Abstract
Gwynne Holford Ward (GHW) is an inpatient rehabilitation Unit at Queen Mary’s Hospital in London, UK, which provides care for patients with amputation rehabilitation needs (10 beds) as well as Level 1 and 2 specialist neurorehabilitation needs (26 beds). The ward MDT has encouraged all inpatients to be vaccinated either during or prior to admission. We have conducted a weekly snapshot audit over a 3-week period in March 2021, which has shown an increase of the percentage of inpatients vaccinated, progressively from 68.75% to 80%, and 73% of vaccinated inpatients received the vaccine whilst on the ward. We also conducted inpatient interviews, which highlighted that: (1) opening dialogue about vaccines increased uptake of COVID-19 vaccine; (2) patients felt that all vaccination sites provided quick, efficient service; and (3) all patients who received the first COVID-19 vaccine were willing to have the second COVID-19 vaccine. Finally, although there were many hurdles faced whilst organizing the inpatient vaccination process, we have been able to cumulatively vaccinate 80% of rehabilitation inpatients making our ward a safer place to work and rehabilitate.
Keywords
“Can we get everybody vaccinated?” The Neurorehabilitation Consultant and I sat contemplating on a mid-February 2021 clinic day in reference to vaccinating all the ward inpatients on the 36-bed off-site London Amputee/Neurorehabilitation ward where we worked. Not too long before this, our ward had suffered, like many others around the United Kingdom, yet another COVID-19 outbreak. 1
With the presence of rising COVID-19 nosocomial infections in the United Kingdom 2 and considering the impact of our ward's January COVID outbreak (6 out of 36 patients and 9 out of 38 staff members were COVID-19 positive), our team decided to embark on a mission to maintain a COVID free ward, starting with the aim of vaccinating 100% of our inpatients.
“Were we going to be able to do this? What did hurdles would we face and how would patients feel about it all?”
Approximately 6 miles away from the rehabilitation unit, the hospital vaccine clinic was set up in December 2020 and provided vaccination for hospital inpatients.
All rehabilitation doctors on our ward agreed to discuss COVID vaccination with patients on bi-weekly ward rounds. For patients unable to consent to vaccination, the best interest discussion including family was held, and decision documented.
The co-authors (registrar and consultant) coordinated the COVID vaccination process and supported COVID-19 discussions with patients and families.
Being an off-site unit was one of the main limiting factors in trying to vaccinate inpatients. The main hospital vaccination procedure guidelines included vaccine clinic staff being required to physically collect consent forms daily from wards, booking an appointment via a designated hospital telephone extension which was unavailable for booking outside of the main hospital, and in-hospital patient transfers from ward to the clinic with accompanying staff.
To arrange the vaccines, our ward staff were required to contact the vaccine clinic supervisor directly to discuss individual vaccine requests. We then had further discussions with a separate hospital COVID booking team to confirm appointments, followed by arranging hospital transportation as well as obtaining a required escort for each appointment.
Thankfully, some of this work was eased through Multidisciplinary Collaboration:
The vaccine clinic coordinator agreed to prioritize off-site ward patients to reduce waiting time and allowed for direct booking with the hospital COVID vaccine booking team. Extra staff shifts were requested by the ward Nursing Matron to provide escorts. Members of the therapy, nursing, medical, activities teams also volunteered (when they could!) to accompany patients. Hospital transport agreed to increase the number of patients being transported for vaccine appointments.
There was a significant change to the vaccination procedure on March 18, 2021, when a community vaccination “hub” opened in a car park next to our hospital. Although this was set up only for local community residents, a discussion with the vaccine hub manager led to an agreement for vaccination of our ward inpatients.
Despite some initial difficulties, for example, communication was limited due to the lack of a hub telephone line, the majority of the patients enjoyed the relative ease of going only a few meters away. However, we were soon informed by the porter’s manager that hospital porters were not allowed to take patients to the car park and therefore many of our ward staff again volunteered to take patients themselves!
So How Did We Do?
On March 12, 2021, we took a “snapshot” audit of our ward- meaning that on that day, we calculated the percentage of patients on the ward who were currently vaccinated (received at least one dose of a COVID-19 vaccine). The snapshot audit showed that 69% (22 out of 32) of patients were vaccinated. This snapshot was repeated 1 week later and the vaccination rate improved to 74.2% (23 out of 31) and to 80% (24 out of 30) in the 3rd week (see Table 1).
Percentage of Patients Vaccinated on Gwynne Holford Ward Over a 3-Week Period.
Cumulatively, over the 3-week period, a total of 30 out of 36 inpatients (83%) were vaccinated, with 22 patients receiving vaccines during admission.
What Did Patients Think?
A ward interview was conducted on March 18 and 19, 2021. 30 out of 31 admitted patients agreed to a face-to-face interview conducted by myself, the ward rehabilitation specialist registrar. The remaining patient was unable to engage in discussion about the vaccine due to severe cognitive impairment. For 2 patients with severe aphasia, a total communication approach was used: nonverbal bodily responses including thumbs up/down, head nodding, and pointing to body parts was employed as well as the use of personalized patient picture communication books containing pictures of body parts and faces to show emotions, for example, happy/sad/angry.
Questions posed to the patients included:
What were/are your initial thoughts about the COVID-19 vaccine?
For those who had received the vaccine:
Are you happy that you have received the vaccine? Describe your experience of the vaccination process? How did you feel after receiving the vaccine physically and emotionally?
At the time of the interview, 23 out of 31 ward patients had received at least one dose of a COVID-19 vaccine. Of the 8 patients who had not received the COVID-19 vaccine, 6 patients (4 of whom were in adjacent beds) had refused to have the vaccine citing concerns about lack of research and potential side effects, with one patient being concerned about a risk of “clots” due to her recent stroke. One patient (without cognitive impairment) denied the existence of COVID-19. All patients were offered a post-interview medical discussion around COVID-19 vaccination. Two patients in adjacent beds accepted this offer. One of these patients changed her mind about vaccination and received the COVID-19 vaccine the following week.
Of the vaccinated patients, the majority (16) had been excited to receive the vaccine. A total of 4 patients reported feeling anxious about receiving it. One patient reported that he “did not feel good about receiving the vaccine,” but “just went along it all.”
Patients’ experiences of the vaccination process itself were overwhelmingly positive. All patients felt that were prioritized at sites and received prompt service. Negative feedback included transportation difficulties and the duplication of consent or screening forms.
What Have We Learned From the Inpatient Vaccination Process/Considerations for the Future?
So, we didn’t get to 100%. However, it was a worthwhile effort; at the time of submission, there has not been a single case of nosocomial COVID-19 infection on our ward since January 21, 2021.
We realized that simply opening the dialogue about COVID-19 vaccines increased the uptake of vaccines.
We continue our efforts in advocating for COVID-19 vaccination for all patients and staff on our ward and within the healthcare system.
Footnotes
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
