Experts weigh in on the factors that healthcare system leaders must consider in distributing new COVID-19 vaccines to their workers.
At least 200,000 U.S. healthcare workers have been infected with the coronavirus.
Healthcare professionals have been on the frontlines of the COVID-19 crisis since the virus first arrived on U.S. shores, caring for and coming in close contact with infected and potentially infected patients in crowded hospitals and healthcare systems on a daily basis.
Help is on the way.
In December, the Food and Drug Administration (FDA) approved the Pfizer-BioNTech coronavirus vaccine for emergency use, with the first doses being administered within days of the vaccine’s approval.
Less than one week later, the FDA authorized use of Moderna’s vaccine against COVID-19 individuals 18 years of age or older. The U.S. government ordered a total of 200 million doses, retaining the option to purchase up to an additional 300 million.
As of late December, more than one million U.S. individuals had received their first COVID-19 vaccination. Many of those receiving these first rounds of vaccines are the very healthcare professionals who have been among those at the greatest risk for the coronavirus over the past 11 months.
Distributing the vaccine quickly and on a large scale is not without its difficulties, of course, and hospital and healthcare system leadership has a variety of factors to weigh in rolling out vaccinations to their workforce. With these challenges in mind, we asked experts to provide some guidance.
Obstacles to overcome
There are indeed many variables for healthcare system leadership to consider as vaccinations become available to healthcare personnel.
At the moment, the sheer number of healthcare workers in need of vaccinations presents a hurdle to overcome, says Anjali Kataria, CEO of Mytonomy and a former FDA official.
“One of the biggest challenges is that there are not yet enough doses of the vaccine (both combined) to cover all the healthcare workers and senior citizens who are high priority and high risk,” says Kataria. “So, leadership in hospitals across the country are figuring out how to determine who will get vaccinated in this first group.”
Being forced to categorize employees into such groups puts healthcare system leadership in a difficult position as well, says Kataria.
“It’s tough, because, as a leader, you want to take care of all of your people at once, and make sure everyone feels equally valued. And, though more and more vaccine doses will be available, tough decisions have to be made right now, based on fact, science and risk,” she says, noting that most hospitals are vaccinating frontline workers and those exposed to COVID-19 patients first, while some are using lotteries and/or doing voluntary sign-ups for vaccinations.
Indeed, categorizing workers to determine who will receive vaccinations and when—and communicating this plan to the workforce—presents a challenge for administration, says Lindsay Boyd, RN, MS, CCRN-K, sepsis and infection prevention clinical nurse specialist at the University of Washington Medical Center.
“There is the consideration of how to bring as many people as possible through the clinic as the vaccine allotment allows,” she adds, “with appropriate spacing for staffing and social distancing needs.”
Even identifying an appropriate location to set up vaccine distribution can create quandaries.
“Many facilities don’t have readily available space that’s large enough to accommodate numerous vaccine stations and meet social distancing standards,” says Boyd.
Planning and prioritizing
Rapidly vaccinating any population is a significant logistical challenge in and of itself, says Steve Arner, chief operating officer at Carilion Clinic, a Roanoke, Va.-based non-profit integrated healthcare organization.
At Carilion Clinic, the leadership team “wanted to ensure we had provided up-to-date information and answered questions our team had about the vaccines” once they were approved for use, he says.
“So we’ve focused on providing forums to ask questions of the experts, as well as a central hub with videos, documents and other information. This has been effective for us in encouraging vaccinations.”
As is the case with any rapid deployment, there are many unknowns that must be planned around—when the vaccines will arrive, how many the facility will receive and scheduling vaccines, for example.
“We’ve chosen to be conservative in our planning, expecting less and hoping for more,” says Arner. “This has enabled us to scale our plans when needed.”
“First and foremost, we wanted frontline healthcare workers who are regularly engaging with COVID-positive patients and potentially positive patients in our facilities to receive the vaccine. Beyond that group—which is a pretty significant number of our employees—we set out to vaccinate healthcare workers in our ambulatory practices and other locations who interact with patients.
“For us,” continues Arner, “throughout the pandemic it has always been about taking care of those most at-risk for contracting the virus through their work. Our approach to vaccination is no different.”
Keeping employees informed
Administrators must also be careful to ensure healthcare personnel have accurate information concerning the vaccines.
“There are a lot of myths out there, i.e., that the vaccine might not be safe or work well, and the facts are that these vaccines have efficacy in the mid-90 percent [range],” says Kataria.
“This is really great news. It means that they are likely going to work for 95 percent of all the people who take them,” she says. “They also passed all the safety requirements set by the FDA that all vaccines go through. Every COVID-19 vaccine went through all phases of development and was tested and studied on tens of thousands of people.”
Some selfless healthcare workers might also need reminding that they have to be healthy in order to properly care for patients.
“Now more than ever, we need our healthcare workers to put themselves first and get comfortable with taking the vaccine,” says Kataria. “Because, to use the airline analogy, when they ‘put their oxygen mask on first,’ they can take care of the rest of America, who needs them [to be] better, and ensure they aren’t spreading the infection innocently to their own family and friends.”
Communication is key and messaging is important in order to ensure that employees understand the facts about the vaccines.
“And it’s not just the frontline health workers,” says Kataria. “We need to ensure we are including the cleaning staff, the front desk, the patient navigators and so on. It’s all healthcare workers.”
Leaders must be frequently communicating, and they also need to rely on others’ input to successfully distribute vaccinations, says Boyd.
“The hospital and healthcare system leadership can overcome hurdles by identifying the stakeholders, listening to key input and working with a multi-disciplinary team to ensure efficient and safe implementation of the overall plan,” she says. “Leadership also needs to continually revise the process through models such as the Plan-Do-Study-Act quality improvement cycle. The workflows will change as new information, new availability comes in and vaccine capacity ramps up.”
At the University of Washington Medical Center, “one lesson we’ve learned in 2020 was to remove ‘this is the way we have always done it’ from our vocabulary, and to truly think outside the box. The only constant in COVID times is change, and the system must adapt accordingly.”
As any other individual receiving the vaccine might, healthcare personnel could have the same types of reactions—redness or tenderness at the injection site, body, head or joint aches, swollen lymph nodes, fever and fatigue, for instance.
These are just possible symptoms that might last for a few days, and are manageable, says Kataria.
“Compared to the devastation and loss of life that we are currently experiencing, it doesn’t seem like a lot to endure these possible side effects for a short time period,” she says, noting that Mytonomy offers a set of educational resources for staff who are making decisions as to whether to get vaccinated.
Healthcare personnel should self-monitor for post-vaccination symptoms, “just as we have been monitoring for signs of COVID-19 for the past several months,” adds Boyd, pointing out that symptoms such as localized pain at the injection site is common and can often be resolved by non-pharmaceutical interventions and/or over-the-counter medications.
“Symptoms extending beyond this need to be treated in the same way we have been approaching possible COVID symptoms. If you are experiencing any [symptoms], you need to follow your hospital or healthcare system’s protocol with regard to reporting symptoms and ability to be at work,” she says, noting that symptoms can be self-reported to the CDC.
Boyd also urges those experiencing symptoms that warrant care to seek out their primary care provider, urgent care or an emergency department for more pressing evaluation needs.
Washington University Medical Center has constructed a clinic in the hospital’s main lobby to administer vaccines to WUMC workers, and the reported adverse effects the facility has seen “are quite low” and have subsided fairly quickly, says Boyd.
Within days of setting up, temporary walls were added, “and we were able to have a smoothly functioning clinic running.”
“It has been absolutely incredible to see the teamwork come together, and to see everyone contribute to this life-saving work. There are clear feelings of elation, newfound hope and relief in those coming in to get vaccinated,” says Boyd, noting that the arrival of COVID-19 vaccinations has presented the facility’s employees an opportunity to deal with the complex feelings that the coronavirus pandemic have brought up for so many in the healthcare profession.
“The vaccination process seems to be opening up emotions for people related to how rough this year has been. We are implementing a reflection card in our observation area to allow staff to use this time to journal on their reflections and emotions from a year we will never forget.”
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