens-vaccinations-prototype/pull/24 +screenshots: + items: + - Child page + - Expanded medical history with no triage needed + - Expanded medical history with triage notes + - Expanded vaccination questions if vaccination site is needed + - Check and confirm details + - Vaccination saved (offline) + - Vaccination saved (online) +--- + +We’ve made changes to make it faster to record each vaccinations – focusing more on the default options, but keeping the ability to change defaults for the rarer exceptions. + +Design changes include: + +- shortening the page by removing the parent section, and putting parent details in a shorter summary at the top (but keeping all the necessary details) +- putting medical notes and triage notes directly on the page, with improved summaries +- putting the ‘Did they get the vaccination?’ question directly on the child page + + + +## Notes on the vaccination journey + +After saying ‘Yes’ to ‘Did they get the vaccination?’ we show the Check and Confirm page. Defaults can be changed on this page. + +On confirmation, users are taken directly back to the child list. We have removed the confirmation page and replaced it with a success banner. They can now continue with the next child they need to vaccinate. + +If they did not get the vaccination, we ask for a reason, which is an extra page in the journey for this rarer exception. + +We have not changed the journey for the 3 in 1/MenACWY sessions yet, because of the complexity around giving multiple vaccines. + +We have not yet fully considered the journey for recording non-nasal flu vaccines. For example – if triage states they should have the injection rather than nasal. diff --git a/app/posts/manage-vaccinations-in-schools/2023/01/manage-users.md b/app/posts/manage-vaccinations-in-schools/2023/01/manage-users.md new file mode 100644 index 000000000..abe3c5b55 --- /dev/null +++ b/app/posts/manage-vaccinations-in-schools/2023/01/manage-users.md @@ -0,0 +1,36 @@ +--- +title: Manage users +date: 2023-01-31 +related: + items: + - text: Prototype pull request + href: https://github.com/nhsuk-archive/manage-childrens-vaccinations-prototype/pull/33 +screenshots: + items: + - Dashboard + - Manage users + - Edit user + - Changes saved +--- + +There is a need to manage who can and cannot access the service. + +Typically, users need to: + +- add users +- remove users +- edit users (names, email addresses) +- change user permissions +- temporarily suspend a user (for example, maternity) + +We don’t know if there are established patterns for doing this in NHS services. If the service uses some sort of integrated sign-in, then these pages will probably change. + +These designs are a first-pass to indicate what features might be available, and to gauge users’s response to them. + +We have purposefully avoided the concept of bank staff for now. + +## Permissions + +We need more research to understand what permissions different users will need. Bank users will probably need different roles and access. + +For the pilot, we anticipate that all users will have the same permissions. This is also based on the hypothesis that bank staff are predominantly needed during flu season in autumn, and the pilot will run through the summer. diff --git a/app/posts/manage-vaccinations-in-schools/2023/01/offline-iteration.md b/app/posts/manage-vaccinations-in-schools/2023/01/offline-iteration.md new file mode 100644 index 000000000..24e7bfac6 --- /dev/null +++ b/app/posts/manage-vaccinations-in-schools/2023/01/offline-iteration.md @@ -0,0 +1,55 @@ +--- +title: Choosing what’s available offline +date: 2023-01-23 +related: + items: + - text: Original pull request + href: https://github.com/nhsuk-archive/manage-childrens-vaccinations-prototype/pull/24 + - text: Uploaded banner pull request + href: https://github.com/nhsuk-archive/manage-childrens-vaccinations-prototype/pull/27 +screenshots: + items: + - Dashboard with offline sessions + - School session + - School session is available offline + - Child list is available offline + - Child is available offline + - You are working offline banner + - Help working offline + - Offline vaccination saved + - Online vaccination saved + - You have offline changes + - Your offline changes have been saved + - School session not available offline +--- + +We’ve iterated the [offline designs from the original design spike](/manage-vaccinations-in-schools/2023/01/offline-spike/), moving away from magical implicit offline functionality, to an explicit offline choice. + +Our hypothesis around this is that: + +- users will expect some degree of control over what is offline +- they will need clarity about what is and is not available +- they are more likely to trust the service if they’ve done the thing +- this process will be familiar to users who already prepare for offline sessions (such as spreadsheets or preparing a file for MOIRA) + +## Making a session available offline + +On each session page there’s a section and button to save the session offline. This status is also reflected on the dashboard. + +We do not know how long a session should be kept offline, but we might want to use logic such as until the date of the session plus X days. Or alternatively, as soon as it is uploaded, it is no longer available offline. + +Once offline, the child list and child record pages have an indicator showing they are available offline. + +## When working offline + +We still show a banner, but we’ve simplified it and used a blue colour to match the offline statuses used elsewhere. + +A help page explains what you can and cannot do while offline, we have used a do and don’t list. We need to see if this meets user’s expectations. + +Any sessions not saved offline are unavailable. + +## When going back online + +When a user goes back online, any offline changes are automatically uploaded and a green success banner is shown at the top. This banner persists until dismissed. + +Any records that have the status ‘Saved offline’ will be updated to ‘Saved’. diff --git a/app/posts/manage-vaccinations-in-schools/2023/01/offline-spike.md b/app/posts/manage-vaccinations-in-schools/2023/01/offline-spike.md new file mode 100644 index 000000000..c691308a1 --- /dev/null +++ b/app/posts/manage-vaccinations-in-schools/2023/01/offline-spike.md @@ -0,0 +1,104 @@ +--- +title: Working offline +date: 2023-01-11 +screenshots: + items: + - Online – can you work offline status + - Get ready to work offline + - You are ready to work offline + - You are working offline + - Help working offline + - Working offline in the Check a vaccination appointment service +--- + +It became clear during the first round of research that many SAIS teams have a need to work offline. Many don’t have internet access, or if they do have access it can be patchy or unreliable. + +They often: + +- are not allowed to connect to the school Wi-Fi +- go to schools that do not have a Wi-Fi network +- don’t have mobile signal for 4G or 5G connectivity + +We’ve heard that some teams take with them technology to try and get online, whether that’s laptops with mobile internet built in or USB dongles (which are harder to use). + +## How teams work offline + +Most teams have a strategy for working offline, but these vary from team to team. + +Several teams reported using Excel spreadsheets to capture vaccination events. These were uploaded once the teams were able to reconnect to the internet. Teams will prepare spreadsheets of children and download them before going to a school. + +Other teams have their own offline systems, MOIRA is one example. + +We also heard about some admin team members keeping a paper backup as a data safeguard. We still need to learn more about paper use in schools. + +## Options for offline working + +Our point of care service could be built as: + +- a website that has offline functionality +- an installed app that works offline +- both + +Each will have a different user experience and expectation. There are also different technical considerations, which are being explored separately. + +We expect most teams to either be fully online or fully offline, and the case where they have intermittent connectivity to be less common. The effect of this being that data must be prepared beforehand, and any offline work uploaded afterward. + +### Offline websites + +It’s possible to build a website that works offline. Users can continue to use the site, or a subset of the site’s features, even without connectivity. + +However, these sites are rare and the concept of a website that works offline will be unfamiliar. We don’t know whether users will trust an offline website. + +During a research session we tried asking, ‘Would you use an offline website?’, but the concept was difficult to imagine. We need to show an example of an offline website and how it would be used, and gauge reception to it. It is also hard to do offline research via an online video session. + +### Offline apps + +An app is more commonly used offline, whether on a phone, tablet or laptop. We believe there is more of an expectation that it will work when not connected. + +An app would need to be installed on to devices being used by teams. Users do not usually have permission to install applications on their work devices, they may need permission and assistance from IT. + +## Preparing data for offline working + +When offline, the device will need all the appropriate data downloaded so that the user can: + +- find children +- check their consent and answers to health questions +- record vaccinations + +Data could be downloaded in two ways: + +1. Implicitly, where the website or app will automatically keep a local copy of all recent and upcoming school sessions. This happens without the user being prompted. +2. Explicitly, where a user will need to actively make school sessions available offline. + +The right answer might be a balance of these two approaches. We need to test them. + +An explicit approach is similar to the practice of preparing and downloading an Excel spreadsheet to work offline. (Our solution must be good enough that users don’t continue to use spreadsheets – for example, if they consider our service to be unreliable or don’t understand it.) + +We want to explore how to draw people’s attention to the fact they are offline. + +In both cases we’ll need to indicate what can and can’t be done offline with the currently downloaded data. + +### Implicitly making sessions available offline + +The service would need to determine the right logic for what to download and when. It would need to err on the side of downloading more. + +In our designs we’ve created a status region at the bottom of each page which indicates whether the website or app is ready to be used offline. There is still an explicit action to download all appropriate data if the service is not yet ready. + +### Explicitly making sessions available offline + +This might look like a list of download links against each school session, alongside some indication of download status. + +## Other things to consider + +- Security of data, such as encryption and lifecycle +- Technology available to SAIS teams +- The complexity of building an offline capable service +- Users’ willingness to accept an offline option +- There might be a need to refresh data +- What are the contingencies? Such as, can offline work be exported somewhere + +## Design notes + +The screenshots below are a first pass at what an implicit offline service might look like. + +We use a clear yellow banner to indicate when a user is offline. This is similar to the [offline patterns used by the ‘Check a vaccination appointment’ service](https://vimeo.com/707743949/19ed2f596b). diff --git a/app/posts/manage-vaccinations-in-schools/2023/01/poc-3-in-1-campaign.md b/app/posts/manage-vaccinations-in-schools/2023/01/poc-3-in-1-campaign.md new file mode 100644 index 000000000..5ec057c3e --- /dev/null +++ b/app/posts/manage-vaccinations-in-schools/2023/01/poc-3-in-1-campaign.md @@ -0,0 +1,44 @@ +--- +title: "Point of care: Record 3-in-1 and MenACWY vaccinations" +date: 2023-01-10 +screenshots: + items: + - Your campaigns + - School session + - Record vaccinations + - Child page – multiple consent + - Child page – single consent + - Single consent warning + - Multiple consent call to action + - "Multiple: Which vaccine first?" + - Record 3-in-1 + - Was 3-in-1 given? + - Record MenACWY + - Was MenACWY given? + - Check and confirm details + - Record vaccinations showing vaccination +--- + +The 3-in-1 teenage booster and MenACWY vaccinations are given at the same time. We capture consent for both in the same parent journey. + +On the day, a child might: + +- get both vaccinations +- get just the MenACWY vaccination +- get just the 3-in-1 vaccination +- refuse one or both vaccinations + +## Indicating consent + +Consent may have been given for one or both of the vaccines. It needs to be clear to the nurses which vaccines they should be giving. + +We’re attempting to do this with: + +- a warning message if only a single vaccine has consent +- highlighting the vaccine type in the call to action + +## Vaccination order + +The vaccinations could be given in any order, but we’ve heard that some nurses prefer to give MenACWY first. Children will already have some level of protection against diphtheria, tetanus and polio (3 in 1) from earlier vaccinations. So if they have their first injection but then refuse the second, they have had the most important one. + +We ask which vaccine the nurse will be giving first, and put MenACWY first in the list of choices. diff --git a/app/posts/manage-vaccinations-in-schools/2023/01/sais-campaign-summary-and-needs.md b/app/posts/manage-vaccinations-in-schools/2023/01/sais-campaign-summary-and-needs.md new file mode 100644 index 000000000..cd12b78f5 --- /dev/null +++ b/app/posts/manage-vaccinations-in-schools/2023/01/sais-campaign-summary-and-needs.md @@ -0,0 +1,260 @@ +--- +title: School-aged immunisation campaign summary and needs +date: 2023-01-27 +related: + items: + - text: Mural board + href: https://app.mural.co/t/nhsdigital8118/m/nhsdigital8118/1671013853603/30e4ce7245629846f6fee298642fa3f40f666992?sender=ue0cc45098e9e9674a3fa9366 +--- + +We have mapped the journey that SAIS teams follow over the course of the academic year when delivering each of their vaccination campaigns based on our research interviews with 6 SAIS teams, previous research done by NHS Digital and our own desk research. + +[![SAIS campaign journey map.](journey-map.png)](journey-map.png) + +The school aged vaccination campaigns are: + +- Seasonal flu in school years 1 to 6 (year groups can vary each season) +- HPV dose 1 in school year 8 +- HPV dose 2 6 months later (typically school year 9) +- 3-in-1 teenage booster (Diphtheria, Tetanus and Polio) in school year 9 +- MenACWY in school year 9 (often delivered together with the 3-in-1) +- MMR catch ups for children who have not yet received both doses (routinely delivered before age 4) + +We have summarised the common thread through all of these vaccination campaigns except for MMR catch ups. + +The specific needs (e.g. around triaging responses and recording vaccinations) vary depending on the campaign. + +Although the activities shown are common to all SAIS teams, the way they achieve the activities and how much work they do on each differs based on the technology they use, their staffing and the demographics of the populations they serve. + +## Identify cohort and monitor uptake + +We don’t have enough information yet about how SAIS teams achieve this to derive user needs for all of the activities. + +### Find out which children and which schools comprise whole cohort in this area + +As a SAIS programme co-ordinator: + +- I need an up to date list of children per year group per school, so that I can keep track of their vaccination status throughout the school year +- I need to know the size of the cohort per school, so that I can work out how long will be required per school to vaccinate all children +- I need to know which children have received a vaccine at the GP or other setting so that I know not to vaccinate them again +- I need a list of all home educated children, so that I can keep track of their vaccination status throughout the school year + +## Schedule + +### Confirm a date for a school vaccination session + +As a SAIS programme co-ordinator: + +- I need to know all schools’ availability, so that I can create a timetable for the year + +### Confirm a community vaccination date & location + +As a SAIS programme co-ordinator: + +- I need to leave time in the yearly schedule to return to schools, so that I can ‘mop up’ as many outstanding children as possible who were not able to be vaccinated on my first visit. +- I need to provide a way for children not educated in schools to be vaccinated so that all children have equal access to vaccination + +As a SAIS nurse: + +- I need suitable and affordable location to hold catch up clinics, so that I can administer vaccines safely and effectively. + +## Get consent + +### Create a consent request + +As a SAIS programme co-ordinator: + +- I need to provide parents with clear and accurate information about the vaccine, so that their decision whether to consent is not misinformed or emotionally charged. +- I need to ensure parents fully understand what they are consenting to, so that I fulfil my duty of care +- I need to provide an accessible method to consent for every parent, so that all children have equal access to vaccination + +As a school administrator: + +- I need to have a vaccine invitation letter so that I can distribute it to parents. + +### Get contact details for parent/carer of each child in school cohort + +As a SAIS programme co-ordinator: + +- I need to be able to contact parents either directly or indirectly, so that I can invite them to give consent. + +### Get contact details for parent/carer of all remaining children in area + +As a SAIS programme co-ordinator: + +- I need a way to contact the parents of home educated children, so they can be invited to be vaccinated at a community clinic +- I need a way to contact the parents of children in the travelling community, so they can be invited to be vaccinated at a community clinic +- I need a way to contact parents of children who have not been vaccinated in school and have not refused consent, so that I can provide information on catch up clinics + +### Send out consent requests + +As a school administrator: + +- I need to send out invitations on a SAIS team’s behalf so that I can protect the personal information of parents. +- I need to understand what contact information I can legally share with SAIS teams, so that I can support the vaccination programme in the most efficient way for me + +### Consent or refuse + +Until we research with parents, we can’t derive their needs. + +### Monitor consents and refusals + +As a SAIS programme co-ordinator: + +- I need to know which parents have not responded per school, so that I can chase them or ask the school to +- I need to be able to easily track which school a child whose parents consent to vaccination is attending, so that I know how many vaccines to bring on the day. + +### Send chasers or call parents + +As a SAIS programme co-ordinator: + +- I need to be able to contact parents, so that I can chase them if they don’t respond to the request for consent. +- when a school won’t give me parent contact details due to GDPR, I need the school to have visibility of parents who haven’t responded, so that they can contact them on my behalf. +- I need to limit the number of ‘on the day’ consenters so that I can ensure I have time to triage and vaccinate everyone safely + +### Contact parents who refused consent to clarify + +As a SAIS nurse: + +- I need to understand why a parent has refused consent for a vaccine, so that if this is based on a misconception (e.g. “my child has asthma so can’t have a flu jab”) I can contact them to clear it up +- I need to speak to parents who have refused consent and confirm the reason for this decision, so that I can try to address their concerns or offer them an alternative. + +### Close consent + +As a SAIS programme co-ordinator: + +- I need to leave the opportunity to consent open as long as possible, so that the team can vaccinate as many children as possible on the day. +- I need time to prepare vaccination trolleys and paperwork for the right number of children, so that the nurses can take them into school. +- I need to give the school a list of who has consented prior to the day of vaccination, so that they can plan bringing the children to be vaccinated and minimise lesson disruption. +- I need time to ensure most triaging is done in advance of the session, so that I can make sure all medical queries have been resolved. + +### Assess Gillick competence + +As a SAIS nurse: + +- I need to inform parents in advance if their child may have the opportunity to self-consent to vaccination, so that parents are aware that their child may be allowed to access medial care without their direct consent +- when I’m at a vaccination session with a child in front of me who doesn’t have pre-consent, I need to assess their Gillick competence based on my local SAIS policy, so that competent children can consent to their own vaccination + +### Record Gillick consent + +As a SAIS nurse: + +- when I assess that a child is Gillick competent and they consent to their own vaccination, I need to keep a record of the competence assessment and the self-consent, so that I can explain exactly why a given child was vaccinated if challenged in the future + +### Request parental consent on the day + +As a parent: + +- when I have forgotten to fill out the pre-consent form, I need the opportunity to consent to vaccination on the day, so that my child doesn’t lose out on the opportunity for vaccination + +As a parent with low literacy: + +- I need to consent to vaccination verbally, so that my child can be vaccinated + +As a SAIS nurse: + +- I need a way to contact parents who haven’t responded to a consent request at the point of vaccination, so that I can give the child every opportunity possible to get vaccinated +- I need to keep a record of consents received verbally by the SAIS team at any time in the run up to vaccination, so that I can give the child every opportunity possible to get vaccinated +- when I’m at a vaccination session with or without internet access, I need to record verbal consent received from parents, so that I can explain exactly why a given patient was vaccinated if challenged in the future +- when I see a child whose parents have refused consent, I need to speak to the parent and confirm that this decision was correct, so that I can ensure as many children as possible are vaccinated. + +## Triage + +### Triage response + +As a SAIS nurse: + +- I need to know whether any of the contraindications for a particular vaccine specified in the green book apply to each child whose parent has consented, so that I can protect them from harm +- I need to triage consent forms in advance, so that I can bring the right stock and maximise the time I have for vaccinating on the day +- I need to confirm everyone filling out a consent form has parental responsibility for the child, so that I know that valid consent has been given + +### Contact parent to get more information or discuss options + +As a SAIS nurse: + +- when a parent has indicated a potential contraindication but not provided enough information for me to triage, I need to contact the parent to find out more, so that I can determine the safest way to proceed +- when I determine that a particular contraindication prevents a child from being vaccinated, I need to contact the parent and inform them, so they are aware in advance +- when I believe that it would be better for a child to be vaccinated at a clinic or hospital (e.g. so that their parent can be present), I need to contact the parent and inform them, so that they will understand why their child is not vaccinated at school and can prepare to attend a session +- when a parent has partially completed a consent form, I need to contact the parent to get the remaining information, so that I can determine the safest way to proceed + +### Record triage decision + +As a SAIS nurse: + +- when I have determined that a child can be vaccinated in school, I need to clearly record the decision and any special measures to take, so that the vaccinator will know exactly what to do +- when I have determined that a child cannot be vaccinated in school, I need to clearly record the decision and the details around it, so that there is no risk to their health if they attend the vaccination session + +## Prepare to vaccinate + +### Order vaccines + +As a SAIS programme co-ordinator: + +- I need to provide extra vaccines to take into schools, so that any children whose parents consented last minute can still be vaccinated. + +### Record vaccines in stock + +As a SAIS administrator: + +- I need to record the batch numbers and expiry dates of all of the vaccine doses we receive, so that I meet the Green Book guidelines for maintaining the vaccine cold chain + +## Set up online/offline POC recording + +As a SAIS nurse: + +- I need access to the internet at a vaccination session, so that I can access the most up to date consent, triage and medical records for the children I vaccinate +- when I don’t have access to the internet, I need to still be able to access consent records and record vaccinations for all children in a particular school cohort, so that I can do all the necessary checks and keep accurate records when I’m in a school with no connectivity + +## Vaccinate + +### ID the child + +As a SAIS nurse: + +- I need to be certain of the identity of the child in front of me, so that I can access the correct consent & triage record + +### Find consent and triage record + +As a SAIS nurse: + +- I need to confirm that consent has been given before I vaccinate a child, so that I am not at risk of harming a child who cannot receive the vaccine, or prosecution for vaccinating a child without consent +- I need to know about any concerns raised during triage of a child at the time that I vaccinate them, so that I can confirm that it’s appropriate to vaccinate them on the day and take any necessary precautions +- I need it to be really quick and easy to see immunisation history when vaccinating a child, so that I have enough time to check I’m not vaccinating anyone unnecessarily or to inform them of vaccinations they have missed + +### Record vaccination + +As a SAIS nurse: + +- I need to keep a record that I have vaccinated a child, so that it can be recorded in their GP and Child Health records and the SAIS programme can report on uptake +- I need to record the batch numbers and expiry dates of the vaccinations I deliver, so that if there is a problem with a batch, I know who may have been affected + +### Record non-vaccination + +As a SAIS nurse: + +- I need to keep a record that I did not ultimately vaccinate a child and the reason why, so that a SAIS coordinator can determine if the child needs to be invited to a catch up session + +## Report vaccinations + +### Send vaccination records to CHISes and GPs + +As a SAIS co-ordinator: + +- I need a quick and simple way to share vaccination records with the relevant CHIS, so that so that I can fulfil my statutory duty to report vaccinations within 5-10 working days +- I need to ensure all vaccinations are recorded in the patient’s GP record within 5-10 days, so that clinicians are aware of the patient’s vaccination status if they have any adverse reactions or when they access health services in the future. + +As a Child Health team member: + +- I need a record of vaccinations performed by School Aged Immunisation Services, so that I can fulfil my statutory duty to keep comprehensive child health records + +As a patient: + +- I need my vaccination to be recorded in my GP record, so that clincians are aware of my vaccination status if I have any adverse reactions or when I access health services in the future. + +## Report uptake + +### Report on how many children in yearly cohort were vaccinated + +As a SAIS program co-ordinator: + +- I need to report data on vaccination coverage to NHS England, so that I can fulfil my statutory duty. diff --git a/app/posts/manage-vaccinations-in-schools/2023/02/poc-3-in-1-iteration.md b/app/posts/manage-vaccinations-in-schools/2023/02/poc-3-in-1-iteration.md new file mode 100644 index 000000000..98b1d9671 --- /dev/null +++ b/app/posts/manage-vaccinations-in-schools/2023/02/poc-3-in-1-iteration.md @@ -0,0 +1,84 @@ +--- +title: Recording complex vaccinations more quickly +date: 2023-02-03 +related: + items: + - text: Prototype pull request + href: https://github.com/nhsuk-archive/manage-childrens-vaccinations-prototype/pull/35 +screenshots: + items: + - Which vaccines given? + - Which vaccines given, with warning + - Where was vaccine given? + - Check and confirm details + - None selected + - Give reason vaccine not given + - Check and confirm details – no vaccines given + - Check and confirm details – single consent +--- + +The 3-in-1 teenage booster and MenACWY vaccinations are the most complex of those offered by SAIS teams. Two different vaccines are usually administered in the same session. Consent can be for either, both or none. + +[We previously used a page-per-thing pattern](/manage-vaccinations-in-schools/2023/01/poc-3-in-1-campaign/) to record these vaccinations, asking which was given first, checking the vaccine type, recording the site, and whether it was given or not. + +This was a long journey that would need be repeated many times over. We needed to simplify it and shorten it to save nurses’ time. + + + +## What we changed + +Like flu and HPV, we added the question about whether the vaccines were given to the child page. We now ask about both vaccines together: + +![Screenshot of form asking for vaccines given.](which-vaccines-given.png) + +When a vaccine has been given we ask where it was given: + +![Screenshot of form asking for vaccines given, showing conditional options for where given.](where-was-vaccine-given.png) + +By asking about both vaccines we: + +- do not need to ask which was given first (so can drop the ‘which first’ page) +- can compare the sites for each vaccine + +This revised design lets us then jump straight to the confirmation page in the most common scenario (ie vaccination given where consent was given). + +## Shorter site options + +We’ve shortened the list of sites from: + +- Left arm +- Right arm +- Left thigh +- Right thigh +- Left buttock +- Right buttock + +To simply: + +- Left arm +- Right arm +- Other + +Our hypothesis is that in school-based vaccination anything other than arms is very rare, and can be handled differently should it occur. This will simplify the design for the most common case. + +We’ve also applied this to the HPV journey. + +## When consent is for one vaccine + +We’ve chosen to always show both vaccines, even when consent has only been given for one. Consent might be given at the time of vaccination for the other vaccine, and nurses will still need a way to record it. + +We show a warning beforehand indicating that the child must only get one vaccine. We need to research how SAIS teams currently deal with this situation. + +If a user tries to record a vaccine that no consent was not given for in advance, then we might need to double-check that’s correct. We probably also need to record what type of consent was given. This is not in the designs at the moment. + +## When we ask why a vaccine was not given + +We only ask why a vaccine was not given if it was a vaccine that had consent in advance (ie it was expected that they would be getting it). + +For example, if consent is given for both and only one is recorded, we would ask for a reason for the other one. If none are recorded, we would ask for a reason for both. + +By asking for a reason, we incorporate a check for false-negatives – ie if the nurse accidentally didn’t record one of them, at this point they can realise their mistake. + +## Design notes + +When the ‘None’ checkbox is checked, the other checkboxes and any site values are removed with javascript. Without javascript we return a validation error. This prevents a user from submitting a form in an ambiguous state. diff --git a/app/posts/manage-vaccinations-in-schools/2023/03/asking-users-to-sync-their-offline-changes.md b/app/posts/manage-vaccinations-in-schools/2023/03/asking-users-to-sync-their-offline-changes.md new file mode 100644 index 000000000..5d3e03e1b --- /dev/null +++ b/app/posts/manage-vaccinations-in-schools/2023/03/asking-users-to-sync-their-offline-changes.md @@ -0,0 +1,55 @@ +--- +title: Asking users to sync their offline changes +date: 2023-03-30 +screenshots: + items: + - You’re back online + - Syncing your changes + - Synced successfully + - Sync errored + - text: Sync errored – try again later + caption: When the website is unavailable +--- + +Following our investigation into [automatic and manual offline syncing](/manage-vaccinations-in-schools/2023/03/manual-offline-syncing/), we’ve designed the user journey for users to sync their changes manually. + +> The main issue with automatic syncing is recovering from errors. Errors can occur due to invalid data being submitted, from downstream APIs rejecting the data, or from server errors. +> +> When the syncing is in the background, surfacing these errors can be difficult. The user could be interrupted from their current context. Or they might never notice them to begin with. + +When sync was automatic we also found that users did not see the large green banner. Even when we made it really big. + +## You’re back online + +We’ve found that banners do not work, banner blindness means people don’t see them. + +When users are back online we will show them a full page interstitial that they cannot miss. We will ask them if they want to sync their changes now. + +We have not designed the journey if they say ‘No’ at this point. + +We also need to think about the intermittent connection scenario – where they may be going online and offline repeatedly – we do not want to spam them with this message. Perhaps a ‘do not show me this message for [X time]’ type of option. + +## Syncing your changes + +Upon pressing ‘Sync your changes’, we show a syncing page with an animation. This may artificially show for longer than is necessary to sync to give the right user impression that something has happened successfully. And to avoid any flashing of content. + +On success, we summarise the number of changes synced based on school name, date and count of children. + +We have not designed what batch or vaccine changes would look like when synced. + +## Syncing with errors + +The error scenarios we’ve considered are: + +- you are back online, but the website is returning a 500 error +- you have attempted to sync but there was a conflict + +## Conflict resolution + +When there is a conflict, we will still sync all changes, so that data is not stored solely on the nurse’s device. + +Changes with a conflict will go into a support queue for review and manual resolution. + +We have chosen to avoid the complexity of designing user based conflict resolution for all the types of conflict that could occur. + +Later we might know what the common types of conflict are and the simple fixes for them – then we might move this from a support process to a user one. diff --git a/app/posts/manage-vaccinations-in-schools/2023/03/consent-for-an-hpv-vaccine-iteration.md b/app/posts/manage-vaccinations-in-schools/2023/03/consent-for-an-hpv-vaccine-iteration.md new file mode 100644 index 000000000..0b7081e87 --- /dev/null +++ b/app/posts/manage-vaccinations-in-schools/2023/03/consent-for-an-hpv-vaccine-iteration.md @@ -0,0 +1,120 @@ +--- +title: Consent for an HPV vaccine – Iteration +date: 2023-03-23 +screenshots: + items: + - Email asking for consent + - Reminder email asking for consent + - Email to student informing them about the HPV vaccine + - Email confirming consent + - Email confirming vaccination + - Start page + - What is your child’s name? + - What is your child’s date of birth? + - Confirm your child’s school + - About you + - Do you agree to them getting vaccine? + - "If they do not agree: Why do they not agree?" + - "If they do agree: Is your child registered with a GP?" + - Home address + - Any severe allergies? + - Any existing medical conditions? + - Any regular medication? + - Anything else? + - Check answers and confirm + - Confirmation page +--- + +Based on user research, we iterated [our initial consent journey for parents](/manage-vaccinations-in-schools/2023/03/consent-for-an-hpv-vaccine/). + +## Shortening the journey + +Parents told us they had the impression the journey was longer than previous services they had used, and that there were lots of questions. + +We pruned the journey to make it shorter. + +We have: + +- removed email and email code pages at the start +- removed the NHS number page +- removed the MMR questions + +We might later remove the GP question too, depending on how important the data is. + +### Removing the NHS number page + +No parent we tested with told us they would fill this in, no one would bother to find it. + +### Removing email codes + +We might already have their email address, depending on who and how they were initially contacted. + +We will show users the email they have entered at multiple points during the journey, which will help with spotting typos: + +- on the check your answers page +- on the confirmation page + +The email field has been moved to the ‘About you’ page, where we already ask for telephone number. + +### Removing MMR + +SAIS nurses told us they could not rely on parent’s responses, and parents couldn’t easily remember – MMR vaccines would have been 10 years ago. + +A vaccination record should be used by SAIS teams instead. + +## Content improvements + +We’ve added two new emails: + +- confirmation of consent +- confirmation of vaccination + +We also iterated content within the journey. + +### When the vaccine should be given + +We had not made it clear that the best time for the HPV vaccine to be given is before someone is sexually active. Without this we saw parents making incorrect assumptions that they could delay the vaccine until their children were much older. + +### Request for consent email + +Parents told us they wanted to know more about HPV before we ask them to refuse or give consent for vaccination. + +We rebalanced the email by: + +- putting the key points about HPV first +- asking for consent +- giving further details after the consent link + +### A shortened start page + +Our start page and request email were repeating the same details about HPV. We’ve favoured keeping that content in the email and made the start page much shorter. + +Both pages had been written in isolation, and when seen together in the journey the repetition was clear. + +### Guidance text when asking for child’s name + +We tweaked the hint text for ‘Official name’ to ask for what’s on a passport rather than a birth certificate. This way we take into account any changes to their name since birth. + +This is more relevant when thinking about 14 year olds, as opposed to 5 year olds for flu. + +‘Are they known by another name?’ was also a question that confused parents. We saw some give their full name with middle names, and then a shortened name in this box. Others gave name abbreviations. Without changes, this question would get a lot of false positives. + +We are trying a new label, ‘Do they use a different name in school?’ + +We are looking to capture scenarios like: + +- going by a different surname to their official name +- going by a different first name, for example children going through transition +- using their middle name rather than their first name + +### Asking for telephone number + +We now tell users that we may use this number to contact parents about their child’s vaccination. + +### Removing contraception + +In our question about regular medication we asked, ‘Does your child take any regular medication, excluding contraception?’. + +We excluded contraception because nurses do not need to know about it. However, by highlighting this in the question, we were giving parents undue reason to pause and think. + +They questioned why it was there. We’ve chosen to remove this to make the question easier to answer. diff --git a/app/posts/manage-vaccinations-in-schools/2023/03/consent-for-an-hpv-vaccine.md b/app/posts/manage-vaccinations-in-schools/2023/03/consent-for-an-hpv-vaccine.md new file mode 100644 index 000000000..1d45ade69 --- /dev/null +++ b/app/posts/manage-vaccinations-in-schools/2023/03/consent-for-an-hpv-vaccine.md @@ -0,0 +1,66 @@ +--- +title: Consent for an HPV vaccine +date: 2023-03-22 +related: + items: + - text: Pull request adding HPV emails + href: https://github.com/nhsuk-archive/consent-for-vaccinations-prototype/pull/39 + - text: Simplification of consent journey + href: https://github.com/nhsuk-archive/consent-for-vaccinations-prototype/commit/f4592581bc1502a048fabd6e0ec505df9d140b4d +screenshots: + items: + - text: Email asking for consent + caption: | + Research findings: Generally this email tested well. + + - A couple of participants felt that it would be better to explain what the vaccine protected against before asking for consent. + + - When asked, participants said they would expect an email like this to come from the school rather than from the NHS. + - Reminder email asking for consent + - text: Email to student informing them about the HPV vaccine + caption: | + Research findings: + + None of the parents we spoke to were aware that children could give/refuse consent themselves, and their reactions to this information varied hugely. + + Those who had given consent were generally happy with the idea of their child receiving this email, but expressed mild concern about their child being able to refuse the vaccine after the parent had consented. + + One parent said they could imagine that if pupils realised they could say no to the vaccine then it would spread across the year with many trying to get out of having it. + + The 2 participants who had refused consent for the HPV vaccine felt very angry at the idea of their child being able to ‘overrule’ that decision and choose to have the vaccine. + + Several participants, regardless of whether they had said yes or no to the vaccine, also felt that sending this email to their child undermined the purpose of asking the parent for consent at all and felt it made the process of giving parental consent pointless. + - text: Start page + caption: "Research findings: A couple of participants mentioned it felt repetitive to have the same information as the email repeated." + - Your email address + - Confirm your email address + - text: What is your child’s name? + caption: "Research findings: Some participants struggled with understanding the purpose of the ‘known as’ field - one retyped her child’s full name as she thought she needed to confirm that this was the name he was known by." + - What is your child’s date of birth? + - Confirm your child’s school + - About you + - Do you agree to them getting vaccine? + - "If they do not agree: Reason they do not agree" + - "If they do agree: Is your child registered with a GP?" + - Home address + - text: Do you know their NHS number? + caption: "Research findings: Nobody knew their child’s NHS number, or felt they would be able to find it easily." + - We need to ask some health questions + - Any severe allergies? + - Any existing medical conditions? + - text: Any regular medication? + caption: "Research findings: A couple of participants felt taken aback by the mention of contraception as they felt their child was too young for this to be relevant. + - Anything else?" + - Checking MMR status + - text: Has child had their MMR doses? + caption: "Research findings: Most participants were not able to accurately say for sure whether their child had both doses, but said they would put yes as they believed the child was up to date with all vaccines offered." + - Can we contact you about a catch-up? + - Check answers and confirm + - Confirmation page +--- + +An overview of the journey for parents who are giving consent for their child to receive the HPV vaccine. These are the designs as we built them before our first round of research with parents. + +During the research this journey generally tested well, and parents were able to fill the form out easily with only a few issues, which are detailed below against the relevant screenshots. + + diff --git a/app/posts/manage-vaccinations-in-schools/2023/03/first-pass-at-triage.md b/app/posts/manage-vaccinations-in-schools/2023/03/first-pass-at-triage.md new file mode 100644 index 000000000..9f5963495 --- /dev/null +++ b/app/posts/manage-vaccinations-in-schools/2023/03/first-pass-at-triage.md @@ -0,0 +1,35 @@ +--- +title: A first pass at triage +date: 2023-03-02 +--- + +We know that before nurses record vaccinations, they triage consent responses. This is important for: + +- knowing how many vaccines they’ll need to bring to a session +- identifying which children they still need consent for (in case they want to chase) +- reviewing parents’ answers to health questions + +We’ve created a table view within the triage area of the service. Nurses can now see: + +- a list of all children eligible for vaccination +- details of who has and hasn’t received consent (given, refused, unknown) +- whether children have any medical notes or triage notes +- the triage statuses for individual children (to do, needs follow up, cannot triage yet, ready for session, do not vaccinate) + +![Screenshot of triage page.](triage.png) + +Nurses can filter by: + +- year group +- notes (triage or medical) +- triage status + +## Information about individual children + +The information available about individual children is similar to that in the ‘Record vaccinations’ area. However, here, we’ve added some details about the type and timing of consent because SAIS nurses told us this was relevant. + +We also added an area for nurses to add triage notes. + +![Screenshot of patient record.](patient-record.png) + +This is a work in progress, and we need to test all these designs. diff --git a/app/posts/manage-vaccinations-in-schools/2023/03/iterating-our-offline-designs.md b/app/posts/manage-vaccinations-in-schools/2023/03/iterating-our-offline-designs.md new file mode 100644 index 000000000..aaef02698 --- /dev/null +++ b/app/posts/manage-vaccinations-in-schools/2023/03/iterating-our-offline-designs.md @@ -0,0 +1,30 @@ +--- +title: Iterating our offline designs after research +date: 2023-03-02 +--- + +We knew we needed to iterate our offline designs after testing them with just three SAIS nurses because they were fundamentally confused about the syncing process. + +They didn’t understand that the syncing process was automatic, and they weren’t clear about which offline changes had been uploaded when they went back online. + +## Recording offline changes + +We’ve now updated the message that appears on the child information page when a nurse makes a change offline. This makes it clear that any changes will automatically sync when the nurse reconnects to the internet. + +![Screenshot of message on child information page.](child-information-page-available-offline.png) + +## Showing a running total of offline changes + +On session pages, we’ve also added a running total of the total number of changes made so that nurses have confidence that everything is being captured. + +![Screenshot of session overview page.](session-page.png) + +## Spelling out the syncing process + +We’ve also changed the wording nurses see when they go back online. The success banner now reads ‘Your offline changes have synced successfully’ to spell out what’s happened. + +There’s also a message on the right-hand side of the child information page telling nurses exactly when their offline changes were synced. + +![Screenshot of updated message on child information page.](child-information-page-your-changes-were-synced.png) + +We plan to test all these iterations to see if they help users better understand how to work offline. diff --git a/app/posts/manage-vaccinations-in-schools/2023/03/manual-offline-syncing.md b/app/posts/manage-vaccinations-in-schools/2023/03/manual-offline-syncing.md new file mode 100644 index 000000000..a8cb15102 --- /dev/null +++ b/app/posts/manage-vaccinations-in-schools/2023/03/manual-offline-syncing.md @@ -0,0 +1,30 @@ +--- +title: Automatic and manual offline syncing +date: 2023-03-16 +--- + +Automatic syncing hasn’t tested well with users. It also introduces some technical issues of its own. + +## Problems with errors + +The main issue with automatic syncing is recovering from errors. Errors can occur due to invalid data being submitted, from downstream APIs rejecting the data, or from server errors. + +When the syncing is in the background, surfacing these errors can be difficult. The user could be interrupted from their current context. Or they might never notice them to begin with. + +## Problems with collaborating + +Conflicts can occur when multiple people are attempting to edit the same resources. This is common in online collaborative applications such as Google Docs. Dealing with these types of issues is non-trivial, and automatic syncing introduces more opportunities for them to arise. + +## Problems with unreliable internet connections + +When dealing with flaky connections, users could have to sync in the background multiple times per minute. If the syncing process can error, this introduces multiple opportunities for errors to occur, and can be disruptive. + +All these can combine to create the feeling that the syncing process isn’t reliable, and erode user trust in the service. They might choose to only use it if they are on a very stable connection, to minimise the possibility of failure. This defeats the point of building robust offline capabilities. + +## Potential solutions + +We are considering exploring a design which implements manual syncing. + +In this design, users would be able to prepare for offline and work offline as before. Once they regain connectivity, they would encounter banners, or potentially interstitial pages prompting them to sync their changes. If they do not do so, their changes stay local. + +Once the user accepts to sync, they could be taken to a separate page to submit a form to sync. Any errors in syncing could be surfaced here, giving the user an opportunity to see what’s wrong and attempt to resolve it. diff --git a/app/posts/manage-vaccinations-in-schools/2023/03/recording-consent-on-the-day-of-the-vaccination.md b/app/posts/manage-vaccinations-in-schools/2023/03/recording-consent-on-the-day-of-the-vaccination.md new file mode 100644 index 000000000..3fbfe060a --- /dev/null +++ b/app/posts/manage-vaccinations-in-schools/2023/03/recording-consent-on-the-day-of-the-vaccination.md @@ -0,0 +1,49 @@ +--- +title: Recording consent on the day of the vaccination +date: 2023-03-21 +related: + items: + - text: Prototype pull request + href: https://github.com/nhsuk-archive/manage-childrens-vaccinations-prototype/pull/59 +screenshots: + items: + - A child page when no-one has responded + - Who are you trying to get consent from? + - Do they agree? + - "If they do not agree: Why do they not agree?" + - "If they do not agree: Check and confirm answers" + - "If they do agree: Health questions" + - "If they do agree: Check and confirm answers" + - Did they get the vaccine? + - Check and confirm vaccination details + - Success after consent and vaccination + - Updated child page +--- + +Several of the SAIS teams we spoke to early on in our research told us they regularly get consent to vaccinate on the day of the session itself. + +While there’s a preference to get parents to consent well in advance of a session (because this allows time for triage and greater accuracy when calculating how many vaccines will be needed), there’s also a clear benefit in allowing consent on the day: it increases uptake. + +We’ve learned from research that most nurses getting consent on the day will phone parents or guardians and follow the journey that a parent would go on if completing the consent form provided by the school. + +If the nurse gets consent to vaccinate, they’ll run through the health questions that a parent would normally answer if consenting in advance. The nurses need a way to record these responses. + +## Updating our designs + + + +It’s now possible for nurses to record consent on the day through the service. We’ve added the question ‘Are you attempting to get consent?’ to the child information page. + +We assume that the nurse is in conversation with the parent as they ask: + +- the name of the person giving consent and their relationship to the child +- whether or not they agree to the child receiving the vaccine (including if there’s no response because the parent does not answer the phone) +- the health questions for the vaccine (the nurse has the option to add triage notes if they want to) + +If consent is given, we immediately ask if the child has had the vaccine. + +At the end of the journey, the triage status and the outcome are both updated. + +## Designing the Gillick competence journey + +We haven’t yet added the journey for nurses to follow if they’re assessing Gillick competence. We need to do more research before we can design this. diff --git a/app/posts/manage-vaccinations-in-schools/2023/03/refining-what-sais-nurses-see.md b/app/posts/manage-vaccinations-in-schools/2023/03/refining-what-sais-nurses-see.md new file mode 100644 index 000000000..a910d3e47 --- /dev/null +++ b/app/posts/manage-vaccinations-in-schools/2023/03/refining-what-sais-nurses-see.md @@ -0,0 +1,60 @@ +--- +title: Refining what SAIS nurses see +date: 2023-03-02 +--- + +We’ve made a number of changes to the service following feedback from SAIS nurses. Some are minor tweaks; others are significant redesigns and additions. + +## Tweaking the dashboard + +Some nurses questioned our use of the word ‘campaign’, saying it sounded like a one-off event rather than a routine session, so we’ve changed this to ‘session’. + +We also observed some nurses struggling to work out where to record vaccinations, so we’ve simplified the dashboard to make the right link easier to see. + +![Screenshot of dashboard page.](dashboard.png) + +## Redesigning the table view + +Once SAIS nurses start recording vaccinations, they get a table view. Our previous designs assumed that: + +- they would only need to see a list of children whose parents had given consent to vaccinate +- nurses would use this list primarily to check whether children had been seen or not + +Our research showed these assumptions were wrong. Many SAIS teams will see all children who are eligible for vaccinations and try to get consent for them (or assess Gillick competence) on the day. The outcomes that nurses are interested in are also more varied than seen and not seen. + +We’ve now redesigned the table view so that nurses can see: + +- a list of all children eligible for vaccination +- details of who has and hasn’t received consent (given, refused, unknown) +- a range of outcomes for children (vaccinated, could not vaccinate, no consent, no outcome yet) + +The filters on the on the left of the table are now working and allow nurses to filter by: + +- year group +- consent status +- outcome status + +![Screenshot of record vaccinations page.](record-vaccinations.png) + +## Expanding the child information page + +Following feedback from nurses, we’ve also added more details to the child information page (this is what nurses see if they click on the name of the child from the table view). + +This page now includes: + +- a banner showing whether consent has been given, refused or is unknown +- details of who has given consent and what their relationship to the child is +- the child’s address +- a space for nurses to add notes + +![Screenshot of child information page.](child-information-page.png) + +We added the child’s address because nurses told us they often use this when identifying children – an important part of a vaccination session. They also told us they’d like a space in which to jot down anything that might be relevant to the vaccination, so we’ve put one in. (There’s a separate section for nurses to record notes after they’ve given the vaccination. We need to test what nurses think about these two options.) + +## Creating a way for nurses to record consent + +We’ve also added a section called ‘Are you attempting to get consent?’. This is because we learned from research that nurses will often contact parents or guardians if they haven’t responded to consent requests, and even if they’ve refused to give consent. + +We still need to design the journey nurses will go on if they choose either of the yes options, but we expect it to be similar to the journey a parent would go on if they were giving consent through the service. + +![Screenshot of form to start recording consent journey.](recording-consent.png) diff --git a/app/posts/manage-vaccinations-in-schools/2023/04/paper-consent.md b/app/posts/manage-vaccinations-in-schools/2023/04/paper-consent.md new file mode 100644 index 000000000..15f9e5324 --- /dev/null +++ b/app/posts/manage-vaccinations-in-schools/2023/04/paper-consent.md @@ -0,0 +1,44 @@ +--- +title: Designing a paper consent form for HPV +date: 2023-04-17 +screenshots: + items: + - First page + - Second page + - src: printed.jpg + text: When printed in black and white + caption: On a low toner printer +--- + +We know some parents and SAIS teams have a need to deal with consent requests offline. + +As such, we’ve designed a paper consent form that is as close as possible to the consent journey in the digital service. + +Our current thinking is that each form will be customised, with the name of the school and the date of the vaccination session at the top of the form. + +[Download a PDF of the paper consent form](hpv-paper-consent.pdf) + +## What the form does not include + +The form does not include any general information about what the HPV vaccination is for, or when it is usually given. These details will go in a covering letter. + +## Refining the form + +We did a quick test of the form with family members. One mum thought she had to give all her child’s official names, so we tweaked the wording of the ‘Name’ section to make it clear that we only need first and last names. We also added some more space to allow for longer names. + +In our original form, we had a question about communication needs which people could use to indicate whether they were unable to receive particular types of communication. + +Choices were: + +- I cannot receive voice calls +- I cannot receive text messages + +One mum worked in an area with limited mobile coverage, and could only receive texts at certain times of the day. Our question didn’t allow her to add this type of detail, so she was confused about what to put. + +We’ve taken the question out for now. We’ll see how it tests with users of the digital service and return to it if we need to. + +## Other improvements we need to consider + +We need to think about how to make it as easy as possible for users to transfer information from the paper form into the digital service. We have not yet explored the technology that we could use to do this – barcodes and QR codes, for example. + +We hope to learn more about offline processes in our upcoming in-person research. diff --git a/app/posts/manage-vaccinations-in-schools/2023/05/assessing-gillick-competence.md b/app/posts/manage-vaccinations-in-schools/2023/05/assessing-gillick-competence.md new file mode 100644 index 000000000..088f54fc0 --- /dev/null +++ b/app/posts/manage-vaccinations-in-schools/2023/05/assessing-gillick-competence.md @@ -0,0 +1,28 @@ +--- +title: Assessing Gillick competence +date: 2023-05-11 +--- + +Gillick competence is the principle nurses use to judge young people’s capacity to consent to vaccinations. + +Nurses might assess young people for Gillick competence in the following situations: + +1. the parent/guardian has not responded to consent requests for an HPV vaccination +2. the parent/guardian has refused to give consent for an HPV vaccination, but the young person has indicated they want it +3. the parent/guardian has given consent for an HPV vaccination, but the young person has indicated they do not want it + +We’ve designed a way for nurses to record their Gillick competence assessment through the digital service for the first two scenarios. + +![Screenshot of form for assessing Gillick competence.](are-they-gillick-competent.png) + +## If a nurse decides a young person is Gillick competent + +If a nurse decides the young person is Gillick competent and they want to have an HPV vaccination, the nurse will be prompted to ask the same health questions that parents currently respond to when they give consent. + +![Screenshot of form asking health questions.](health-questions.png) + +Once the nurse has captured the young person’s responses, they’ll be taken to a ‘Check answers’ page and then back to the main dashboard. + +## We still need to test these designs + +We haven’t yet tested these designs with SAIS nurses. diff --git a/app/posts/manage-vaccinations-in-schools/2023/05/managing-vaccine-batches.md b/app/posts/manage-vaccinations-in-schools/2023/05/managing-vaccine-batches.md new file mode 100644 index 000000000..ad973f3a5 --- /dev/null +++ b/app/posts/manage-vaccinations-in-schools/2023/05/managing-vaccine-batches.md @@ -0,0 +1,67 @@ +--- +title: Managing vaccine batches +date: 2023-05-31 +screenshots: + items: + - Dashboard + - Manage vaccines + - Edit batch + - Which batch did you use? + - "Which batch did you use: Batch selected" + - "Which batch did you use: Batch not in list" +--- + +We’ve made 2 changes to the way vaccine batches are managed to match the processes of SAIS teams: + +1. Managing vaccines has moved from the school session level to the top level dashboard +2. We do not immediately default to a batch during vaccination, instead we ask first + +## Managing batches + +SAIS teams do not manage batches on a campaign or school session level. Instead they have a vaccine store which they use for all sessions or clinics. + +From research we found that teams receive their batch numbers by email when they order. The batch numbers are reconfirmed on delivery, and each vaccine has a batch number and expiry on the box. + +Batches are in the order of 500 doses. Some teams use methods to group batches together, for example packs of ten grouped with elastic bands, on specific fridge shelves. They try to avoid mixing batches. + +We’ve observed paper sheets being used as a way of managing: + +- vaccines taken out +- vaccines brought back +- wastage. + +Stock was not managed digitally. + +Teams can: + +- add batches at point of order +- add them at point of delivery +- forget to add them + +## Asking about batches + +When teams go to sessions they may take one batch or many batches. We’ve heard that they try to use up older batches first, and any vaccines that were previously taken out but not used. + +Our original design defaulted to a specific batch which we tried to infer from the school session, on the assumption that a batch was known beforehand. However, nurses will not know the batch numbers until they leave on the day – it depends who is collecting the vaccines and the fridges they get them from. + +Instead of inferring the batch from a school session, we now need to list all the batches appropriate to the vaccine type and ask which the nurses are using. We will ask which batch they used at the point of their first vaccination of the session. + +We do not want to have to ask this question for every vaccination because this is repetitive. If they are using a single batch there’s an option to default to it. When a default is set, the question is not asked. + +### Missing batches + +Sometimes a team will not have the batch number on the digital system. We do not want this to prevent the nurses from giving and recording vaccinations in the service. + +If a batch is missing, we allow users to add the batch they have (including when offline). + +## Design notes + +When batches expire they should automatically be removed from the list. + +When stock runs out, nurses need to be able to remove them. We’ve added ‘Move to archive’ to do this – that marks the batch as inactive (but is kept within the system as it’s needed for historic records). + +We have not yet designed a view or filter for historic batches. + +When listing batches order them by expiry date (oldest first). + +There are other details about a batch that we have not included, such as dose and route (intramuscular, nasal, etc). This is because we can infer these details from the vaccine brand itself. diff --git a/app/posts/manage-vaccinations-in-schools/2023/05/protecting-offline-data.md b/app/posts/manage-vaccinations-in-schools/2023/05/protecting-offline-data.md new file mode 100644 index 000000000..4bdd79f16 --- /dev/null +++ b/app/posts/manage-vaccinations-in-schools/2023/05/protecting-offline-data.md @@ -0,0 +1,70 @@ +--- +title: Protecting offline data +date: 2023-05-05 +related: + items: + - text: Prototype pull request + href: https://github.com/nhsuk-archive/manage-childrens-vaccinations-prototype/pull/72 +screenshots: + items: + - Use a code to make offline changes + - Begin working offline + - Alternative offline password +--- + +When saving data offline we need to encrypt it. Encryption will make the data secure. We will do this using a secret that the user must remember. + +So far we’ve explored two options for doing this. We ask the user to: + +- enter a password +- give a code we generated + +We’ve chosen to go with the code option because it eliminates half of the pain and risk of a password – that is, the user does not need to try and think of something, and they do not think of something that is insecure. They also do not try and reuse their sign-in password – which has other security implications. + +We expect to use 3-word codes, from easy-to-spell word lists. We will make sure the word list in combination with a slow decrypt process will make it very unlikely for attackers to brute-force the encryption. + + + +## Potential problems + +We haven’t tested any of these designs with users. We are keen to test them as soon as possible, as we already foresee potential problems, such as the need to recall the 3-word code. + +Our hypothesis is that some users will forget this code, or if they’ve written it down, forget to bring the written record when they need it. They could also write it down somewhere insecure on their computer. + +Unfortunately, asking users to create their own password carries the same problem. + +## When we will set the code + +We will ask the user to note down their code when they first save something for offline use. + +## When we will ask for the code + +We will only ever ask for a code when a user is working offline. + +The flow diagram below shows the scenarios when we will ask for a code. + +A ‘hot app’ is one that is still in memory and unencrypted, meaning no code is needed to decrypt. A ‘cold app’ is not in memory and needs decrypting. + +![](flow-diagram.png) + +## If the user forgets their code + +If they forget their code while working offline they will not be able to access their encrypted offline data. When they go back online their data will be recoverable, we will have an online record of their code that we can use to decrypt the data and save the records. + +However, if they are in a session that is offline, they will not be able to record anything. This is a significant problem that we will need to design around. + +Examples include: + +- trying to minimise how much we ask for their code +- emphasising when to use the code and where to keep it +- trying to make codes more memorable +- encouraging users to save their code in their browser + +## Design notes + +We will try to minimise risk by keeping the same code for offline use until a user requests a new one. This should make it easier for them to remember their code. + +When we ask for the code, we will: + +- make it case-insensitive (TOMATO-Lettuce-pear) +- strip out spaces and hyphens, so that everything should work (tomato-lettuce-pear, tomato lettuce pear, tomato - lettuce - pear, etc) diff --git a/app/posts/manage-vaccinations-in-schools/2023/07/making-minor-changes-after-our-first-model-office.md b/app/posts/manage-vaccinations-in-schools/2023/07/making-minor-changes-after-our-first-model-office.md new file mode 100644 index 000000000..a4bbad31b --- /dev/null +++ b/app/posts/manage-vaccinations-in-schools/2023/07/making-minor-changes-after-our-first-model-office.md @@ -0,0 +1,64 @@ +--- +title: Making minor changes after our first model office +date: 2023-07-12 +--- + +We recently ran a ‘model office’ with Solent NHS Trust. Its School-aged Immunisation Service (SAIS) manages vaccinations for children in Portsmouth, Southampton and the Isle of Wight. + +## What we asked nurses to do + +We asked two SAIS nurses in separate rooms to carry out some common tasks using our service. This included: + +- triaging consent requests on laptops +- recording vaccinations on phones +- recording details of vaccinations not given + +We deliberately added some complexity – for example, asking the nurses to triage the records of children with contraindications, and asking them to record adverse reactions to vaccinations. + +Our team closely observed the nurses as they worked through a range of scenarios. + +## What we’ve changed following nurses’ feedback + +Some of the nurses’ suggested changes were so manifestly good, we decided to make them straight away. + +### We’ve tweaked the position of triage notes + +One nurse commented that the triage notes she saw in the ‘Record’ part of the service were hard to understand because they were above the answers to health questions. + +She said it would be more helpful to have the notes below the answers to health questions so she could establish some context first. We’ve now made this change in the service. + +![Screenshot of triage notes below answers to health questions.](medical-history.png) + +### We’ve differentiated types of absence + +Another nurse told us that in the system they currently use for recording vaccinations, they differentiate types of absence. Some children don’t come to a vaccination session because they’re not at school, while others don’t come because they’re deliberately avoiding a session (“hiding in the toilets” as she put it). As parents are told why their child hasn’t received a vaccination, it’s useful to specify why they haven’t attended a session. + +Our service has a list of possible reasons for explaining this. Up until the model office, there was just one ‘They were absent’ option. + +Following the nurse’s comment, we’ve decided to differentiate absence from school from absence from a session. To do this, we’ve added a new radio button to the ‘Why was the vaccine not given’ list. + +![Screenshot showing form with options for reason vaccine was not given.](not-given.png) + +## Renaming the service + +Another minor change we made following the model office was renaming the service from ‘Record children’s vaccinations’ to ‘Manage vaccinations for school-aged children’. We did this to reflect the full scope of the service (requesting consent, triaging and recording). We’ll see how this tests in the next model office. + +![Screenshot of service start page with updated service name.](start-page.png) + +## How our model office differed from other research sessions + +The model office was a particularly rich way of learning from users. It differed from other research sessions we’ve carried out so far in that we: + +- used real software rather than a prototype +- asked nurses to perform tasks repeatedly rather than just once +- used synthetic data to generate discussion about scenarios we were interested in + +We’re still processing the numerous insights we got, but we don’t plan to make any significant changes until we’ve done more research and analysis. Questions we’re considering following the model office include: + +- Do we need to revisit the wording of the health questions, or make them customisable? (Solent’s questions were different from the ones we have in the prototype, and we know there’s variation across the country.) +- Should we consider differentiating ‘Do not vaccinate for now’ from ‘Do not vaccinate ever’? The Portsmouth team currently flag temporary contraindications, which keeps children in the triage area, but they also flag permanent contraindications, which moves children out of triage. +- Do we need to add on-the-day screening questions to the ‘Record’ area of the service? +- Should we consider moving the ‘refused’ records to the ‘Get consent’ tab in triage? +- Should we find a way of personalising the email parents get once the session has taken place – for example, including notes the nurse has left? + +We’re planning two more model offices soon – in Yeovil and Cumbria – and we’ll report back on how these go. diff --git a/app/posts/manage-vaccinations-in-schools/2023/08/updating-the-consent-journey-for-flu.md b/app/posts/manage-vaccinations-in-schools/2023/08/updating-the-consent-journey-for-flu.md new file mode 100644 index 000000000..596252f5b --- /dev/null +++ b/app/posts/manage-vaccinations-in-schools/2023/08/updating-the-consent-journey-for-flu.md @@ -0,0 +1,38 @@ +--- +title: Updating the consent journey for flu +date: 2023-08-24 +--- + +Having decided to pilot our service with Cumbria’s SAIS team in the autumn, we needed to update our designs for the flu journey (Cumbria’s team give flu vaccinations between October and December). + +Most of the iterations we’ve made in recent months have been to the HPV consent journey, so we needed to reflect these in the flu journey. We also needed to act on some of the insights we got during our model office sessions in Yeovil. + +## Shortening the flu start page + +When we tested the start page of the HPV journey, several parents commented that the content there duplicated what they’d read in the email directing them to the service. As such, we substantially cut the volume of content on the start page. + +We’ve now done the same for the flu journey, so that parents aren’t reading the same information twice. + +![Screenshot of start page.](start-page.png) + +## Creating separate fields for the child’s first and last name + +Up until now, we’ve only had one field for the child’s name. However, we’ve now created separate fields. This will be useful if the data from the service is exported to the National Immunisation and Vaccination System (NIVS). + +![Screenshot of form asking for child’s name.](childs-name.png) + +## Letting the parent explain why they’re refusing to give consent + +During the model office, a couple of nurses said it would be helpful if parents could expand on their reasons for refusing to consent to a vaccination (we previously only had a notes field if the parent selected the ‘Other’ radio button). We’ve now added an optional notes field so that parents can explain their decision, should they want to. + +![Screenshot of form asking reason for refusal.](reason-for-refusal.png) + +## De-scoping parts of the service + +Given the limited time we have to prepare for the pilot, we’ve de-scoped some parts of the service. + +In our original designs, there was a way for parents to give consent for a flu injection if they objected to the gelatine used in the nasal spray. As there isn’t time to design and build this journey for the pilot, we’ve simplified what happens if a parent refuses to give consent because of the spray’s gelatine content. They’ll now get a call from a SAIS nurse rather than consenting to an injection through the service. + +![Screenshot of form asking if would like to be contacted about having an injection instead.](injection.png) + +We’ve also de-scoped the school picker we’d hope to have on the ‘Confirm your child’s school’ page. If the school shown isn’t the right one, we now direct the parent to use the paper form instead. diff --git a/app/posts/manage-vaccinations-in-schools/2023/09/checking-we-re-asking-the-right-questions-for-hpv.md b/app/posts/manage-vaccinations-in-schools/2023/09/checking-we-re-asking-the-right-questions-for-hpv.md new file mode 100644 index 000000000..32e59144d --- /dev/null +++ b/app/posts/manage-vaccinations-in-schools/2023/09/checking-we-re-asking-the-right-questions-for-hpv.md @@ -0,0 +1,499 @@ +--- +title: Checking we’re asking the right questions +date: 2023-09-11 +--- + +To make sure we’re asking the right questions when requesting consent for vaccinations, and not burdening users unnecessarily, we’ve created something called a [question protocol](https://www.uxmatters.com/mt/archives/2010/06/the-question-protocol-how-to-make-sure-every-form-field-is-necessary.php). + +This shows: + +* what we ask +* why we ask it +* what we do with the answers we get + +## Questions in the digital service + +### What is your child’s name? (official name) + +Vaccination +: All + +Mandatory +: Yes + +Why do we ask for it? +: We need this to confirm the child’s NHS number, which is important for nurses to find the right child health record to check the child’s vaccination history, and report the vaccination to the child’s GP properly. + +What do we do with it? +: Use it to look up NHS number. If the child health team have a different name, tell the child health team. + +### Do they use a different name in school? If yes, known as + +Vaccination +: All + +Mandatory +: Yes + +Why do we ask for it? +: We need this so nurses can call the child by the right name when they’re at school and can match the school’s class list to the Child health records, to ensure they are covering every eligible child. + +What do we do with it? +: Nurses will use the ‘known as’ name when talking to children during a vaccination session. + +### What is your child’s date of birth? + +Vaccination +: All + +Mandatory +: Yes + +Why do we ask for it? +: See: child’s name. + +What do we do with it? +: Nurses sometimes use date of birth to identify children during a vaccination session. + +### Confirm your child’s school + +Vaccination +: All + +Mandatory +: Yes + +Why do we ask for it? +: We need to know that the child is assigned to the right vaccination session, or assign them to another session if necessary. + +What do we do with it? +: If the user confirms their child’s school is the one shown, they proceed with the consent journey. If it’s not, they need to follow a different journey. + +### Your name + +Vaccination +: All + +Mandatory +: Yes + +Why do we ask for it? +: We need to know the name of the person is giving or refusing consent. SAIS teams may need to contact the person who completed the form during triage. + +### Your relationship to the child + +Vaccination +: All + +Mandatory +: Yes + +Why do we ask for it? +: We need to check that the person filling out the consent form has parental responsibility. + +What do we do with it? +: If the person filling out the form does not have parental responsibility, someone from the SAIS team will contact them and ask them to suggest a more suitable contact. + +### Email address + +Vaccination +: All + +Mandatory +: Yes + +Why do we ask for it? +: We use this to send a confirmation of the parent’s responses in the consent form. + +What do we do with it? +: We use this to send a confirmation of the parent’s responses in the consent form. + +### Telephone number + +Vaccination +: All + +Mandatory +: Yes + +Why do we ask for it? +: SAIS teams use this to contact parents if they have questions during triage. + +What do we do with it? +: SAIS teams use this to contact parents if they have questions during triage. + +### I need to tell you how to contact me + +Vaccination +: All + +Mandatory +: No + +Why do we ask for it? +: We need to know if parents have any communication needs so we can contact them successfully. SAIS teams will try to honor parents’ communication preferences. + +### Do you agree to them having a nasal flu vaccine? + +Vaccination +: Flu + +Mandatory +: Yes + +Why do we ask for it? +: We need to get consent in order to vaccinate the child. + +What do we do with it? +: This is used to create the list of which children to vaccinate. + +### Do you agree to them having both doses of the HPV vaccination? + +Vaccination +: HPV + +Mandatory +: Yes + +Why do we ask for it? +: Currently, the HPV vaccine is given as two doses and we need consent for each one. + +What do we do with it? +: This is used to create the list of which children to vaccinate. + +### Do you agree to them having the 3-in-1 teenage booster? + +Vaccination +: 3-in-1 and teenage booster + +Mandatory +: Yes + +Why do we ask for it? +: We need to get consent in order to vaccinate the child. + +What do we do with it? +: This is used to create the list of which children to vaccinate. + +### Do you agree to them having the MenACWY vaccine? + +Vaccination +: MenACWY + +Mandatory +: Yes + +Why do we ask for it? +: We need to get consent in order to vaccinate the child. + +What do we do with it? +: This is used to create the list of which children to vaccinate. + +### (If no above) Please tell us why you do not agree + +Vaccination +: All + +Mandatory +: Yes + +Why do we ask for it? +: It’s valuable to know the parent’s reasons for refusing the vaccine. Some SAIS teams will follow up with parents to try to counter their objections, or talk through their reservations. + +### Is your child registered with a GP? (If yes, name of GP surgery) + +Vaccination +: MenACWY + +Mandatory +: Yes + +Why do we ask for it? +: It’s useful to know which GP to contact to check the child’s vaccination record. + +### Home address + +Vaccination +: All + +Mandatory +: Yes + +Why do we ask for it? +: Some SAIS teams use this to identify children during vaccination sessions. It’s also helpful for looking up NHS numbers. + +What do we do with it? +: Some SAIS teams use this to identify children during vaccination sessions. It’s also helpful for looking up NHS numbers. + +### Does your child have a disease or treatment that severely affects their immune system? (If yes, give details) + +Vaccination +: Flu + +Mandatory +: Yes + +Why do we ask for it? +: This information is needed for triage; if the child has contraindications, the SAIS nurse might decide not to vaccinate. + +What do we do with it? +: Used by nurse during triage. If the answer is ‘yes’, they may decide not to vaccinate. + +### Is anyone in your household having treatment that severely affects their immune system? (If yes, give details) + +Vaccination +: Flu + +Mandatory +: Yes + +Why do we ask for it? +: This information is needed for triage; if the child has contraindications, the SAIS nurse might decide not to vaccinate. + +What do we do with it? +: Used by nurse during triage. If the answer is ‘yes’, they may decide not to vaccinate. + +### Has your child been diagnosed with asthma? (If yes, give details) + +Vaccination +: Flu + +Mandatory +: Yes + +Why do we ask for it? +: This information is needed for triage; if the child has contraindications, the SAIS nurse might decide not to vaccinate. + +What do we do with it? +: Used by nurse during triage. If the answer is ‘yes’, they may decide not to vaccinate. + +### Has your child taken any oral steroids for their asthma in the last 2 weeks? (If yes, give details) + +Vaccination +: Flu + +Mandatory +: Yes + +Why do we ask for it? +: This information is needed for triage; if the child has contraindications, the SAIS nurse might decide not to vaccinate. + +What do we do with it? +: Used by nurse during triage. If the answer is ‘yes’, they may decide not to vaccinate. + +### Is your child taking aspirin medication? (If yes, give details) + +Vaccination +: Flu + +Mandatory +: Yes + +Why do we ask for it? +: This information is needed for triage; if the child has contraindications, the SAIS nurse might decide not to vaccinate. + +What do we do with it? +: Used by nurse during triage. If the answer is ‘yes’, they may decide not to vaccinate. + +### Has your child been admitted to intensive care because of a severe egg allergy? (If yes, give details) + +Vaccination +: Flu + +Mandatory +: Yes + +Why do we ask for it? +: This information is needed for triage; if the child has contraindications, the SAIS nurse might decide not to vaccinate. + +What do we do with it? +: Used by nurse during triage. If the answer is ‘yes’, they may decide not to vaccinate. + +### Does your child have any severe allergies that have led to an anaphylactic reaction? (If yes, give details) + +Vaccination +: HPV, 3-in-1 teenage booster and MenACWY + +Mandatory +: Yes + +Why do we ask for it? +: This information is needed for triage; if the child has contraindications, the SAIS nurse might decide not to vaccinate. + +What do we do with it? +: Used by nurse during triage. If the answer is ‘yes’, they may decide not to vaccinate. + +### Does your child have any existing medical conditions? (If yes, give details) + +Vaccination +: HPV, 3-in-1 teenage booster and MenACWY + +Mandatory +: Yes + +Why do we ask for it? +: This information is needed for triage; if the child has contraindications, the SAIS nurse might decide not to vaccinate. + +What do we do with it? +: Used by nurse during triage. If the answer is ‘yes’, they may decide not to vaccinate. + +### Does your child take any regular medication? (If yes, give details) + +Vaccination +: HPV + +Mandatory +: Yes + +Why do we ask for it? +: This information is needed for triage; if the child has contraindications, the SAIS nurse might decide not to vaccinate. + +What do we do with it? +: Used by nurse during triage. If the answer is ‘yes’, they may decide not to vaccinate. + +### Does your child take any immunosuppressant medication? (If yes, give details) + +Vaccination +: 3-in-1 and teenage booster + +Mandatory +: Yes + +Why do we ask for it? +: This information is needed for triage; if the child has contraindications, the SAIS nurse might decide not to vaccinate. + +What do we do with it? +: Used by nurse during triage. If the answer is ‘yes’, they may decide not to vaccinate. + +### Is there anything else you think we should know? (If yes, give details) + +Vaccination +: All + +Mandatory +: Yes + +Why do we ask for it? +: This information is needed for triage. It’s helpful for nurses to know if a child is needle phobic, for example. + +What do we do with it? +: This information is needed for triage. It’s helpful for nurses to know if a child is needle phobic, for example. + +## Questions on the HPV paper form + +### Child’s official name + +The first and last name on their passport or birth certificate. If their name has changed, tell us their current name. + +Why do we ask for it? +: We need this to confirm the child’s NHS number, which is important for nurses to find the right child health record to check the child’s vaccination history, and report the vaccination to the child’s GP properly. + +What do we do with it? +: Use it to look up NHS number. If the child health team have a different name, tell the child health team. + +### Child also known as + +Tell us if they use a different name in school. + +Why do we ask for it? +: We need this so nurses can call the child by the right name when they’re at school and can match the school’s class list to the Child health records, to ensure they are covering every eligible child. + +What do we do with it? +: Nurses will use the ‘known as’ name when talking to children during a vaccination session. + +### Child’s GP surgery + +Why do we ask for it? +: It’s useful to know which GP to contact to check the child’s vaccination record. + +What do we do with it? +: SAIS teams may use this to contact GP surgeries. + +### Child’s date of birth? + +Why do we ask for it? +: See: child’s name. + +What do we do with it? +: Nurses sometimes use date of birth to identify children during a vaccination session. + +### Child’s home address + +Why do we ask for it? +: Some SAIS teams use this to ID children during vaccination sessions. It’s also helpful for looking up NHS numbers. + +### Your name + +Why do we ask for it? +: We need to know the name of the person is giving or refusing consent. SAIS teams may need to contact the person who completed the form during triage. + +### Relationship to the child + +Why do we ask for it? +: We need to check that the person filling out the consent form has parental responsibility. If the person filling out the form does not have parental responsibility, someone from the SAIS team will contact them and ask them to suggest a more suitable contact. + +### Email address + +Why do we ask for it? +: We use this to send a confirmation of the parent’s responses in the consent form. + +What do we do with it? +: We use this to send a confirmation of the parent’s responses in the consent form. + +### Telephone number + +Why do we ask for it? +: SAIS teams use this to contact parents if they have questions during triage. + +What do we do with it? +: SAIS teams use this to contact parents if they have questions during triage. + +### Do you agree to your child having both doses of the HPV vaccination? + +Why do we ask for it? +: Currently, the HPV vaccine is given as two doses and we need consent for each one. + +What do we do with it? +: This is used to create the list of which children to vaccinate. + +### If you do not agree, please tell us why + +Why do we ask for it? +: It’s valuable to know the parent’s reasons for refusing the vaccine. + +What do we do with it? +: Some SAIS teams will follow up with parents to try to counter their objections, or talk through their reservations. + +### Does your child have any severe allergies that have led to an anaphylactic reaction? (If yes, give details) + +Why do we ask for it? +: This information is needed for triage; the SAIS nurse might decide not to vaccinate. + +What do we do with it? +: Used by nurse during triage. If the answer is ‘yes‘, they may decide not to vaccinate. + +### Does your child have any existing medical conditions? (If yes, give details) + +Why do we ask for it? +: This information is needed for triage; the SAIS nurse might decide not to vaccinate. + +### Does your child take any regular medication? (If yes, give details) + +Why do we ask for it? +: This information is needed for triage; the SAIS nurse might decide not to vaccinate. + +What do we do with it? +: Used by nurse during triage. If the answer is ‘yes’, they may decide not to vaccinate. + +### Is there anything else you think we should know? + +Why do we ask for it? +: This information is needed for triage; the SAIS nurse might decide not to vaccinate. + +### Your signature + +Why do we ask for it? +: ?? + +What do we do with it? +: ?? diff --git a/app/posts/manage-vaccinations-in-schools/2023/09/the-question-of-the-health-questions.md b/app/posts/manage-vaccinations-in-schools/2023/09/the-question-of-the-health-questions.md new file mode 100644 index 000000000..d498fae6b --- /dev/null +++ b/app/posts/manage-vaccinations-in-schools/2023/09/the-question-of-the-health-questions.md @@ -0,0 +1,24 @@ +--- +title: The question of the health questions +date: 2023-09-18 +--- + +All our consent journeys include health questions. If a parent agrees for their child to have a vaccination in school, they answer a series of questions about the child’s health. Nurses triage the answers to these questions to make sure the child stays safe. + +![Screenshot of health questions in the service.](health-questions.png "Our original health questions for flu.") + +We know from our research that different SAIS teams use different health questions for different vaccines. While the sorts of questions asked are generally similar, the number of questions asked varies, as does the wording used. + +## To standardise or not to standardise + +An important decision for our team is whether to have standardised sets of questions within our service (such as those suggested by the UK Health Security Agency), or whether to allow SAIS teams to tailor health questions according to their preferences. + +While there are obvious advantages to standardising questions, we think that getting all SAIS teams to agree to this approach and adopt the agreed questions could take some time. + +For the pilot we plan to run in Cumbria this autumn, we’ve agreed to go with the questions currently used by Cumbria’s SAIS team for flu vaccinations. These are subtly different from UKHSA’s questions and the questions we originally had in our service. + +![Screenshot of Cumbria’s health questions as shown on the parent-facing check and confirm page.](health-questions-cumbria.png "Cumbria’s health questions for flu.") + +We’re testing these questions in the research we’re currently doing with parents, and we’ll keep a close eye on how parents respond to them during the pilot. + +We’ll report back on what we learn, and whether we decide to standardise the health questions. diff --git a/app/posts/manage-vaccinations-in-schools/2023/11/introducing-mavis.md b/app/posts/manage-vaccinations-in-schools/2023/11/introducing-mavis.md new file mode 100644 index 000000000..740ccaf45 --- /dev/null +++ b/app/posts/manage-vaccinations-in-schools/2023/11/introducing-mavis.md @@ -0,0 +1,18 @@ +--- +title: Introducing Mavis +date: 2023-11-22 +--- + +We recently did a round of research with SAIS nurses to test some significant changes to the [handling of consent responses](https://childhood-vaccinations.designhistory.app/multiple-consent-responses) and [triage notes](https://childhood-vaccinations.designhistory.app/multiple-triage-notes). During testing, every nurse we spoke to commented that the name of our service – Manage vaccinations for school-aged children – wasn’t particularly snappy. Their existing systems (Cinnamon and Riviam, for example) have much shorter names, which makes it easy for teams to refer to the systems internally. + +## We needed a new name + +While we recognised the need for a snappier name, we also wanted the name of our service to be clear, logical and descriptive, in line with [NHS naming guidance](https://www.england.nhs.uk/nhsidentity/identity-guidelines/naming-principles/). + +After some reflection, we decided to keep a verb-based, descriptive name – Manage vaccinations in schools – but we’ve now added an abbreviation, which SAIS teams can use easily among themselves. + +Reader, we’d like to introduce you to Mavis. + +We’ll report back on how the new name tests in future research sessions. + +![Screenshot of the service’s start page.](start-page.png "The MAVIS start page") diff --git a/app/posts/manage-vaccinations-in-schools/2023/11/multiple-consent-responses.md b/app/posts/manage-vaccinations-in-schools/2023/11/multiple-consent-responses.md new file mode 100644 index 000000000..17f0f246b --- /dev/null +++ b/app/posts/manage-vaccinations-in-schools/2023/11/multiple-consent-responses.md @@ -0,0 +1,80 @@ +--- +title: Managing multiple consent responses +date: 2023-11-08 +screenshots: + items: + - text: Session homepage showing new ‘Check consent responses’ section + caption: To this view, we also added the number of children in the session cohort, and a brief summary below the link to each section. + - Check consent responses + - text: Patient record with consent given + caption: The ‘Responses to health questions’ expander is closed as all respondents answered ‘No’. + - text: Patient record needing triage + caption: In this example, both respondents have given consent and provided differing answers to health questions. Their answers are shown together under an expanded ‘Responses to health questions’ section. This makes it easier to compare responses during triage. + - Patient record with conflicting consent responses + - Patient record with consent refused + - text: Patient record with a confirmed refusal + caption: In this scenario, both responses appear collapsed as this record now has an overall outcome. Reasons for refusal appear in the summary at the top of the page. + - Patient record with no consent responses + - Who are you trying to get consent from? +--- + +Until now, the design for managing consent has assumed there will only ever be one consent response. However, it is possible for multiple consent responses to be submitted against a child. This can occur because: + +- a number of parents or guardians got an email requesting consent and all submitted a response, +- the same person submitted multiple responses, +- consent was given using the online service as well as on a paper form. + +Given our current consent model, in which we don’t use NHS Login or confirm that the respondent appears on a list of known parental contacts for a child, we can’t prevent multiple responses being submitted against a patient record. + +This presents a number of scenarios that need addressing: + +- All respondents have given consent, but provided different answers to health questions or different reasons for refusing consent, +- If no one has responded, we need a way for users of the service to retrieve parental contact information stored in CHIS or SAIS records which they can then use to contact a parent. + +When there are conflicting consent responses: + +- We need a way to resolve this so that any respondents that have refused can be contacted and change their mind and choose to give consent, +- If one respondent confirms their refusal, then other respondents that have given consent can be notified that their child won’t be getting the vaccination. + +## Splitting consent and triage + +Previously, we recorded consent outcomes needing follow-up as a reason for triage. As the interface needed to account for managing many more different consent outcomes, this made the triage section more complicated. + +We also felt it was important to keep these journeys separate as non-clinical admin users may be responsible for chasing and confirming consent responses whereas SAIS nurses will be responsible for triaging answers to health questions. + +Moving consent out from triage meant there was no longer a need to display a reason for triage; a patient will only need triage if a parent answers ‘yes’ to any health question. + +## Reviewing consent responses + +A new ‘Check consent responses’ section is shown on the session homepage. This view contains a list of patients that can be filtered using the following tabs along the top of the page: + +- Consent given +- Consent refused (including confirmed consent refusals) +- Consent conflicts +- No response + +The consent panel on a patient record page shows each response in an open [details component](https://service-manual.nhs.uk/design-system/components/details). A summary list displays the respondent’s name, relationship to the child, contact details and their response (with date and method of response shown). + +Every time the consent response changes (such as after contacting a parent to confirm their refusal), a new event is added which shows what changed, and which user contacted the parent. + +Above the responses, the overall consent outcome is shown. + +Below responses, answers to health questions are combined. This makes it easy to compare answers to each health question if respondents have provided different questions (if all respondents answered no, we show ‘All responded: No‘). This uses the [expander component](https://service-manual.nhs.uk/design-system/components/expander), and this appears collapsed when all the answers given are ‘No’. + +### Getting consent + +Where there has been no response, the ‘Contact parent or guardian’ journey asks the user to choose from a predefined list of contacts that may be available on the service via data uploaded from CHIS or other SAIS records. + +Where consent is conflicting, a similar journey is followed, but as we already have a parent’s contact details, we skip over the question that asks the user to choose a parental contact. + +## A consistent appearance for the patient record + +With the addition of this third section, we took the opportunity to revisit the patient record. Previously there was a slightly different ordering of cards and different labels used for similar sections of the page. + +Now the patient record uses the same section ordering and naming: + +- **Current status or outcome:** Rather than using a custom banner design, using a variant of the card component with the offset featured heading, the background colour of which reflects the different outcome status +- **Child details:** Name, date of birth, address etc. is shown the same across all sections +- **Consent:** Consent outcome, responses and answers to health questions appear within this one section +- **Triage notes:** where relevant +- **Action:** Where a patient needs triage, a form to enter triage outcome and notes is shown. When a session is in progress, and if a patient is ready to vaccinate, a form to record vaccination outcome is shown. diff --git a/app/posts/manage-vaccinations-in-schools/2023/11/multiple-triage-notes.md b/app/posts/manage-vaccinations-in-schools/2023/11/multiple-triage-notes.md new file mode 100644 index 000000000..cb9133b9c --- /dev/null +++ b/app/posts/manage-vaccinations-in-schools/2023/11/multiple-triage-notes.md @@ -0,0 +1,31 @@ +--- +title: Adding multiple triage notes +date: 2023-11-08 +screenshots: + items: + - Patient record needing triage + - Patient record with triage notes +--- + +[The previous design for triaging patients](/manage-vaccinations-in-schools/2023/03/first-pass-at-triage/) provided a form field to add notes, but with no space to indicate who created the note and when they added it. + +During the model office, different users wanted to add subsequent notes later in the triage process. Without the ability to add multiple notes, they would append their notes to an existing triage note, sometimes adding their initials and a date. + +Relying on ad hoc methods like this makes it likely that earlier notes would get lost. The nurses we spoke to asked for notes to show who had written them and when. + +## Adding a triage note + +The design for adding a note is similar to how it was previously. + +The name of the panel where a triage outcome can be recorded has been re-titled ‘Is it safe to vaccinate [patient’s full name]? so that it aligns with the title we use when recording a vaccination outcome (‘Did [patient’s full name] get the vaccine?’). + +The triage outcome options are now labelled: + +- Yes, it’s safe to vaccinate +- No, do not vaccinate +- No, delay vaccination to a later date +- No, keep in triage + +The field to enter a note is now shown below triage outcome options instead of above, and we indicate that this is an optional field. + +Once this information is submitted, a ‘Triage notes’ panel appears on a patient’s record. Each note is shown alongside the user who added it and the date and time it was added, in reverse chronological order. diff --git a/app/posts/manage-vaccinations-in-schools/2023/12/matching-consent-responses-to-childrens-records.md b/app/posts/manage-vaccinations-in-schools/2023/12/matching-consent-responses-to-childrens-records.md new file mode 100644 index 000000000..d3452abb5 --- /dev/null +++ b/app/posts/manage-vaccinations-in-schools/2023/12/matching-consent-responses-to-childrens-records.md @@ -0,0 +1,61 @@ +--- +title: Matching consent responses to children’s records +date: 2023-12-07 +--- + +## The problem + +At the start of each vaccination campaign, SAIS teams put together their cohort, which is the complete list of children they know about in their area who are eligible for a vaccination. + +It is a list of children (typically several thousand) in a particular academic year group who either live, attend a school or are registered with a GP within the SAIS team’s geographical boundary. + +(We’re aware that this means some children are part of more than one SAIS cohort, which causes lots of headaches - this is something we want to look at in our future roadmap.) + +SAIS teams use multiple data sources to create the cohort: + +- Child Health Information Services (CHIS) are responsible for tracking the home address, school and GP of children in England (amongst other things like their vaccination and screening history). They typically provide an initial version of this list to the SAIS team. + +- Some SAIS teams get information about school-aged children and whether they attend a school directly from local authorities, instead of – or in addition to – the CHIS list. + +* Most SAIS teams request full class lists from every school in their region, because these provide the most accurate and up to date information for children who go to school. Some schools provide parents’ contact details so that SAIS teams can contact them directly. Others do not feel comfortable doing this and instead prefer to share comms on the SAIS teams’ behalf. + +SAIS teams typically have to resolve these disparate sources manually to create their cohort lists. + +In our research, none of the SAIS teams we’ve spoken to have a system which allows them to do all of the following in the same place: + +- see their entire cohort +- record attempts to contact parents +- view consent responses they’ve received for each child + +Most teams have their full cohort either in a patient records system or spreadsheets, and use a different ‘e-consent’ system to manage consent responses they’ve received and record vaccinations they administer. This separation makes chasing up non-responders a time consuming and manual process. + +SAIS teams also have to deal with frequently receiving multiple consent responses for one child. This can happen because more than one parent responds for a particular child, or because a parent responds twice by mistake. + +Existing SAIS e-consent tools treat each consent response independently. SAIS teams have to identify multiple consent responses for a child as ‘duplicates’ and deactivate one of them, so they don’t see the child twice in their list of children to vaccinate. + +This is even more risky when one parent gives consent but another refuses. SAIS teams cannot vaccinate a child if someone with parental responsibility has refused (unless the child is Gillick competent and consents for themselves). But because they have received a ‘yes’ response from one parent, this consent response will appear in the list of children to vaccinate, with no direct link to the refusal. + +To ensure the child doesn’t appear in the list, the SAIS team must identify that there are two responses for that child and deactivate the ‘yes’ response, so the only remaining response is a refusal. This is a significant source of manual work and stress for SAIS teams. + +## Child-centred records in MAVIS + +We think we can solve these problems in MAVIS by linking consent responses together with a child record. + +The SAIS team can import their cohort list into MAVIS, and when consent responses come in, we will automatically match them to the right child wherever we can. If we can’t match them automatically, a SAIS team member will be able to manually link the response to the right child. + +We will match a consent response to a cohort record automatically if any three of the following values in the consent response match to exactly one cohort record: + +- first name OR preferred first name +- last name OR preferred last name +- date of birth +- postcode + +This means that acceptable matches include full name + date of birth, full name + postcode or partial name + date of birth + postcode. + +To start with we will only accept exact matches, and we’ll look at fuzzy matching in future. + +If there is no match or multiple possible matches, we will flag the response to a nurse to link to the right child. + +Doing this matching will allow us to show all the consent responses that relate to the same child together, so nurses won’t have to process duplicates and can easily see non-responders to chase consent. + +If this approach works, in the future we want to extend the matching further so that SAIS teams, CHIS teams and/or schools can import different cohort lists independently, and MAVIS can use these sources to identify the full list of unique children for vaccination. diff --git a/app/posts/manage-vaccinations-in-schools/2024/03/pilot-consent-and-triage.md b/app/posts/manage-vaccinations-in-schools/2024/03/pilot-consent-and-triage.md new file mode 100644 index 000000000..81617683f --- /dev/null +++ b/app/posts/manage-vaccinations-in-schools/2024/03/pilot-consent-and-triage.md @@ -0,0 +1,39 @@ +--- +title: Consent and triage journey for the pilot +date: 2024-03-12 +screenshots: + items: + - Session landing page + - text: Check consent responses – No response view + caption: | + If there are unmatched responses (that is, responses the system could not [automatically match](/manage-vaccinations-in-schools/2023/12/matching-consent-responses-to-childrens-records/) to existing patient records), a link is shown to a section where these responses can be reconciled. + - Unmatched consent responses + - Search for a child record + - text: Link consent response with child record? + caption: Any values that don’t match are highlighted in yellow. + - Unmatched consent responses – Confirmation of matched record + - text: Patient record with no consent response + caption: | + While the journey to assess Gillick competence was available, the pilot was structured in such a way that SAIS teams didn’t need to use it. + + A member of the SAIS team could use the ‘Get consent’ journey when chasing consent and contacting a parent by phone. + - text: Get consent – Who are you trying to get consent from? + caption: Details for ‘Full name’ and ‘Phone number’ were pre-filled using information from the expression of interest forms. In the future, users would be able to choose from information found in a team’s CHIS records. + - Get consent – Do they agree to them having the HPV vaccination? + - text: Get consent – Consent given – Health questions + caption: | + The same questions used in the [parental consent journey](/manage-vaccinations-in-schools/2024/03/pilot-parental-consent/) are shown here, but on one page. + - Get consent – Consent given – Check and confirm answers + - text: Get consent – Consent refused – Why are they refusing to give consent? + caption: Like the parent consent journey, choosing ‘Vaccine already received’, ‘Vaccine will be given elsewhere’, ‘Medical reasons’ or ‘Other’ takes the user to a second page asking for more details. + - Get consent – Consent refused – Check and confirm answers + - text: Patient record with consent given response + caption: The final card on a child’s record (‘Did they get the HPV vaccine’) was only shown when a session was in progress. + - Patient record with consent refused response + - Patient record with conflicting consent responses + - Triage health questions + - Patient record which needs triage + - Patient record with triage completed +--- + +The following images are a snapshot of the consent and triage journeys used for the pilot that ran in March 2024. diff --git a/app/posts/manage-vaccinations-in-schools/2024/03/pilot-expression-of-interest.md b/app/posts/manage-vaccinations-in-schools/2024/03/pilot-expression-of-interest.md new file mode 100644 index 000000000..dbfa03faf --- /dev/null +++ b/app/posts/manage-vaccinations-in-schools/2024/03/pilot-expression-of-interest.md @@ -0,0 +1,32 @@ +--- +title: Expression of interest journey for the pilot +date: 2024-03-09 +screenshots: + items: + - text: ✉️ Email to schools + caption: This email shows an incentive of £20, but we raised it to £30 due to low take-up. We thought boosting the incentive would increase the number of registrations. + - text: ✍️ Register your interest in the NHS school vaccinations pilot + caption: | + The expression of interest form used a plain, unbranded design, with all questions appearing on one page. + + This was to prevent causing confusion with the NHS-branded consent journey which asks many of the same questions. + - ℹ️ Thank you for registering your interest in the NHS school vaccinations pilot + - ✉️ Email confirming that parents can take part in the pilot + - ✉️ Email confirming that parents cannot take part in the pilot + - ℹ️ The deadline for registering interest in the NHS school vaccination pilot has passed + +--- + +The following images are a snapshot of the expression of interest journey used for the pilot that ran in March 2024. + +Children were eligible for the pilot if: + +- they were part of the existing cohort that the SAIS team had already planned to vaccinate at participating schools (children at other schools or in other year groups were not eligible) + +- they had not already had the HPV vaccine + +- their parent/guardian had completed a consent form according to the current process (it did not matter whether the response was to give or refuse consent) + +Each SAIS team was also limited to including 100 children in their pilot cohort, typically 50 per school. + +A link to this form was sent by schools to parents whose children would be vaccinated in an upcoming HPV campaign. Responses to this form would then be used to select the cohort for the pilot against the above criteria. diff --git a/app/posts/manage-vaccinations-in-schools/2024/03/pilot-parental-consent.md b/app/posts/manage-vaccinations-in-schools/2024/03/pilot-parental-consent.md new file mode 100644 index 000000000..c9b75f1c7 --- /dev/null +++ b/app/posts/manage-vaccinations-in-schools/2024/03/pilot-parental-consent.md @@ -0,0 +1,42 @@ +--- +title: Parental consent journey for the pilot +date: 2024-03-11 +screenshots: + items: + - ✉️ Email asking for parent to give or refuse consent + - ✉️ Email reminding parent to give or refuse consent + - ✍️ Give or refuse consent for an HPV vaccination + - ✍️ What is your child’s name? + - ✍️ What is your child’s date of birth? + - ✍️ Confirm your child’s school + - text: ℹ️ You cannot give or refuse consent through this service + caption: Page shown if selected ‘No’. + - ✍️ About you + - ✍️ Do you agree to them having the HPV vaccination? + - ✍️ Refuse consent – Why are you refusing to give consent? + - text: ✍️ Refuse consent – Where did your child get their vaccination? + caption: Question shown if selected ‘Vaccine already received’. + - text: ✍️ Refuse consent – Where will your child get their vaccination? + caption: Question shown if selected ‘Vaccine will be given elsewhere’. + - text: ✍️ Refuse consent – What medical reasons prevent your child from being vaccinated? + caption: Question shown if selected ‘Medical reasons’. + - text: ✍️ Refuse consent – Tell us why you don’t agree + caption: Question shown if selected ‘Other’. + - ✍️ Refuse consent – Check your answers and confirm + - ℹ️ Refuse consent – Your child will not get an HPV vaccination at school + - ✉️ Refuse consent – Email confirming response + - ✍️ Give consent – Is your child registered with a GP? + - ✍️ Give consent – Home address + - ✍️ Give consent – Does your child have any severe allergies? + - ✍️ Give consent – Does your child have any medical conditions for which they receive treatment? + - ✍️ Give consent – Has your child ever had a severe reaction to any medicines, including vaccines? + - ✍️ Give consent – Check your answers and confirm + - ℹ️ Give consent – [Child’s name] will get their HPV vaccination at school on [session date] + - ✉️ Give consent – Email confirming response + - text: ✉️ Give consent – Email confirming response, answers needs triage + caption: If response includes answers to health questions, this email is sent instead. + - ✉️ Email asking parent for feedback on the pilot + - ✉️ Email reminding parent of upcoming vaccination session +--- + +The following images are a snapshot of the consent and triage journeys used for the pilot that ran in March 2024. diff --git a/app/posts/manage-vaccinations-in-schools/2024/03/pilot-record-a-vaccination.md b/app/posts/manage-vaccinations-in-schools/2024/03/pilot-record-a-vaccination.md new file mode 100644 index 000000000..5b3ce33df --- /dev/null +++ b/app/posts/manage-vaccinations-in-schools/2024/03/pilot-record-a-vaccination.md @@ -0,0 +1,24 @@ +--- +title: Record a vaccination journey for the pilot +date: 2024-03-13 +screenshots: + items: + - Manage vaccines + - Add a batch + - Record vaccinations – Action needed + - Record vaccinations – Vaccinated + - Record vaccinations – Could not vaccinate + - Patient record – Safe to vaccinate + - text: Vaccinated – Which batch did you use? + caption: | + If no vaccine has been selected as the default, a vaccinator can select a batch, and choose to make it the default for this session. + + To change the default, they can use the functionality on the ‘Manage vaccines’ page. + - Vaccinated – Check and confirm + - Patient record – Vaccinated + - Could not vaccinate – Record reason + - Could not vaccinate – Check and confirm + - Patient record – Could not vaccinate +--- + +The following images are a snapshot of the journeys used to manage vaccines and record vaccinations for the pilot that ran in March 2024. diff --git a/app/posts/manage-vaccinations-in-schools/2024/03/pilot-select-and-invite.md b/app/posts/manage-vaccinations-in-schools/2024/03/pilot-select-and-invite.md new file mode 100644 index 000000000..1417d787e --- /dev/null +++ b/app/posts/manage-vaccinations-in-schools/2024/03/pilot-select-and-invite.md @@ -0,0 +1,25 @@ +--- +title: Select and invite journey for the pilot +date: 2024-03-10 +screenshots: + items: + - text: Manage pilot + caption: A new ‘Manage pilot’ section was provided for SAIS teams that provided a way to see who had registered an interest in the pilot, download and upload cohort data, as well as find helpful guidance on how to create a cohort for the pilot. + - Parents interested in the pilot + - text: Are you sure you want to close the pilot to new participants at this school? + caption: Closing the pilot to new participants prevents new expressions of interest being registered, and [this page](/manage-vaccinations-in-schools/2024/03/pilot-expression-of-interest/#the-deadline-for-registering-interest-in-the-nhs-school-vaccination-pilot-has-passed) being shown to anyone following an old link. + - Create a pilot cohort + - Upload the cohort list + - text: The cohort list could not be added + caption: Any errors with the CSV cohort data was flagged. + - Cohort data uploaded + - New session – Which school is it at? + - New session – When is the session? + - New session – Choose cohort for this session + - New session – What’s the timeline for consent requests? + - New session – Check and confirm details + - text: New session landing page + caption: Once a session had been created, users were taken to the session’s landing page, where the number of children included in the cohort would show as children without consent responses. +--- + +The following images are a snapshot of the select and invite journey used for the pilot that ran in March 2024. diff --git a/app/posts/manage-vaccinations-in-schools/2024/04/pilot-mission-patch.md b/app/posts/manage-vaccinations-in-schools/2024/04/pilot-mission-patch.md new file mode 100644 index 000000000..c89c91588 --- /dev/null +++ b/app/posts/manage-vaccinations-in-schools/2024/04/pilot-mission-patch.md @@ -0,0 +1,19 @@ +--- +title: A mission patch for the pilot +date: 2024-04-04 +--- + +The mission patch for our pilot features Mavis the polar bear protecting her 2 cubs. + +![A circular badge featuring a polar bear protecting her 2 cubs.](mission-patch.png) + +We chose a polar bear as the team’s mascot because: + +* they’re big on protecting cubs +* they live in hostile environments +* they’re highly adaptive +* they’re great at conserving energy + +That, and everyone on the team seems to love [The Bear](https://www.imdb.com/title/tt14452776/). + +To celebrate completion of the pilot, our first mission patch features the northern lights, reflecting the colours of the teams involved with its development, while the 3 stars represent the 3 SAIS teams we piloted with. diff --git a/app/posts/manage-vaccinations-in-schools/2024/05/registering-children-into-vaccination-sessions.md b/app/posts/manage-vaccinations-in-schools/2024/05/registering-children-into-vaccination-sessions.md new file mode 100644 index 000000000..4fcec20fa --- /dev/null +++ b/app/posts/manage-vaccinations-in-schools/2024/05/registering-children-into-vaccination-sessions.md @@ -0,0 +1,39 @@ +--- +title: Registering children’s attendance at vaccination sessions +date: 2024-05-02 +--- + +When our project team observed live vaccinations in schools, we noticed that all SAIS teams registered children’s attendance at sessions before recording vaccinations. This process typically involves: + +- identifying the child +- checking whether the child has consent to be vaccinated +- directing a child with consent to queue for a vaccination +- directing a child without consent (or without a record) to wait in a different area while someone from the team tries to get consent for them + +The main benefit of registering children’s attendance is that it makes the vaccination process smoother and more efficient. + +In the sessions we observed, some registrations were carried out by nurses, but the majority were carried out by support staff. + +## We’ve updated our designs to include a registration phase + +Mavis now has a ‘Register attendance’ flow. It is only possible to record a vaccination once a child is marked as attending. + +![A picture of Mavis’s ‘Register attendance’ area](session-overview.png) + +![A picture of the ‘Register attendance’ list](session-register-attendance.png) + +![A picture of a page with radio buttons for registering a child’s attendance or absence](attending-session.png) + +We believe adding this flow will make it easier to differentiate children at the session who have consent from those who haven’t. It should also be quicker for time-short nurses to find children ready to be vaccinated. + +## We’ve also added some questions to the ‘Record’ flow + +Another observation we made while attending sessions was that all SAIS teams ask children some standard questions before giving vaccinations. We’ve added these questions to the ‘Record’ flow. + +![A picture of the pre-screening questions where a nurse has indicated a child is ready to vaccinate](prescreening-ready.png) + +Children’s answers to these questions determine whether the vaccination can go ahead. For example, a child with consent who feels very unwell on the day of a session may have their vaccination delayed. + +![A picture of the pre-screening questions where a nurse has indicated a child cannot be vaccinated](prescreening-not-ready.png) + +![A picture of the screen nurses use to record why a child has not been vaccinated if they’re attending a session](could-not-vaccinate-reason.png) diff --git a/app/posts/manage-vaccinations-in-schools/2024/06/how-sais-staff-will-contact-parents.md b/app/posts/manage-vaccinations-in-schools/2024/06/how-sais-staff-will-contact-parents.md new file mode 100644 index 000000000..a061b208c --- /dev/null +++ b/app/posts/manage-vaccinations-in-schools/2024/06/how-sais-staff-will-contact-parents.md @@ -0,0 +1,51 @@ +--- +title: How SAIS staff will contact parents +date: 2024-06-27 +--- + +SAIS teams need to contact the parents/carers of children within their cohort, to offer them vaccinations for their children. Currently, different teams do this in a variety of ways, like: + +- maintaining their own contact lists across multiple years +- using contact details from their Child Health Information Service (CHIS) +- obtaining parents’ contact details from their children’s school +- asking the children’s schools to send messages through the school distribution lists and comms platforms +- using contact details from the Personal Demographics Service (PDS), + +and combinations of the above. + +## Pilot + +During the Mavis pilot, the participating SAIS teams collected email addresses and phone numbers from participating families. Consent requests were then sent directly to the email addresses of the pilot parents using [GOV.UK Notify](https://www.notifications.service.gov.uk/). One of the pilot learnings was that some parents would have preferred to receive SAIS comms by text. Comms over text was originally planned to be included in the pilot, but was eventually dropped when the Mavis team ran out of time. + +## Private beta + +We evaluated using [NHS Notify](https://digital.nhs.uk/services/nhs-notify) for parent comms. At the time of writing, if provided with an NHS number, NHS Notify fetches the contact details against that NHS number in Personal Demographics Service (PDS), and uses those contact details to send out NHS app notifications, text messages, emails or letters. + +For private beta, we have decided to continue to deliver messages using GOV.UK Notify. Choosing NHS Notify over GOV.UK Notify would result in an operational change for SAIS teams, as NHS Notify contact details (i.e. the ones from PDS) are less likely to be up-to-date than those gathered during the SAIS process. Such an operational change should only be done with the involvement of the SAIS team, after building up a quantitative evidence base that PDS contact details get a better response than what SAIS currently does. + +## Restricted patient records + +Some patient records in PDS are [restricted or “S-flagged”](https://digital.nhs.uk/services/personal-demographics-service/national-back-office-for-the-personal-demographics-service/management-of-nhs-numbers-and-pds-records#restricting-access-to-a-patient-s-record). This is to ensure that patient location information such as the patient’s address or landline phone number is protected from viewing by healthcare professionals. + +This is to protect vulnerable patients, for example: + +- victims of domestic violence +- victims of forced marriages +- family break-ups +- vulnerable children awaiting adoption (the flag is not set for adoption cases, but it may be requested for children who are on the pathway to adoption or post adoption on specific request – this is likely due to specific vulnerabilities rather than the adoption) +- law court witnesses +- patients who are keen to restrict as much data that is held about them as possible, for their own personal reasons/their feeling this is their human right +- short-term protection pending identity change + +Having a sensitive flag applied to your record is ultimately a patient’s individual choice (or their parent’s) rather than being rule-based. + +SAIS teams currently source their contact details from two main places: schools and CHIS teams. Schools and CHIS teams both have their own independent processes in place to ensure that they have appropriate contact information for vulnerable children, and therefore SAIS do not apply any further checks. + +When using NHS Notify, it is not possible to contact people with an S flag at all. This would reduce the ability of the SAIS team to offer vaccinations to every child within their cohort, as per their responsibility, and risks widening health inequalities. + +## Future considerations + +In future, the Mavis team could explore: + +- how sending comms and updates through the NHS app compares to text messages and emails +- what might happen if Mavis pushed the contact details collected through SAIS back into PDS. This brings opportunities e.g. potential for increasing the deliverability of messaging in other clinical settings due to up-to-date contact details, risks e.g. of unexpectedly replacing the contact details for one parent in PDS with another parent’s details, and challenges e.g. clearly explaining to the end user what the implications of updating their PDS details would be, while not distracting them from giving consent. diff --git a/app/posts/manage-vaccinations-in-schools/2024/06/how-staff-will-access-mavis-during-private-beta.md b/app/posts/manage-vaccinations-in-schools/2024/06/how-staff-will-access-mavis-during-private-beta.md new file mode 100644 index 000000000..c5d6c9db7 --- /dev/null +++ b/app/posts/manage-vaccinations-in-schools/2024/06/how-staff-will-access-mavis-during-private-beta.md @@ -0,0 +1,29 @@ +--- +title: How staff will access Mavis during private beta +date: 2024-06-27 +--- + +## Authentication + +SAIS staff will use the [Care Identity service](https://digital.nhs.uk/services/care-identity-service) (also known as CIS2) to access Mavis. We expect most (but not all) staff to already have [Care Identity smartcards](https://digital.nhs.uk/services/care-identity-service/smartcard-and-authentication-users). + +When working from an office, we expect the majority of staff to access Mavis on a smartcard-capable laptop or desktop device, and have a fast internet connection. + +In school and community clinics, we expect staff to access Mavis on a combination of laptops, tablets and phones. When issued by their organisation, staff prefer to use tablets and phones during sessions due to those devices’ portability and superior battery life. + +## Bank staff and staff without smartcards + +We’ve heard in research that SAIS bank staff don’t always have smartcards. CIS2 allows authenticating using authenticator apps, physical dongles and an iPad app instead of smartcards, so the lack of a smartcard shouldn’t prevent Mavis access. + +We believe that [authenticator apps](https://digital.nhs.uk/services/care-identity-service/applications-and-services/cis2-authentication/microsoft-authenticator) are likely to provide the most flexibility. CIS2 supports the Microsoft and Google authenticator apps, both of which are available on Android and iOS. + +## Authorisation + +Mavis will rely on [National role-based access control](https://digital.nhs.uk/developer/guides-and-documentation/security-and-authorisation/national-rbac-for-developers) to ensure that different staff users, such as members of the SAIS or CHIS teams, have access only to parts of Mavis that they need. This access control will be managed by their organisations’ [registration authorities](https://digital.nhs.uk/services/care-identity-service/smartcard-and-authentication-users/find-your-registration-authority). + +## Using Mavis offline + +It’s common for staff devices to have limited or no connectivity during point-of-care recording. In order to continue using Mavis when that happens, staff will need to: + +- log into Mavis on the day of the session, while they still have connectivity +- prepare for offline usage (see previous design work around [offline access](https://childhood-vaccinations.designhistory.app/protecting-offline-data)). diff --git a/app/posts/manage-vaccinations-in-schools/2024/09/cohorting-for-hpv-with-mavis-release-1.md b/app/posts/manage-vaccinations-in-schools/2024/09/cohorting-for-hpv-with-mavis-release-1.md new file mode 100644 index 000000000..5316caccb --- /dev/null +++ b/app/posts/manage-vaccinations-in-schools/2024/09/cohorting-for-hpv-with-mavis-release-1.md @@ -0,0 +1,57 @@ +--- +title: Cohorting for the HPV programme with Mavis in 2024/25 +date: 2024-09-19 +--- + +Mavis will be available for Coventry and Warwickshire SAIS team to use to run their HPV programme in 2024/25 from Monday 2nd December 2024. + +All young people in school year 8 who attend school in the C&W area, or who do not attend school but who live or have a GP in the area, are eligible for the HPV vaccination for the first time in 2024/25. Additionally, all young people in school year 9, 10 and 11 who were not vaccinated in previous academic years are eligible for a catch up vaccination. SAIS teams need to invite all of these children to get a HPV vaccination this year. + +Even though they are vaccinated at the same time, officially, children in different academic years and with different biological sexes form different cohorts: + +- Catch ups for year 9, 10 and 11 are treated as an extension of the previous years’ programmes (in this case the 2023/24, 2022/23 and 2021/22 programmes respectively) +- Each sex is treated as a separate cohort. + +These distinctions are important for measuring uptake and other reporting needs. + +There are currently 101 secondary schools in the C&W area. In recent years the eligible year 8 cohort has comprised around 12,000 people. Including all those eligible for catch ups, the total cohort may be around 20,000. + +Coventry and Warwickshire are unusual amongst SAIS teams in that their CHIS does not provide a list of the children in the eligible cohorts at the start of their programmes. Instead, they base their cohorts only on information from the education system. C&W request a copy of the Local Authority’s nominal roll twice a year, following on from the May and October school censuses. + +SAIS teams need lists of children in all academic year groups from the start of the year to run the Flu program, which runs each autumn term for all children from reception through to year 11. They are then able to use the information gathered in the flu programme as the basis for their cohorts for the next two programmes, including HPV. + +The flu programme cohort is initially based on the May census, as the October census arrives too late. SAIS teams report that information they receive before the summer holidays about school intentions for next year tends to change quite a bit by the time September comes around. + +C&W use the information from the May census to create their schedule for visiting schools, as the information is accurate enough to get a rough cohort size, so they can predict time and staff required to vaccinate. + +However, to maintain an accurate nominal roll, C&W then request class lists directly from schools (like most other SAIS teams). C&W have a lead nurse for each of their schools, and their current process is for the nurse to request the class lists at the same time as sending the school the consent request template, 3 weeks in advance of the scheduled session. + +Nurses ask schools for a parent phone number for each child at this point, in order to send texts to non-responders, but in the current process, schools have primary responsibility for communicating with parents, so parent contact information is not mandatory. The class lists are not currently integral to the process of contacting parents. + +One of the major goals of the Mavis beta is to validate that communicating with parents directly through NHS branded channels with consistently designed messaging will make it easier for parents to respond to consent requests and SAIS teams to chase non responders, with the aim of improving uptake. + +In order to do this, C&W have agreed to make some changes to their operational process. We have provided C&W with a message for their lead nurses to share with secondary schools, explaining that they are trialling a new method for requesting consent from parents and that as part of this, they will need all schools to provide email and mobile contact details for parents in their school lists. This will also need to happen earlier than the 3 weeks before a session used in previous programs, to give SAIS nurses time to input the information back into Mavis and issue consent requests themselves. + +We will have a backup option available if any schools completely refuse, in which nurses are able to share an email template for the school to send out as they currently do, but we hope that this will not be necessary. + +## Beta cohorting process + +### Before Mavis is live + +1. C&W’s nominal rolls will have already been updated throughout flu season with information from both school lists and parent consent responses to have up to date information about which child goes to which school and their parent’s contact info. However, response rates for the flu campaign in secondary schools are low, so contact information will still be missing for many. +2. In November, according to the newly agreed process, each lead nurse will request new school lists for all year 8, 9, 10s and 11s from their secondary schools in the new template, with email and mobile contact information for up to 2 parents for each child. +3. Mavis release one will go live already set up with a HPV programme for 2024/25. There will be four cohorts linked to the programme: + - 2021/22 year 8s (current year 11s) + - 2022/23 year 8s (current year 10s) + - 2023/24 year 8s (current year 9s) + - 2024/25 year 8s (current year 8s) + +### When Mavis is live (Mon 2nd December) + +1. C&W’s admin team will upload their entire year 8, 9, 10 and 11 nominal rolls into Mavis as one or more cohort uploads. Based on the date of birth of the child, Mavis will automatically sort the children into the correct HPV cohort. If they don’t fit into any of the cohorts, then Mavis will raise an error and won’t import them. +2. The admin team will bulk-upload vaccination records of those children in year 9, 10 and 11 who have already been vaccinated in the previous years’ programmes. +3. Using Mavis’ one record per child model, Mavis will therefore know which children from each cohort are already vaccinated, and which are eligible for vaccination in this programme +4. When lead nurses receive the class lists for year 8, 9, 10 and 11 back from schools, they will upload these directly into Mavis as cohort records (separate uploads by school). +5. Mavis automatically matches the new records to those already in the system, and adds the new parent contact information to existing child records where it does not already exist. Where Mavis cannot reliably find an exact match to a child, the nurse will be prompted to find the correct match manually, or create a new record if the child is new to the area. +6. Records for any children who were previously thought to be in that school but weren’t on the class list will be flagged to the nurse to be moved to the “unknown school” list. +7. Once the class lists are uploaded for a given school, the lead nurse can add a new school session, select the school and select that HPV will be the only vaccination type available. The nurse will then see a list of all eligible children from all active programs who have not yet had the HPV vaccination, to add them to the school session. diff --git a/app/posts/manage-vaccinations-in-schools/2024/09/how-health-questions-varied-in-the-mavis-pilot.md b/app/posts/manage-vaccinations-in-schools/2024/09/how-health-questions-varied-in-the-mavis-pilot.md new file mode 100644 index 000000000..037772d84 --- /dev/null +++ b/app/posts/manage-vaccinations-in-schools/2024/09/how-health-questions-varied-in-the-mavis-pilot.md @@ -0,0 +1,29 @@ +--- +title: How health questions varied in the Mavis pilot +date: 2024-09-05 +--- + +UKHSA has a template consent form which they recommend for use by SAIS teams to get parental consent for the HPV vaccination. + +This consent form has only one screening question. The question is: + +> Does your child have a disease or treatment that severely affects their immune system? + +It also provides helper text underneath the question: + +> It is recommended that children with severe immunosuppression receive 3 doses of HPV vaccine. + +None of the SAIS teams who participated in the Mavis pilot use this exact question. Instead, teams typically ask about health conditions in general, and have specific questions on other topics: + +- **additional needs**: 1 of 3 pilot teams asked parents if their child had additional needs relating to communicating or vaccinations. This covers needle-phobic children, deaf children, children with learning difficulties and other needs. To our team, this seems to be really important for making reasonable adjustments for these children. +- **allergy / severe reaction to vaccines**: 3 of 3 pilot teams asked parents if their child has had a severe reaction to a vaccine before. +- **allergies in general**: 2 of 3 pilot teams asked parents if their child has any other serious allergies (latex has been cited as a relevant example). The third asked parents if their child has had any unexplained anaphylactic reactions in the past. +- **already vaccinated**: 2 of 3 pilot teams asked parents if their child has already had the HPV vaccination. This is relevant for children who were vaccinated in another country or have moved schools within the last year (SAIS won’t have access to this information any other way). Parents can refuse because their child is already vaccinated, but some may not be aware their child only needs HPV once, so give consent again +- **bleeding disorders**: 1 of 3 pilot teams asks if the child takes anti-coagulant medication. This may change when, how and even where a child is vaccinated. This team also asks generally if the child has any medical problems though so it could come up at that point. +- **fainting**: 1 of 3 pilot teams asks if the child is prone to fainting. children prone to fainting are brought for vaccination where they aren’t visible to their peers, to avoid setting off a chain reaction +- **any medical conditions**: 2 of 3 pilot teams ask if the child has any medical conditions. This doesn’t require parents to know whether their child’s particular condition causes immunosuppression or not. + +To standardise the questions we ask across all teams using Mavis, we would need to do two things: + +- identify, for each topic, whether to ask parents about this or not +- for the topics we will ask about, come up with a question wording that works for everyone diff --git a/app/posts/manage-vaccinations-in-schools/2025/01/hpv-mission-patch.md b/app/posts/manage-vaccinations-in-schools/2025/01/hpv-mission-patch.md new file mode 100644 index 000000000..971820197 --- /dev/null +++ b/app/posts/manage-vaccinations-in-schools/2025/01/hpv-mission-patch.md @@ -0,0 +1,8 @@ +--- +title: A mission patch for the HPV private beta +date: 2025-01-10 +--- + +The mission patch for the HPV private beta features Mavis watching the sun rise over the horizon, and represents the launch of our new service. + +![A circular badge featuring a polar bear watching a sunrise.](mission-patch.png) diff --git a/app/posts/manage-vaccinations-in-schools/2025/02/what-sais-teams-need-to-maintain-accurate-cohorts.md b/app/posts/manage-vaccinations-in-schools/2025/02/what-sais-teams-need-to-maintain-accurate-cohorts.md new file mode 100644 index 000000000..61589a5e4 --- /dev/null +++ b/app/posts/manage-vaccinations-in-schools/2025/02/what-sais-teams-need-to-maintain-accurate-cohorts.md @@ -0,0 +1,48 @@ +--- +title: What SAIS teams need to maintain accurate cohorts +date: 2025-02-07 +--- + +## Planning school visits + +At the beginning of the academic year, SAIS teams need to know how many children are in each school in their area so they can make a schedule for when they will visit each school and how they will staff the visits. At this point, complete accuracy is not so important as the records are mainly being used at the aggregate level. + +They also need to know about all the children who live in the area and don’t attend a school in a different SAIS region (homeschooled and not in education children). + +Regional SAIS areas sometimes map to either an ICS area or a Local Authority area and sometimes do not align with either. + +Contractually, SAIS cohort lists are produced by and sourced from CHIS and local authorities via the school census. The SAIS spec says that SAIS must source this information from CHIS, local authorities and schools. + +## Preparing for school visits + +Then, around a month before each planned visit to a school for a given programme (so on a daily basis every school day throughout the year) SAIS teams need lists of all of the children who are currently attending the school in the eligible year groups, so that they can send their parents a consent request for a school session in a month’s time. + +This needs to be the exact list of children attending the school as of that date, which can be different from the local authority / census list by several percent due to school moves throughout the year. It needs to include all children with or without a GP / NHS number. + +The SAIS spec requires that SAIS send the offer to 100% of eligible children so they can’t accept this list being out of date. + +SAIS teams have found that only the school itself has a timely enough view of this information. + +## Determining eligibility + +SAIS teams need their cohort records to include all the children in the year group at a given school, regardless of whether they are already vaccinated. They then need to know about each child’s vaccination history for the following vaccines: + +- HPV +- MenACWY +- Td/IPV +- MMR +- Flu + +including any doses they have already had, the dates of these doses and the dose sequence. + +SAIS teams need access to the details of all children in the age group and their vaccination history rather than just knowing about the unvaccinated cohort so that, for example, when a child presents in a school session, they can tell the difference between someone who is not eligible because they have already had the vaccine, and someone who is simply not on the list because they have recently moved, but whose parents should be contacted to get consent. + +## Contacting parents + +Finally, SAIS teams need to contact the parents of the eligible children in a school to send out the consent request to vaccinate at school. This is currently done based on contact information held by schools, who keep up to date contact information for every child, and not based on PDS, which has stale contacts for a proportion of children. + +## Existing ways of working + +Many SAIS teams already have direct access to CHIS systems in their area, from which they source the cohort information they need. Others have data sharing processes in place with CHIS and Local Authorities to receive this data at regular intervals. + +All SAIS teams rely on individual school level data to ensure a 100% offer, whether through the school sharing the records or the school sending out the offer on the SAIS team’s behalf. diff --git a/app/posts/manage-vaccinations-in-schools/2025/03/importing-menacwy-vaccination-history-into-mavis.md b/app/posts/manage-vaccinations-in-schools/2025/03/importing-menacwy-vaccination-history-into-mavis.md new file mode 100644 index 000000000..b75ea5ed1 --- /dev/null +++ b/app/posts/manage-vaccinations-in-schools/2025/03/importing-menacwy-vaccination-history-into-mavis.md @@ -0,0 +1,70 @@ +--- +title: Importing MenACWY vaccination histories into Mavis +date: 2025-03-25 +--- + +This post describes how we adapted Mavis to handle MenACWY vaccination histories and the issues we encountered when working with an early adopter School Age Immunisation Service (SAIS) team and their Child Health Information System (CHIS). + +## Background + +SAIS teams need children’s vaccination histories to determine who needs to be vaccinated. According to the CHIS specification (section 12.5.2, requirement CHISIM024), CHIS is required to provide these histories: + +> The system must be capable of providing lists of outstanding immunisations required by individual children. The list should include details of the child’s registered GP practice, Health Visitor cluster, School Health Team and Community Paediatric service where available. + +This capability is essential for supporting SAIS programmes effectively. + +## The problem + +When extending Mavis to support MenACWY vaccinations, we encountered several problems. + +### 1. Data access issues + +- No automated way existed for SAIS to download MenACWY vaccination histories from the CHIS’s IT system in bulk +- No standardised format had been agreed for exchanging this information +- The process to obtain sample data took over a month: + - Initial delays just to confirm data could be provided (CHIS team needed management approval) + - Further delays to receive the actual data +- These delays directly impacted our ability to finalise designs + +### 2. Confusion around available vaccines + +We found conflicting information about which MenACWY vaccines are currently in use: + +- NHS.UK guidance stated that MenQuadfi is the only MenACWY vaccine available in England +- The Green Book and Patient Group Direction (PGD) template indicated that three vaccines are approved: MenQuadfi, Nimenrix and Menveo +- Discussions with SAIS clarified that all three vaccines are approved, but selection often depends on cost: + - MenQuadfi will be used this year (and is the only one available for order from UKHSA through ImmForm) + - Nimenrix was used in previous years + +### 3. Incomplete and inconsistent CHIS vaccination records + +![Screenshot of spreadsheet showing vaccinate batch cells, some with batch number and vaccine name, some only with a batch number.](example-1.png) + +Based on the sample provided by CHIS, the historical vaccination data had significant inconsistencies: + +- Many records didn’t specify which MenACWY vaccine was administered: + - Some records included batch numbers and vaccine product information + - Others had batch numbers but no product details + - Some records were missing both batch and product information +- Additional missing or incorrect data included: + - Delivery site + - Dose sequence + - Correct care setting + +![Screenshot of a spreadsheet showing primary schools in the data.](example-2.png) + +Some vaccinations were incorrectly recorded as given in primary schools, though the MenACWY programme doesn’t involve primaries. We suspect this could have happened as a result of stale school information that hadn’t been updated when the child started secondary school, and incorrect assumptions made about where the vaccination took place. + +After the real vaccination data was imported for several schools on Production, it was discovered that the it was missing the vaccination history for Year 11s. We hypothesised that this mistake happened as a result of the manual nature of the report’s production. + +## How we changed Mavis in response + +Based on these findings, we made the following changes to Mavis: + +1. Made data importing more flexible by allowing vaccination records: + - Without vaccine and batch numbers + - Without the organisation that performed the vaccination + - Without a care setting + - Without a dose sequence + - Without a time of day +2. Setting up Mavis with all three approved vaccines (MenQuadfi, Nimenrix, and Menveo), while recognising that MenQuadfi will likely be the primary vaccine used in the current academic year. diff --git a/app/posts/manage-vaccinations-in-schools/2025/03/nhs-numbers-in-mavis.md b/app/posts/manage-vaccinations-in-schools/2025/03/nhs-numbers-in-mavis.md new file mode 100644 index 000000000..bbba2e19f --- /dev/null +++ b/app/posts/manage-vaccinations-in-schools/2025/03/nhs-numbers-in-mavis.md @@ -0,0 +1,24 @@ +--- +title: How NHS numbers are used in Mavis +date: 2025-03-20 +--- + +## Cohort records + +SAIS teams initially upload records for their eligible cohort into Mavis. These can be sourced from CHIS systems, in which case NHS numbers will be present, or from Local Authorities or schools, in which case they will not. + +Where records are uploaded without NHS numbers, Mavis performs an exact match NHS number lookup in PDS. When an NHS number can’t be found in PDS, this is flagged to the SAIS team to look up on the spine. + +We believe that implementing more complex query logic can improve Mavis’s PDS match rate and reduce this manual work - this work is currently at the top of our backlog. + +## Consent responses + +When parents fill out a consent response, Mavis does not ask for an NHS number. We made this design decision guided by research, during which parents told us that they didn’t know their child’s NHS number and might decide to go and hunt through paper documents to find it at this point. If even 10% of parents drop out of the consent journey because they intend to find out their child’s NHS number and then forget to return, this could have a significant impact on response rates. + +Instead, Mavis performs an exact match NHS number lookup in PDS for all consent responses. Where an NHS number can’t be found, Mavis tries to get a match to the SAIS team’s cohort records based on demographic details (name, date of birth, postcode, school) instead. Where this also fails, a member of the SAIS team is prompted to manually match to the right cohort record. + +Here, we had to make a trade off between parent pain points and staff pain points and concluded that the staff pain point was the least damaging to the service overall. We could potentially look at an A/B test to determine whether including an NHS number question affects response rates. + +## Downstream reporting + +NHS numbers are present in Mavis reports to CHIS and GPs, although they are not mandatory. diff --git a/app/posts/manage-vaccinations-in-schools/2025/04/doubles-mission-patch.md b/app/posts/manage-vaccinations-in-schools/2025/04/doubles-mission-patch.md new file mode 100644 index 000000000..5ef474a6c --- /dev/null +++ b/app/posts/manage-vaccinations-in-schools/2025/04/doubles-mission-patch.md @@ -0,0 +1,8 @@ +--- +title: A mission patch for the ‘doubles’ private beta +date: 2025-04-09 +--- + +The mission patch for the release supporting ‘doubles’ (co-administered MenACWY and Td/IPV vaccinations) features Mavis meeting her double. + +![A circular badge featuring two polar bears facing each other.](mission-patch.png) diff --git a/app/posts/manage-vaccinations-in-schools/2025/04/pre-screening-questions.md b/app/posts/manage-vaccinations-in-schools/2025/04/pre-screening-questions.md new file mode 100644 index 000000000..27379d933 --- /dev/null +++ b/app/posts/manage-vaccinations-in-schools/2025/04/pre-screening-questions.md @@ -0,0 +1,63 @@ +--- +title: Asking pre-screening questions +date: 2025-04-10 +screenshots: + items: + - Original design with radio buttons (for HPV) + - Updated design with checkboxes (for HPV) + - text: Updated design with checkboxes (for MenACWY) + caption: In this example, a nurse has manually checked all pre-screening questions prior to administering the first vaccination in the session. + - text: Updated design with checkboxes (for Td/IPV) + caption: In this example, a nurse is now ready to administer the second vaccination. The first question appears pre-selected because it was checked for the previous MenACWY vaccination. +--- + +Before administering a vaccine, a nurse needs to ask the child a number of pre-screening questions. + +These are separate from the health questions asked during the consent process, and are asked to ensure that no contraindications are present on the day of vaccination. This is the last opportunity for any new information to be given before vaccinating a child. + +The nurse needs to confirm that the child: + +- is feeling well +- is not pregnant (only asked for HPV and Td/IPV) +- is not taking any medication which would prevent vaccination (only asked for MenACWY and Td/IPV) +- has no allergies which would prevent vaccination +- has not already had the vaccination +- knows what the vaccination is for, and is happy to have it + +## Radio buttons versus checkboxes + +There are 2 possible ways we could ask pre-screening questions: + +- show each question followed by Yes/No radio buttons +- show a checkbox alongside each question + +We originally chose to use radio buttons as these are clearer, and also consistent with how we ask similar questions elsewhere in the service. + +However, on an already long and complex page, these took up considerable space and required a little more effort to answer. We updated the design to use checkboxes. + +## Pre-screening questions when multiple vaccines are being administered + +When multiple vaccines are being administered, most if not all pre-screening questions will be the same. A nurse will typically ask pre-screening questions for all the vaccines before proceeding. Not only is this quicker, but it also reduces the chance of a child refusing the second vaccination after completing the first. + +Because of this, we decided to pre-select the checkboxes for pre-screening questions for each subsequent vaccination being recorded for a child in a session. However, there is a balance to be struck, between making the vaccination journey efficient, and ensuring it is safe. + +Two of the questions are about the child’s current state (if they are feeling well and if they are pregnant) and the answers would apply to both vaccines. However, the remaining questions are vaccine-specific and the answers could potentially be different for each vaccine. It could therefore be considered a clinical risk to pre-check answers to these questions. + +We considered using a single set of questions covering all vaccines (for example, “Do you know what the vaccinations are for, and are you happy to have them?”). However, this would present problems if the answer was different for each vaccination. + +We updated the design to only pre-select the 2 checkboxes which ask about the child while leaving the others unchecked. + +| Question | Programmes | Can be pre-checked | +| - | - | - | +| Child is feeling well | All | Yes | +| Child is not pregnant | HPV, Td/IPV | Yes | +| Child is not taking any medication
which would prevent vaccination | MenACWY, Td/IPV | No | +| Child has no allergies which
would prevent vaccination | All | No | +| Child has not already had the vaccination | All | No | +| Child knows what the vaccination
is for, and is happy to have it | All | No | + +## Asking if a child is pregnant + +We originally displayed the pregnancy question for relevant vaccines when a child’s sex was female or unknown. However, this value can be unreliable (sometimes it is used to record the child’s sex, sometimes used to record the child’s gender). + +We updated the design to always display this question for the relevant vaccines regardless of the child’s sex. diff --git a/app/posts/manage-vaccinations-in-schools/manage-vaccinations-in-schools.json b/app/posts/manage-vaccinations-in-schools/manage-vaccinations-in-schools.json new file mode 100644 index 000000000..de437fc76 --- /dev/null +++ b/app/posts/manage-vaccinations-in-schools/manage-vaccinations-in-schools.json @@ -0,0 +1,5 @@ +{ + "eleventyNavigation": { + "parent": "Manage vaccinations in schools" + } +} diff --git a/app/styles/application.scss b/app/styles/application.scss index 7bed802fb..0c2e6d158 100644 --- a/app/styles/application.scss +++ b/app/styles/application.scss @@ -10,6 +10,7 @@ eleventyExcludeFromCollections: true src: url("https://assets.nhs.uk/fonts/FrutigerLTW01-55Roman.eot?#iefix"); src: url("https://assets.nhs.uk/fonts/FrutigerLTW01-55Roman.eot?#iefix") format("eot"), url("https://assets.nhs.uk/fonts/FrutigerLTW01-55Roman.woff2") format("woff2"), url("https://assets.nhs.uk/fonts/FrutigerLTW01-55Roman.woff") format("woff"), url("https://assets.nhs.uk/fonts/FrutigerLTW01-55Roman.ttf") format("truetype"), url("https://assets.nhs.uk/fonts/FrutigerLTW01-55Roman.svg#7def0e34-f28d-434f-b2ec-472bde847115") format("svg"); } + @font-face { font-display: swap; font-family: "Frutiger W01"; @@ -30,3 +31,43 @@ $govuk-font-family: Frutiger W01, arial, sans-serif; .govuk-body { line-height: 1.47368; } + +.app-prose-scope { + // Simulate design used in NHS design system + figure { + @include govuk-responsive-margin(6, "bottom"); + @include govuk-responsive-margin(6, "top"); + + background-color: govuk-colour("white"); + border-bottom: 1px solid #d8dde0; + } + + figcaption { + @include govuk-typography-responsive(16); + color: $govuk-text-colour; + margin-top: 0; + padding: govuk-spacing(3); + + * { + @include govuk-typography-responsive(16); + } + + :last-child { + margin-bottom: 0; + } + } + + // Improve display of mission patch images inside figures + figure:has(img[src$="mission-patch.png"]) { + background-color: transparent; + border: 0; + + img { + outline: 0 none; + } + } + + video { + max-width: 100%; + } +} diff --git a/eleventy.config.js b/eleventy.config.js index c5bb4ea3d..e5ecb6483 100644 --- a/eleventy.config.js +++ b/eleventy.config.js @@ -78,15 +78,19 @@ module.exports = function (eleventyConfig) { }) // Vaccination collections - eleventyConfig.addCollection('book-a-vaccination', collection => { + eleventyConfig.addCollection('book-a-vaccination', collection => { return collection.getFilteredByGlob('app/posts/book-a-vaccination/**/*.md') }) + eleventyConfig.addCollection('manage-vaccinations-in-schools', collection => { + return collection.getFilteredByGlob('app/posts/manage-vaccinations-in-schools/**/*.md') + }) + eleventyConfig.addCollection('manage-your-appointments', collection => { return collection.getFilteredByGlob('app/posts/manage-your-appointments/**/*.md') }) - eleventyConfig.addCollection('record-a-vaccination', collection => { + eleventyConfig.addCollection('record-a-vaccination', collection => { return collection.getFilteredByGlob('app/posts/record-a-vaccination/**/*.md') })