Providers’ Take on the First Week of the COVID-19 Vaccine

Vaccine developments continue to move at warp speed.

Last week the Food and Drug Administration (FDA) issued an emergency use authorization for the Pfizer/BioNTech COVID-19 vaccine – and approval for Moderna’s COVID-19 vaccine is expected in the coming days.

Following FDA signoff, rapid vaccination rollout has begun with Premier member hospitals and other facilities across the country beginning to administer the first doses to patients. Thursday afternoon, Premier tapped a diverse roster of health system and long-term care facility (LTCF) pharmacy leaders from across the nation to discuss their initial experiences in COVID-19 vaccine receipt and administration on a member webinar.

Panelists say their COVID-19 vaccine preparedness is paying off, from staggered appointments for their healthcare workers to practice dry runs unpackaging, reconstituting and administering the vaccine.

Panelists included pharmacy leaders from University of Louisville Health (Louisville, KY), Henry Ford Health System (Detroit, MI), Kuakini Medical Center (Honolulu, HI), North Oaks Medical Center (Hammond, Louisiana), Northwell Health (Manhasset, NY), PharMerica (LTCF Pharmacy) and Riverside Health System (Newport News, VA).

Below are the key takeaways and best practices from the panelists on their COVID-19 vaccine rollout efforts, including population prioritization, logistics and administrative considerations.

Prioritization

Approximately 40 million doses of Pfizer and Moderna vaccines are expected by the end of 2020, enough to immunize 20 million people. Official guidance from the Centers for Disease Control and Prevention (CDC) on priority phase 1A populations is 21 million healthcare workers and 3 million residents and staff in nursing homes and other LTC facilities.

As health systems gain a clearer picture of their specific allocations, 73 percent of Premier members have prioritized healthcare workers as the first group to receive the vaccine, according to a Premier member survey conducted Dec. 3 through Dec. 17.

Most are giving precedence to frontline staff on COVID-19 units as well as emergency departments and ICUs ─ administering vaccines first to those with direct patient contact, those handling infectious material and to personnel who provide services to patients or their families.

To help identify these individuals and better understand their risk, one pharmacy leader discussed the development of a priority matrix that factors in role, COVID-19 case prevalence, patient interaction level and individualized risk factors such as age. From there, the information is run through an algorithm to help ensure fair and equitable access, and individuals with higher risk scores are scheduled for vaccine administration first.

Variability in allocations was also prevalent among the panelists ─ one large health system discussed a greater-than-anticipated vaccine supply and its pivot to now focus on throughput improvement and adding clinic locations. Another pharmacy leader gave the LTCF perspective: “There are differences by state department of health (DOH), and even district, on the approach for prioritization of skilled nursing facilities (SNFs) and assisted living facilities (ALFs). Some states have chosen to begin wholly with SNFs while others have chosen to prioritize both SNFs and ALFs at the same time, and this poses a challenge as many of those are on the same congregate care living campus.”

Collectively, the panelists agreed on the importance of staggered and pre-scheduled appointments, including second-dose vaccinations, for staff from the same discipline to avoid any major impacts to one unit. “While significant side effects are rare, this vaccine is new. We’re working with our nurse managers and other unit leaders to take an active role as it’s important we don’t vaccinate one large unit, like the ICU staff, at the same time.”

Logistics

Eighty percent of health systems have designated a specific location within the health system for vaccine administration ─ and 85 percent have identified staff to manage the vaccination process, according to the same Premier member survey.

Although, with COVID-19 cases surging across the country, one pharmacy leader talked about limiting the number of people on health system campuses and pursuing more off-site vaccination clinics with convenient hours and locations ─ and in accordance with CDC and state DOH regulations.

To enhance throughput at vaccination locations, one panelist highlighted leveraging electronic consent forms front-loaded within the electronic health record (EHR) and asking patients to complete them while scheduling the first vaccine appointment. However, for most LTC facility patients, consent is more complicated given the paper forms, manual processes and, many times, the longer-lead times needed to contact powers of attorney or other responsible parties.

Given the critical nature of second-dose adherence, 56 percent of Premier members are also implementing a multi-pronged strategy for second-dose scheduling, including scheduling at the time of the first dose; issuing the patient vaccine card/reminder from the vaccine kit; and email, call or text reminders. “My team developed a scheduling app that’s easy to use,” one panelist said. “This gave our department responsible for administration a real-time schedule and a clear understanding of vaccine quantity to request from ultra-cold storage to the fridge, helping us minimize waste.”

Vial “over-fill” is also a hot topic as pharmacists are finding that they can squeeze an additional dose from some of the Pfizer glass vials. While overfill guidance from the FDA and Pfizer is starting to emerge, questions remain given anticipated details from the CDC as well as the lag in specific state DOH recommendations.

On dose preparation and reconstitution, various facilities are designing processes to meet their specific needs. Some pharmacists are preparing doses in batches for a quick transfer to various vaccination sites – “Doses are being prepared by the pharmacy, but we're in constant communication with our vaccination sites” – while others are reconstituting at the point of care, drawing up a patient-specific dose.

Post-vaccination, most organizations are following the CDC-recommended 15 minutes of patient observation, but panelists agreed on the continued need to monitor nationwide vaccination efforts and potential side effect trends to inform decision-making in the future.

Administrative

Overwhelmingly, the pharmacy leader panelists spoke passionately about getting vaccinated and stressed the importance of leadership by example ─ with outreach and education work underway to help alleviate concerns among those who are skeptical about receiving the vaccine.

On challenges with interest and uptake as well as motivating employee and patient populations, here’s some direct perspective from a few of our panelists:

• “This is the beginning of the end of this pandemic. Some people are hesitant because it's new science and an emergency use authorization. I participated in Pfizer’s clinical trials as did my 17-year-old son. I meet with staff across departments, talk about my experience and answer questions ─ it's interaction by interaction, unit by unit ─ and it makes a difference.”

• “Promoting vaccine safety and education is a major priority for us. Our chief medical officer has offered to have any discussion with any staff member to ensure everyone feels comfortable. They also scheduled themselves to be first in line as well.”

• “When we found out we were the first in the nation to immunize a frontline healthcare worker, it was absolutely unbelievable. People asked us: was it important to be no. 1, how'd you do that? We actually weren’t even aware we were first. It wasn't important to be no. 1; it was important to get the vaccine to our frontline healthcare workers. We have administered over 1,000 vaccinations to-date, and we’re continuing to scale up every day. So far, we’ve been thrilled by the number of our employees who want the vaccine.”

As COVID-19 vaccine rollout continues and more candidates come online, Premier will continue to share education, best practices and solutions ─ while working closely with our members to help ensure this substantial national campaign runs as smoothly as possible.

• Listen to the full member webinar on COVID-19 vaccine receipt and administration best practices (members only).

• Listen to the Nov. 19 member webinar on COVID-19 vaccine preparedness efforts (members only).

• Members can view our regularly updated FAQ sheet, providing intelligence on the various vaccine candidates, storage and handling requirements, distribution information and more, and visit the Pharmacy Community on PremierConnect® for more information.

• Read the latest on the vaccine development and rollout in our Newsroom.

Further reading.

• How Health Systems Are Preparing for a COVID-19 Vaccine
• Four Key Considerations for a Successful COVID-19 Vaccination Program
• Are Providers Ready for a Third Wave of COVID-19?