Tadhg Crowley is a GP partner in Ayrfield and Associate Professor, University Colledge Dublin (UCD) Dept of General Practice, Dublin.
Frank Chambers is a GP partner in Ayrfield, with an interest in palliative medicine.
Conall MacConamara is a GP partner in Ayrfield, involved with post graduate training at the University of Limerick (UL).
Ayrfield Medical Centre is a nine doctor group practice. We are a primary care centre that has academic ties with UCD and UL schools of medicine.
The COVID‐19 pandemic has significantly altered General Practice. In our practice we wanted to marry safe practice in COVID‐19 times with running busy covid vaccination clinics. There was a big demand for the covid vaccine but wanted to keep both patients and staff safe and thus, set about organising a ‘drive through’ covid vaccine clinic. We have now had two clinic days vaccinating.
The government planned on the use of the Astra Zeneca vaccine for the over 70 population, given via general practice. As a result of doubts in the numbers over 70’s in the initial trials they decided on the use of mRna vaccines for this cohort in general practice, this has provided a number of challenges for general practice in terms of handling of the vaccine and the recommendation that patients should wait for 15 minutes after the vaccine delivery. These events made us even more determined to use our drive through clinic for everyone’s safety. We had used it for the flu vaccine campaign, and we did a cross sectional study during it to assess satisfaction.
Challenges for general practice ….. made us even more determined to use our drive through clinic.
The government so far have asked general practice to vaccinate the over 70’s in four cohorts. We started firstly with over 85’s and over the next 12 weeks we will vaccinate the rest.
In early March 2020 the implications of the pandemic dawned on us in general practice. We had erected a small tent in our carpark for patient reviews. During the planning stage for the flu vaccine and as Storm Francis was causing havoc on our tent, we realised we needed a solid structure. After pricing up the various options we settled on a Portakabin with a storm proof drive through marquee to the side. We installed lights in the marquee and connected the cabin to a power point.
We were determined to run a service that was both safe and effective. We clarified with our insurance providers (medical and public liability) that we were covered, albeit at small premium where public liability was concerned.
We formed a subcommittee at work to look at all aspects of the clinic. We based our set up on the CDC recommendations for kerbside and using the HSE (health service executive) recommendations.
Ireland’s Political situation
There is currently a shortage of vaccines in the country. We had been promised 1.75 million doses which is now reduced to 1.15 million doses. There have been seventeen seperate setbacks to the rollout of vaccines in the country. A month before the planned rollout to GPs, one of these was doubts over the use of the Astra Zeneca vaccine in the over 70 cohort. The national immunisations authority initially allowed only the use of mRNA vaccines in this cohort.
This was an issue in terms of the recommendations around the use of Pfizer Biontic vaccine. The regulations re its storage, handling and transportation brought a few challenges for its use in general practice and particularly in a drive through clinic.
We ordered cones and signage, and clearly marked out a one-way system with four lanes for vaccination. A dedicated area for post vaccine observation was also marked out. This was in a supervised area of the car park that patients of the practice used. Inside the cabin we set up a computer, label printer, printer, and an internet port. We installed storage, bins, and a desk. We stocked the cabin with PPE, a basic doctor’s bag, an anaphylaxis kit, a cushion, and a foil blanket for emergencies.
The nature of the vaccine (Pfizer/Biontic) demanded that it was drawn up in the cabin and passed immediately for use to the patient. We had a team of two nurses and four doctor vaccinators. There was also a doctor in the observation area monitoring patients post vaccination and observing that they adhered to waiting 15 minutes post vaccination.
We decided after reviewing our online drive through flu clinic bookings that this might not be suitable for our over 85 cohort. We felt it was important that we reached as many of our cohort as possible. Our admin staff phoned the cohort and also phoned a relative of the patient giving them details of their vaccination and details of vaccination literature. We are now getting ready for the third clinic day, and we are using an online booking system for patients.
This was a novel concept in Irish General Practice and there was no template other than our previous drive through flu clinic and guidelines from the CDC for kerbsides clinics. We were lucky to have a dynamic practice manager and enthusiastic nursing and medical staff. Everyone worked together to get the project off the ground.
We scheduled adult appointments for 5 minutes per clinician. There were four doctor vaccinators. Two nurses drew up the vaccine as per HSE guidelines. On our first day we started with two doctors, to learn from any errors. After each clinic we had a review meeting. We had a nurse manager on the day who operated as a link between the vaccinators, and oversaw any administration issues on the day. We also had an administrator who came to collect forms that could be entered in real time to record vaccine delivery.
It was important that all vaccines were used. The nature of the vaccine vials meant anywhere between 5 to 7 vaccines could be extracted from the vial, dependent on type of syringes provided and also nurse experience. This dictated whether we could vaccinate more people but his could not be decided until the end of our clinic.
100 percent of people who booked turned up to the clinic. Each person was asked how they found the experience and no complaint was received by any staff member from booking, vaccination through the post vaccination observation area.
The drive through clinic was safe, efficient, and popular with patients, and safe for our staff.
We have a covid vaccine clinic running during afternoons that will be delivered in a timely and safe fashion. The practice itself will continue to function in a safe way during the covid pandemic with local cases still prevalent. It was important to us as general practitioners that we would continue to provide a good GP service. We also felt that the drive through clinic was safe, efficient, and popular with patients, and safe for our staff.
The delivery of this vaccine to all our over 70s population is one of Irish General Practice’s most important challenges in recent times. We feel after two clinics that our drive through service will allow us to do this, but also continue to provide an ongoing general practice service to our community.
Acknowledgements: Dr Gobnait Kearney and Dr Seathrun o Casaide gave their comments on the drafting of this article.
Top and embedded photos both from Dr Tadhg Crowley.