Rolling-out a COVID-19 vaccination hospital hub

Case study: Vicky Parker, Clinical Education Facilitator, University Hospitals Coventry and Warwickshire NHS Trust.

Case study summary

Key learnings from University Hospitals Coventry and Warwickshire NHS Trust (UHCW):

  1. Continuity of staff: a proportion of substantive staff alongside temporary staff
  2. A robust and thorough competency assessment and training process
  3. Separate the competency into ‘skills’ and only train staff on necessary sections
  4. Consider alternative staffing groups for appropriate ‘skills’
  5. A clear and robust appointment booking process with admin support

Background to learning

On December 8 2020, staff at University Hospitals Coventry and Warwickshire NHS Trust (UHCW) delivered the world’s first COVID-19 vaccination outside of a clinical trial.

Hospital hubs like UHCW have led the way in the rollout of the vaccine and rapidly developed and implemented safe processes which address the logistical challenges of administering the vaccine.  As further hospital vaccination centres and community-based sites are launched, staff in these organisations will be busy preparing to deliver vaccinations to priority groups on a large scale.

This case study explores key learning from the approaches and processes utilised at UHCW.

Learning to be shared

  • The trust has identified dedicated COVID-19 vaccination nurse educators to teach and assess staff competence in delivery of the vaccine, initially under a Patient Specific Direction and now a National Protocol. The nurse educators have maximised training opportunities prior to vaccinators’ first shifts in the clinics (via online theory and practical simulation training/assessment), enabling a leaner induction of staff into the clinical environments and vaccination process. The ongoing presence of these dedicated practice facilitators and educators in the clinics has also ensured the cascade of up-to-date information and changes in guidance/protocol to all vaccinators.
  • Staffing and skill mix in the vaccination service needs to be carefully considered. Continuity in the staffing of the service can minimise the need for continuous ‘induction training and competency assessment’.  Ensuring a significant proportion of substantive staff alongside regular deployment of temporary staff creates opportunity to expand services and deliver increased numbers of vaccinations whilst maintaining quality.
  • Identifying each core vaccination skill and assigning these to appropriate groups (registrants and non-registrants) can support staffing of the hubs and enable expansion of capacity. By breaking skills (such as patient assessment, vaccine preparation and vaccine administration) down in this way:
      • staff groups from which additional support for nurses and other registered vaccinators could be drawn from can be more easily identified, for example utilising pharmacy staff for vaccine preparation and increasing involvement of unregistered staff in vaccine administration
      • education and training can be tailored to the specific staff groups undertaking each part of the process.
  • A clear and robust appointment booking system helps maximise uptake of appointment slots and avoid bottlenecking at peak times due to drop-in scenarios. It is important to engage staff with this booking process early on to ensure that they can take unfilled appointment slots and optimise the rollout of the vaccination to frontline staff.
  • By considering how additional space can be created and optimising patient flow through the hubs, UHCW has been able to maximise its productivity and service delivery to meet its daily vaccination targets. Review of patient experience and flow provides opportunity for constant improvement of processes.
  • Ensuring robust governance processes are in place to guarantee that the key elements of the vaccination process are in line with national guidance are of paramount importance. Keeping staff up to date with changing policy and guidance can be achieved by holding daily oversight meetings and safety huddles with all key stakeholders and clinic staff.

Would it be beneficial to keep this change?

The COVID-19 vaccination programme is an unprecedented national effort to protect people from the COVID-19 virus and NHS staff are implementing services locally at pace to meet these requirements.  Real time learning and reflection provides us with the opportunity to effect change on a large scale. NHS organisations which are currently standing up their vaccination hubs can utilise this learning when planning service delivery.

Whatever stage organisations are at, sensitively engaging staff will be an ongoing and important part of the approach to securing participation in the vaccine programme.  NHS organisations are already doing this and there are resources available from PHE to support the vaccination rollout.

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