Weitzman ECHO on COVID-19, live on March 31 2021

1. Staff Roles, Responsibilities, and Training
for COVID-19 Vaccination Clinics
March 31, 2021

2. Continuing Education Credits
In support of improving patient care, Community Health Center,
Inc./Weitzman Institute is jointly accredited by the Accreditation Council
for Continuing Medical Education (ACCME), the Accreditation Council for
Pharmacy Education (ACPE), and the American Nurses Credentialing
Center (ANCC), to provide continuing education for the healthcare team.
This designation confers simultaneous continuing education
accreditation across nine national accrediting bodies.
This series is intended for physicians, nurse practitioners, nurses,
physician assistants, psychologists, clinical social workers, dentists,
pharmacists, and dietitians.
Please complete the survey – linked in the chat, and emailed to all
attendees – to request your continuing education credit for live viewing.
A comprehensive certificate will be sent out at the end of the series.

3. This week’s COVID-19 ECHO session
is a collaboration with
This resource is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant
number U30CS29049 entitled "Training and Technical Assistance National Cooperative Agreements (NCAs)" for grant amount $2,045,000 with 0% financed with
non-governmental funds. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor
should any endorsements be inferred by HRSA, HHS or the U.S. Government.

4. Disclosure
• With respect to the following presentation, there has been no relevant
(direct or indirect) financial relationship between the parties listed above
(or spouse/partner) and any for-profit company in the past 12 months
which would be considered a conflict of interest.
• The views expressed in this presentation are those of the presenter and
may not reflect official policy of Community Health Center, Inc. and its
Weitzman Institute.
• We are obligated to disclose any products which are off-label, unlabeled,
experimental, and/or under investigation (not FDA approved) and any
limitations on the information hat I present, such as data that are
preliminary or that represent ongoing research, interim analyses, and/or
unsupported opinion.

5. COVID-19 Update in the United States
March 31, 2021
Stephen Scholand, MD
Infectious Disease Specialist, Midstate Medical Center

6. 30,349,019 cases on 3/30/21 with 550,371 deaths
https://coronavirus.jhu.edu/us-map
COVID-19 in the United States

7. https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html
Now
going up

8. https://coronavirus.jhu.edu/covid-19-daily-video

9. How many ‘jet liners’? A320 seats 182 passengers

10. Pressure on Hospital Systems
https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html

11. The Danger of Variants
• Two more variants have approximately 20% more
transmissibility than preexisting variants
– B.1.427
– B.1.429 (first detected in CA)
• Classified by the CDC as “variants of concern”

12. • Two doses of the AZD1222 vaccine had no efficacy against mild-to-
moderate symptomatic COVID-19 caused by the B.1.351 variant
• These findings reinforce the need to continue nonpharmacologic
interventions despite vaccination (i.e. masking, socially distancing, hand
washing) until SARS-CoV-2 is no longer at large
The Danger of Variants
Carlos del Rio, MD, reviewing
Madhi SA et al. N Engl J Med
2021 Mar 16

13. www.cdc.gov/coronavirus/2019-ncov/transmission/variant-cases.html

14. COVID-19 Vaccinations Across the Nation
https://covid.cdc.gov/covid-data-tracker/#vaccinations

15. https://covid.cdc.gov/covid-data-tracker/#vaccinations

16. Trusted Resources
• Nuvance health 2500+ articles reviewed:
https://spark.adobe.com/page/UZKkcCzp4vjWP/
• CDC:
https://www.cdc.gov/coronavirus/2019-ncov/index.html
https://emergency.cdc.gov/coca/calls/2021/
• WHO:
https://www.who.int/emergencies/diseases/novel-coronavirus-2019
• Johns Hopkins:
https://coronavirus.jhu.edu/map.html
• Others
https://www.thelancet.com/coronavirus
https://covidactnow.org/

17. Staff Roles, Responsibilities, and Training
for COVID-19 Vaccination Clinics
Amanda Schiessl, MPP – Project Director, National Cooperative
Agreement on Clinical Workforce Development
Community Health Center, Inc.
Kate Gager – Patient Experience Supervisor
Community Health Center, Inc.
Mette Smith, MS, LSSBB, CPHQ – VP, Practice Administration
Community Health Center, Inc.

18. Clinic Types
Drive-Through
– Vaccinate large patient populations
Fixed Site
– Convenient for patients who may not have the ability to travel to a
drive-through clinic, or who are hesitant about the vaccine
– Offers familiarity and access
Mobile Events
– Operate through community partners
– Homeless shelters, congregate housing, church groups, community
organizations, public housing authorities, schools

19. Drive-Through
Staffing
Onsite
• Logistics – segmented roles
• Vaccinators
• Site Leads – oversees on-site COVID vaccine site
• Clinical Lead – responsible for overall vaccine
management
• Medic – responds to request for medic evaluation
• Registration Support (Remote)

20. Site Lead • Oversees on-site COVID vaccine site
• Assists with on-site onboarding and training of team members
• Conducts morning huddles and afternoon debriefs with staff and leadership
• Prepares for daily site opening and responds to a wide variety of mid-day needs
• Scans and shreds pre-vaccination questionnaires daily
• Reviews inventory and submits requests to Purchasing for supplies
• Escalates press inquiries, patient feedback, questions, or concerns to Senior
Leadership as needed
Leadership / Operations

21. Nursing Lead • Responsible for overall vaccine management
• Conducts morning huddles with vaccinating staff, including assignment of trailers, paying
particular attention to newly added staff to ensure appropriate orientation
• Documents routine emergency medication and equipment checks daily in logbook, along
with twice-daily temperature checks of fridge/freezer.
• Responds to questions and clinical issues that come up throughout the vaccinating day
• Responds with the Medic as needed and as able to support emergency response
• Carries out End of Day process in collaboration with Site Lead to ensure zero wasted vaccine
doses
• Completes inventory reconciliation at the end of the vaccinating day
• Receives vaccine orders as the come in, and adds to inventory immediately
• Escalates clinical concerns, including temperature excursions, doses soon to expire, adverse
clinical outcomes and concerns and other issues to the applicable Clinical Director
immediately and as needed
Medic • Respond to requests for medic evaluation
• Leads patient transport efforts if warranted
• Completes appropriate documentation on all encounters
• Completes incident report if applicable
• Equipment – Emergency Bag, O2, AED, Emergency Medication Bag

22. Station Duties
Equipment /
Access Needed
A
Checks whether patients have an appointment and is eligible:
• Marks patient as arrived
• Directs patient to the appropriate lane (red, blue, or exit lane)
• Directs early patients (more than 30 minutes prior to appointment time)
to waiting area
• Connects with remote Registration Support to locate patients not listed
on the sheet
Enhanced iPad (with Google
Sheets and Zoom)
B
Asks if patient has ever been prescribed an EpiPen. Depending on answer:
• Places car topper on roof (if no) or hood (if yes)
• Blue car toppers denote VAMS self-scheduling (standard clinic)
• Red car toppers denote 211 scheduling (3rd party clinic)
• Provides red patients with the paper pre-vaccination questionnaire and
vaccine EUA document
Car toppers, step stool,
vaccine EUAs, pre-
vaccination questionnaires,
cardboard backers, pens
C
• Directs cars to the appropriate vaccination lane
• Ensures cars are evenly allocated / being mindful of delays in lanes and
lane closures
N/A
D
• Checks patients into their appointment
• Verifies demographic information
Enhanced iPad (with Zoom)

23. Station Duties
Equipment /
Access Needed
Vaccination
Trailers
• Locates patient in VAMs.
• Reviews clinical questionnaire responses (paper or in VAMS)
• Administers vaccine if clinically appropriate, documents in VAMS,
and gives vaccine card to vaccinated patient
iPad, VAMS Healthcare
Provider access (standard
and 3rd party)
E
• Writes vaccine time on each car topper
• Assists cars merging as needed
• Directs patients with car toppers on roof to slowly drive to site exit
for 15 minute wait; Directs patients with car toppers on hood
(known allergy) to waiting area staffed by Station F
• Calls for Medic as needed
Dry erase marker and eraser,
step stool,
watch/phone for time,
training on call for Medic.
F
• Ensures known allergy patients enter special waiting area.
• Monitors patient for 30 minutes, rounding on cars to liaise with
Medic as needed for questions/concerns. Calls for Medic as
needed.
• Directs patient to exit site once their waiting period is completed.
Watch/phone for time,
training on call for Medic
G
• Watches the flow of cars in the lazy river / lanes.
• Calls for Medic as needed.
Training on call for Medic
H
• Ensures cars have waited the required the 15 minutes.
• Removes and wipes off all car toppers.
• Provides patient with a CHC card and sticker.
• Directs patient to exit site.
Watch/phone for time, dry
eraser marker, step stool,
CHC 4x6, vaccine sticker,
training on call for Medic

24. Integrating Scheduling Pathways/Systems
• Online Self Scheduling
• Statewide Phone System
• Pre-Registered Patients Mobile Events/Special Events
CT Vaccine
Assistance
Phone Line
VAMS Self-
Scheduling
Mobile Event
Patient Lists
CT Vaccine
Assistance Online
Scheduling
VAMS
3rd Party
Clinic
VAMS
Open Clinic

25. Appointment Check-In Lists for Clinics
• Export data from all scheduling sources
• Compile into one list
• Create ‘check-in list’ with minimum necessary PHI
• Full report in secured folder with limited access
Arrived Appt Time Last Name First Initial Lane Reg Source Notes
8:30 AM Smith A MODERNA 211
8:30 AM Smith C MODERNA 211
8:30 AM Rodriguez B MODERNA 211
8:30 AM Jones A PFIZER VAMS
8:30 AM Chu C PFIZER 211
8:30 AM Sanchez M MODERNA VAMS

26. Pre-Registration for Events
• Provide partners with blank excel template with
required data fields
• Provide times/slots as part of the blank spreadsheet
• Uploaded to VAMs via third-party clinic before event

27. Real Time Registration Support
(Remote)
• Operational staff on Zoom room
• Providing real-time problem solving for mass vax sites
• End of day reconciliation
• Identify patients that are scheduled at the drive-
through clinics for the wrong vaccine and supporting
rescheduling

28. • Screeners at door
• Registration
• Observers
− Post-vaccine observation period and rooming
• Vaccinators
Onsite Clinics

29. • Placed at all entrances to screen and assess everyone who
enters
• Upon individual presenting for their COVID vaccine, door
screener will:
– Offer mask to patients who present without a mask or face covering
– Verify vaccine appointment time
• Individuals allowed to enter the building no more than 5
minutes prior to scheduled appointment time
• Ask the recipient to show you the text message/email
appointment confirmation
– Take temperatures and ask the COVID screening questions
Screener

30. 1. Have you tested positive for COVID-19 or been exposed to anyone who has?
2. Have you traveled outside of CT within the last two weeks?
3. Are you having any flu-like symptoms, diarrhea, nausea or vomiting, new loss of
smell or taste?
4. Are you having any of the following additional symptoms?
 Fever > 100.1F (37.8C)
 Chills
 Cough
 Shortness of breath or difficulty breathing
Patients will need a nurse triage visit if they:
• Tested positive for COVID-19
• Were exposed to anyone who has tested positive for COVID-19
• Are exhibiting symptoms consistent with COVID-19
COVID-19 Screening Questions
 Fatigue
 Sore throat
 Runny nose or Congestion
 Muscle or body aches
 Headache

31. Supplies and PPE Needed for Screener
• Face shield or goggles
• Surgical masks
• Gloves
• Hand sanitizer
• Tympanic thermometer or other
• Alcohol wipes and/or disinfectant, such as Cavicide
Spray
• Post-It note pad and pen

32. • Locate the recipient in system VAMS/Practice Management
System
• Verify and update the recipients information
OR
• Create new recipient record if one does not already exist
• Schedule the first and second dose visits in scheduling system
• Check-in the recipient
• Provide Emergency Use Authorization Form and Pre-Vaccination
Questionnaire
Registration
1 Registration Associate to 80 vaccines

33. • Second dose appointments must be scheduled no sooner than,
but as close to:
– 28 days after their initial dose (Moderna)
– 21 days after their initial dose (Pfizer)
• Vaccines are supplied in multi-dose vials of:
– 10 vaccines per vial (Moderna)
– 5 vaccines per vial (Pfizer)
• An open vial must be used within 6 hours of opening
• To prevent vaccine wastage:
– Registration must monitor the schedule
– Ensure recipients are scheduled in groups of 10 (Moderna)
or 5 (Pfizer)
Registration Scheduling Second Dose

34. End of Day ‘No Wastage’ Policy
• Registration should:
– Huddle with nurse at the beginning of morning and afternoon
shifts
– Review number of recipients seen/scheduled as compared to the
number of available slots
• If extra doses at the beginning of the afternoon shift exist:
– Team should contact the COVAC Scheduling Team
– CHC will call recipients scheduled in the future/waitlisted patients
per the no-wastage policy and document steps taken

35. Thank You!
To learn more about The Path Forward series
WeitzmanLearning.org/the-path-forward
To view previous COVID-19 sessions:
WeitzmanLearning.org/coronavirus