OR WAIT null SECS
The best way to issue flu shots might be for patients to never enter your office.
The COVID-19 pandemic has added a wrinkle to my pediatric office’s plans to administer more than one thousand influenza vaccines to our patients and their parents.
In previous years we would put families in an exam room, administer the shot or live nasal vaccine, and send everyone back out through the waiting room packed with other families awaiting their turn. We did this both during regular office hours and also during some after-hours times in the evening and on weekends.
This traditional approach will not work this year for several reasons:
The requirement for social distancing means we can’t have several families waiting in the reception area for their turn in an exam room.
Time between each family would now need to be built in, drastically reducing the number of persons we could vaccinate per hour.
Cleaning all the surfaces in a room between each family’s use — something not required previously — would also add time and expense.
So, here in Raleigh, North Carolina, we have come up with a plan.
We have all seen pictures on TV of long lines of cars with people waiting their turn for a COVID-19 test or picking up some free groceries for the unemployed. Why would this drive-through approach not work for your office in giving vaccines?
Find an empty parking lot
If your office is in a commercial building, check with your landlord or fellow tenants to see whether you could commandeer the parking lot for a Sunday morning or afternoon or both. A school parking lot on a weekend morning or a large church’s parking area during the week are also options, but you would need to obtain permission.
Pick a date with a backup plan for inclement weather
You may want to have some tents for your staff and proceed even if it rains. Or, have an alternate date and time. We intend to set our date up on a Saturday afternoon with a plan to move it back 24 hours to Sunday afternoon should it rain.
Get the word out
Tell your patients about your plan for a drive-through vaccination clinic. Social media, your website, your on-hold phone message, signs in your office, and e-mail blasts to all your patients are some options to consider. A press release to your local paper or TV station might lead to some free publicity at the risk of having nonpatients show up on the day of the clinic.
Offer appointment times
Appointments avoid traffic jams and ensure you have enough supplies on hand on the day. I would suggest one car every five minutes. Some cars will have a single person wanting a vaccine and some may have four or five. For our office I think the average will be between three and four people per car.
We will be offering either the shot or the nasal vaccine. Both take about the same amount of time to administer to a cooperative patient. Children will be left in their car seats. A parent may be required to hold their arms, and car doors may need to be opened.
Have your front office staff print out the appointment log
Print it out for next day’s staff the day before the clinic. We plan to have a preprinted sheet for each car with lines for each scheduled patient or parent and a few empty spaces in case of an unexpected extra. As the administration site of the vaccine is supposed to be recorded, four choices for the nurse to circle will be present next to each name — left arm, right arm, left leg and right leg — which cover the four extremity choices in pediatrics. Adult patients require just two, right arm and left arm.
Each preprinted sheet will have the initials of all staff administering the vaccines because that information also must be recorded. Additionally, the sheet must have a list of the vaccines being offered. As we won’t need any vaccines for patients older than age 65, we will simply list the shot or live attenuated influenza vaccine as options for the nurse to circle. The administering provider will circle their initials, the vaccine given, and the location of administration.
Get your supplies together
You will need PPE for your staff, alcohol wipes, Band-Aids, antiseptic hand gel for use between cars for staff, sharps containers, an emergency medical kit with epinephrine available, tables and chairs for staff, and proper storage gear for the vaccines. We will be using prefilled syringes to save time. A laptop on site will allow you to remotely access electronic medical records if required. The CDC has guidelines for off-site vaccine clinics and proper storage requirements at this link: https://www.cdc.gov/vaccines/hcp/admin/mass-clinic-activities/.
Set up two stations in the parking lot,
One is for check-in and one for administration, on your clinic day.
At the check-in station, a staff member will confirm who in the car is receiving vaccinations. Your preprinted sheet will have the names already listed, but you will have to expect some no-shows and also be ready to add someone extra. Names of no-shows will be crossed out and an extra person’s name can be added to the sheet, which will eventually be required for billing.
Vaccine Information Statement sheets should be available here and offered. If you have standard screening questions, this is the place and time to ask them. When check-in is complete, the staff member will hand the driver the preprinted sheet and direct them to the administration station ahead.
Have the nurse collect the preprinted sheet at the administration station
Ask if any other questions need to be answered, and vaccinate those patients who are on the sheet. If the driver is receiving a vaccine, you may want to suggest they pull over into a parking space for 15 minutes to cover yourself from a medical-legal point of view in case of syncope. Someone from your office will need to monitor those spaces. The vaccine administrator then circles the initials, the vaccine given, and the site and saves the sheet for later when information is entered into the medical record and billing. You may wish to have some preprinted sheets available for those patients requesting a copy of what they received (eg., as proof for an employer).
Our office is planning to do a trial run with 12 cars the week before we have our mass clinic(s). Most likely, we will need to modify some things. In pediatrics, we always have a few resistant, uncooperative school-aged children dragged to the office by their parents. In previous years we would leave such families alone in the exam room for that parent-child discussion that can sometimes take 15 minutes. When this happens this year, we will give the vaccine to everyone willing in the car, then the family will be required to get out of line and go back through the check-in line when they think their child is ready.
COVID-19 has caused a lot of changes in our lives. We have all had to think outside of the box and make changes to long-established routines. Some of those changes may end up being for the better (eg., an elbow bump instead of a handshake).
Hopefully, we will find that this drive-through clinic works out better than our old way of doing things.
Terry Brenneman, MD, is a pediatrician and the founder of Pediatrics Partners in Raleigh, North Carolina.