A ray of hope after an incredibly difficult year. That’s what the arrival of vaccines designed to protect people from COVID-19 represent to people around the world. At the LSU Health New Orleans School of Nursing, faculty, administration and students knew they wanted to play an active role in this transformational pandemic response as a way to put the school’s mission into action and provide care for the LSU Health Sciences Center and the New Orleans community.
Since January 13, the LSU Healthcare Network, in partnership with the LSU Health Sciences Center – New Orleans, has been vaccinating faculty, staff, students and patients on weekdays, and some Saturdays, in a vaccination clinic located on the first floor of the Lions Building. As of April 29, 19,207 people have been vaccinated there with the Pfizer BioNTech vaccine, including 90% of School of Nursing faculty and staff. The clinic launched as a closed point of distribution (POD), with vaccines limited to faculty, staff, students and health care network patients. As the need increased and the state expanded the tiers of qualified individuals for vaccination, the clinic was converted to an open POD for the public.
Achieving this has been no small undertaking, but it’s been entirely worthwhile, School of Nursing staff say.
“For me personally, I felt compelled to do this work to impact the health of so many and prevent suffering and death from COVID-19, especially since my mother died from COVID in December,” says Deborah Garbee, PhD, APRN, ACNS-BC, FCNS, Associate Dean for Professional Practice, Community Service and Advanced Nursing Practice; Program Director for the Adult Gerontology Clinical Nurse Specialist Concentration; and Professor of Clinical Nursing. “I want to do everything possible to prevent other families from having this loss. I believe our vaccine clinic offers hope – hope for the future – and that is meaningful for the people of New Orleans and surrounding areas.”
An Incredible Level of Coordination
Fast-paced planning for the clinic occurred within one week, says Demetrius Porche, DNS, PhD, ANEF, FACHE, FAANP, FAAN, Dean and Helen A. & James B. Dunn Professor. The School of Nursing coordinated efforts with multiple entities including the Chancellor’s Office, the LSU Healthcare Network, the School of Medicine, Information Technology and Facility Services.
The interdisciplinary leadership team included Dr. Porche, Dr. Garbee, Dr. Clair Millet and Dr. Sherry Rivera from the School of Nursing; Dr. J. Christian Winters, Professor and Chair of Urology at LSU Health New Orleans School of Medicine, Vice Chancellor for Clinical Affairs at LSU Health New Orleans, and CEO of the LSU Healthcare Network; Louis Colletta, General Counsel for LSUHSC-NO; Ben Lousteau, Interim Associate Dean for Fiscal Affairs at LSUHSC-NO; Ken Boe, Assistant Vice Chancellor for Information Technology at LSUHSC-NO; and Steven T. Zimmerman, Director of Facility Services at LSUHSC-NO.
Initial meetings included identifying an appropriate location to administer the vaccine and figuring out the process required to obtain the vaccine as well as equipment and supplies necessary for appropriate vaccine storage, handling and administration. The team had to ensure that the location chosen was easily accessible, large enough to accommodate the necessary spacing requirements for a large volume of people and was close in proximity to supplies and the medication freezers. Equipment, power supply, telephone access, security of the location, and maintaining appropriate temperatures within the room (per vaccine specifications) were also important considerations.
“We collaborated with the Louisiana Department of Health’s Office of Public Health Immunization Program on vaccine allocations, storage, handling and administration guidance,” says Clair Millet, DNP, APRN, PHCNS-BC, Director of Nursing Continuing Professional Development & Entrepreneurial Enterprise, Robert Wood Johnson Foundation Public Health Nurse Leader, and Instructor of Clinical Nursing. “We also worked very collaboratively with the Immunization Program on utilization of the statewide immunization registry, Louisiana Immunization Network (LINKS) to ensure that the interoperability between our online patient practice management system and electronic medical record information linked and seamlessly transmitted the data to LINKS.”
Dr. Millet says Rebekah Gee, MD, Clinical Associate Professor at the LSU Schools of Public Health & Medicine, assisted with the allocation of the initial vaccine dosages, and that vaccine clinic organizers continue to collaborate with the state to ensure the site is allocated a continuous supply of vaccine.
Meetings were held daily during the early stages of development, and subsequent planning meetings focused on ordering supplies, staffing, workflow and the development of an interface to facilitate communication between Allscripts (LSU Healthcare Network’s EMR system) and LINKS for mandatory reporting.
“Workflow and staffing needs were designed similarly to prior Flu Fair vaccination clinics and POD planning,” says Sherry Rivera, DNP, APRN, ANP-C, Instructor of Clinical Nursing. “Information obtained on the CDC’s website was very useful to determine necessary protocols utilized for administration, mixing and monitoring. We held planning meetings with School of Nursing undergraduate faculty administration to coordinate staffing needs for the clinic and assigned clinical courses specific days of the week to staff the vaccination stations.”
The Vital Role of Information Technology and LSU Healthcare Network Staff
Creating a patient vaccination record that would integrate with each patient’s existing medical record and be easily accessible by their providers was a priority. The state also utilizes LINKS data to assess and report population vaccination status and to allocate vaccine to providers. This made data entry and interoperability between Allscripts and LINKS crucial.
LSU Healthcare Network’s Allscripts EMR system has served as the platform for scheduling, and an online scheduling process that was developed for scheduling patients to receive the flu vaccine was revised to meet the needs for scheduling COVID-19 vaccinations. LSUHSC-NO’s IT department developed an interface to ensure reporting data to the state occurred as seamlessly as possible. Molly Reed, Administrative Operations Manager at LSUHSC-NO; Cleveland Rudolph, Application Analyst at LSUHSC-NO; Lana Gee, Director of Health Information Technology at LSU Healthcare Network; Cindy Argrave, EMR Trainer/Analyst at LSU Healthcare Network; Keoika Fuentes, an EHR Trainer/Analyst at LSU Healthcare Network; and Shawn Marcell, a Training Specialist at LSU Healthcare Network, have worked tirelessly to develop the system’s interface, design and revise online and hard copies of the consent forms as warranted, address all aspects of the patient scheduling process, and monitor data entry to ensure accurate reporting of key components to the LINKS system.
Reed also coordinated the medical assistant staff, residents, medical students and physician assistant student volunteers. Rudolph trained a tremendous number of students to enter the appropriate information into the computer system and made the transition to a new vaccine lot number a smooth process.
“Many days, Cleve also opened the clinic door, greeting patients with a smile,” Dr. Rivera adds.
Each COVID-19 vaccine administered must be reported to the state’s LINKS system within 24 hours of administration, Dr. Rivera says. Reportable data includes demographic information, medication, lot number, expiration date, date and site of administration. Within the first month of being open, the state requirements expanded to include ethnicity and race as reportable data. Adverse events must also be reported to the CDC through the Vaccine Adverse Event Reporting System (VAERS), as needed.
“I believe our vaccine clinic offers hope – hope for the future – and that is meaningful for the people of New Orleans and surrounding areas.”
Deborah Garbee, PhD, APRN, ACNS-BC, FCNS
“We have been working closely with IT since the project began – initially to ensure that all of the appropriate information was included in the scheduling and consent process to report the necessary data to LINKS,” Dr. Rivera says. “Since that time, we have continued to collaborate regarding revising the consent to reflect the most current eligibility criteria and scheduling process. With continued expansion of eligibility, we continued to work with IT to ensure that the link was readily accessible to all patients who may be interested through our LSU Health Sciences Center website.”
Dr. Rivera says clinic leaders closely monitor vaccine dosage availability and work with IT to ensure scheduling is reflective of doses available for administration. They also consistently monitor the number of doses administered, the number of doses scheduled and doses reported to ensure accuracy of data reporting.
“IT has been a vital component for the success of this project,” she says. “The expertise of the team has contributed greatly to ease the reporting process. Without the system currently in place, each vaccine administered would have to be entered manually into the LINKS system. Additional clerical staff would have been needed to manually enter data and it would have limited the number of patients who could be vaccinated daily. Additional staff would have increased overall costs and would have required additional training to use the LINKS system, ultimately resulting in a delayed start date and reduced workflow efficiency.”
A Bold Undertaking with Rewarding Results
The clinic has been a continuously collaborative effort.
Undergraduate faculty and students from the School of Nursing have assisted with staffing vaccination stations to administer thousands of vaccines. Nurse practitioner students and faculty have helped with screening and monitoring. Nursing faculty and students have volunteered to assist with mixing the vaccine. Medical and physician assistant students from the School of Medicine and School of Allied Health have volunteered to collect data at computer stations.
“Rachel Chappell, Program Director of the Physician Assistant Program and Assistant Professor in the School of Allied Health Professions, has been a consistent source of support and has volunteered her services throughout the entire process,” Dr. Rivera says. “Ben Lousteau and Amie St. Germain in the School of Medicine have continued to make sure that all of the supplies needed are readily available.”
School of Nursing and LSUHC-NO staff have also played vital roles in assisting the clinic with vaccination efforts.
“Nathan Fontaine has designed and printed thousands of vaccination card stickers, syringe labels and consent stickers. There have been times that we requested copies and, within minutes, he has delivered the supplies to the clinic. He has helped us to keep lot numbers organized in a logical order,” Dr. Rivera says. “Katy Smith and other nursing staff have helped to apply lot number stickers to the CDC cards. Sherri Chalona and Souad Salloum assisted with taking pictures and sharing them on our news on social media.”
Though she was initially “filled with uncertainty” because she was unsure how receptive the campus would be to receiving the vaccine – and it was a huge undertaking at the systems level – Dr. Rivera says the clinic was a near-instant success. Many patients have thanked clinic staff and commented on how well-managed the system is. She says clinic staff have received several complimentary emails from patients, and she’s heard about positive comments on various social media sites discussing the efficiency and care received at the clinic.
“Some patients have been extremely excited and appreciative about receiving the vaccine. Patients have requested to have their pictures or video taken of them while receiving the vaccine,” Dr. Rivera says. “They are excited to be able to attend weddings and see grandchildren or other family members.”
Faculty and staff were also very appreciative to have access to the vaccine, and in the beginning of the vaccination program some recipients actually cried with joy when receiving their dose, Dr. Porche says.
“Faculty have stated that having access to and actually receiving the vaccine was one of the best benefits of being an LSUHSC employee, and students appreciated the clinical experience,” he says. “For all of us, this was an opportunity to practice within a pandemic, and it felt like true public health practice in action.”
Dr. Rivera says it has also been tremendous to see the role that vaccination has played in the School of Nursing’s return to campus, pre-commencement activities and planning for future clinical experiences – and to realize the impact on the community.
“As COVID-19 numbers in the New Orleans region and the state have continued to decline, it has been very rewarding to know that we were able to participate in the efforts to vaccinate not only those on our campus but also in our region and our state,” Dr. Rivera says. “I never imagined that it would be possible to be participating in mass vaccination efforts one year ago.”
Dr. Porche says this project demonstrates the value of academic health science centers in the community and within the health care system.
“This project engaged multiple health care providers in direct collaborative interprofessional practice through the collaborative efforts of three schools – Allied Health, Medicine and Nursing – and the Healthcare Network,” he says.