Disclaimer: the views and opinions expressed in this article are solely those of the author and do not necessarily represent those of Community Hospital, Community Healthcare System, or Indiana state senator Todd Young. This article reflects the voice of Daniel J. Peterson, PharmD, MBA, MSHI.
The COVID-19 pandemic has posed a myriad of challenges and difficulties for all people, both domestically and abroad. However, it also has given pharmacists and other healthcare professionals a unique opportunity to be involved in the rewarding, but logistically challenging, COVID-19 vaccination effort.
Since December 2020, I have had the privilege to be extensively involved with my health-system’s COVID-19 vaccine clinics. I am proud to contribute to our local vaccination efforts and wanted to take this timely opportunity to reflect on and share my personal experiences.
Let me start by acknowledging that the success of vaccine clinics, similar to all other endeavors, is achieved through collective efforts. Every role is important. My specific responsibilities as a pharmacist in this setting focus on vaccine receipt, storage, inventory, preparation, dispensing, delivery, and recordkeeping.
To start each day, my colleague and I arrive an hour and a half before the clinic opens to begin vaccine preparation. I pull vials which have thawed overnight in the fridge. Vial pulling and vaccine preparation occurs throughout the day to ensure vaccine expirations are staggered.
As my colleague draws up the doses in our pharmacy clean room, I print syringe labels and mark syringe delivery boxes with the appropriate expirations so that everything is ready to go by the time the vaccines are drawn up and sent back through the pass-through. I label, verify, package, document, and deliver the vaccines to the clinic. (As an aside, I have become quite proficient in quickly labeling syringes!)
Every so often, a lot change is required. These changes are carefully coordinated with clinic leadership, vaccinators, and registration representatives to ensure documentation is accurate for each patient. In such instances, prompt communication from the clinic helps indicate when to deliver the new lot to ensure a streamlined transition.
A vaccine shipment day is always busy. Not only do I need to ensure the vials are received in a timely manner, but the items within the ancillary supply boxes also need to be opened, sorted, and stored. This step takes a significant amount of time, especially if multiple boxes are received. I have also learned about dry ice safety as Pfizer-BioNTech COVID-19 vaccine shipments contain dry ice. Also, don’t forget about the vaccine shipment containers themselves! I have to be sure to return these to their respective companies as part of their sustainability efforts.
Vaccine administration syringes are one of the items included in auxiliary supply shipments. The syringe is important, along with needle considerations, as certain types allow for a 6th dose of the Pfizer-BioNTech COVID-19 vaccine and an 11th dose of the Moderna COVID-19 vaccine to be drawn up from each vial. Also contained within such shipments are the appropriate diluent (for the Pfizer-BioNTech vaccine) and vaccination cards. I work with our pharmacy technician operations assistant to direct the quantity and details of stickers that are printed for the vaccine cards. These are prepared in advance for the upcoming clinic days and require an understanding of how many appointments are expected for a given day and when lot changes will occur.
While our vaccine clinic at our main campus now only carries one vaccine manufacturer, we did for a limited time carry both the Pfizer-BioNTech and Moderna COVID-19 vaccines based upon initial available supply. Kudos to clinic leadership for coordinating the scheduling logistics to ensure we had enough vials of each vaccine so each patient could complete their vaccination series on time with the same vaccine manufacturer as their first shot. From the production perspective of my colleague and I during this period, we had to carefully balance preparing the correct amount of each manufacturer’s vaccine at given times within a clinic day to stagger vaccine expiration times.
Our health-system has a second vaccine clinic located off-site from the main campus at our stroke and rehabilitation center. Their vaccine vials, which are inventoried separately, are appropriately stored at our inpatient pharmacy until they are needed. I work with the pharmacy manager at that facility to ensure the right number of vials are sent at the right time. When more vials are needed throughout the week, I have to pull vials, label the date and time of the pull, and package them up with printed syringe labels in time for transport. The vaccine is sent according to package insert specifications.
One of the most challenging aspects of this overall effort has been balancing my manager responsibilities with those of the vaccine clinic. It has been an adjustment servicing a clinic that averages approximately 725 to 750 vaccinations daily (and will soon further increase) while also retaining manager responsibilities such as scheduling and completing time cards for fifteen pharmacists, completing daily reports, keeping inventory and ordering controlled substances, et cetera (not to mention sending the aforementioned vials and syringe labels to our second vaccination site). This has simultaneously been a healthy challenge and an opportunity for growth.
During this time, I have also been invited to complete a cohort-focused leadership development program offered by our health-system in conjunction with an external consultant. As the only pharmacy representative within my cohort, I am able to bring pharmacy-centric experiences to these discussions as well as benefit from the prior learnings of those in other roles within the organization and apply them to practice within both the inpatient pharmacy and vaccine clinic. My simultaneous participation in this program and the vaccine clinic pairs complementary.
I would like to acknowledge my staff, who have done an excellent job. They, along with our pharmacy technicians, have stepped-up and have self-managed themselves to an extent, for which both my manager colleague and I am appreciative. They have also been very flexible with their schedules, helping to cover any open shifts to ensure continuous inpatient pharmacy coverage.
My colleague and I always prepare several hundred vaccines each day and then stop once we reach the point where we require clinic leadership to direct us how many more vaccines to prepare as the end of the clinic day nears. There is a fine balance between inadvertently preparing too much vaccine and not enough. Since each vial contains multiple doses, careful coordination and timely communication is required to ensure that no vaccine goes to waste. Such stewardship ensures the clinic can vaccinate as many people as possible.
As a positive externality of the vaccine clinic, I get my steps in throughout the day. Each day is a physical workout. Since I deliver all of the vaccines from our pharmacy to the clinic, I walk a lot throughout the day (see screenshots below from my personal activity tracker) and quickly went from wearing business professional attire to scrubs and comfortable shoes. My leg muscles began hurting on multiple occasions, but new shoes and the addition of gel shoe inserts have since dramatically helped!
One of the last tasks before the day ends is to transfer vials from the ultra-low temperature freezer to the fridge to allow the vials to thaw overnight (we currently have the Pfizer-BioNTech COVID-19 vaccine). This is surprisingly no small task, as it takes a certain degree of dexterity to grasp small vials while wearing thick, protective gloves. I then ensure the day’s recordkeeping is complete and send any requested data to hospital senior leadership.
When it is all said and done, the clinic day is over. Each day makes for a long yet rewarding day. I would be remiss to not mention my family’s continued understanding and encouragement. My loving wife helps motivate me each day and always has dinner ready when I get home from a long day at work. I love her.
Helping support the vaccine clinic has been a truly remarkable and unique experience. I would like to acknowledge the efforts of my manager colleague who draws up all the doses, clinic leadership, the vaccinators, registration reps, and many others behind the scenes who have helped make the clinic a daily reality. My boss, the director of pharmacy, in particular deserves a shout-out, as she is a very capable clinic leader. I am thankful to play a small role in such a massive endeavor.
It is encouraging to see so many people receiving their vaccines. Many are thrilled to help play their part in helping to beat COVID-19. Indiana state senator Todd Young even stopped by one of our clinics for a visit! For more information regarding the COVID-19 vaccines, please visit the Center for Disease Control and Prevention’s (CDC) webpage.
Thank you for reading, and stay healthy!
– Dan
About The Author
