A Geriatrician’s experience of the beginnings of the COVID-19 vaccination programme
Duncan Forsyth is a Consultant Geriatrician at Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust.
Hurrah, the cavalry has appeared over the horizon! Whilst my hospital is well geared up for staff influenza vaccinations (something that I am proud to have been involved in instigating over 25 years ago), the COVID-19 vaccination programme requires a Herculean effort on behalf of the NHS and its staff, adding further strain on our already stretched services. As I am semi-retired and in a period away from clinical duties, I emailed my Chief Exec and Medical Director offering to help out.
Whilst waiting for the vaccine to be delivered, my first duties were sitting with the call centre staff, discussing their concerns about telephoning an age group (over 75s) that they were unaccustomed to speaking with. We discussed many issues; how they were likely to have a number of calls unanswered, as the hospital number is withheld and many older people will not pick up the telephone when they do not recognise the incoming number; that they would need to allow longer than they were used to doing for their calls to be answered, as the older person may be slower getting to their phone; how to ‘shout’ politely to someone hard of hearing or suggest the speakerphone might be activated, so the older person might have assistance from a spouse or relative in hearing the call centre staff, provided that the older person was happy to do this. Next, we discussed the questions to be asked and simplified them into plain English. The staff needed reassuring that whilst dementia is prevalent in older age, most of the people they were going to call were unlikely to have dementia; although some would, those more severely affected would probably not be the one answering the phone. With the administrative coordinator, I discussed accessibility of the vaccination site for frail older people and ensuring adequate and accurate directions were provided asour hospital campus is ever expanding and becoming more confusing to navigate.
Then to the vaccinators and addressing their concern that they too were going to be dealing with an age group unfamiliar to them – they are used to vaccinating working age adults. They needed the concept of ‘free-range’ older people explaining to them; that most would not be in wheelchairs! We discussed how to ensure that those with dementia knew what they were consenting to; the capacity / consent forms provided by PHE were considered too complicated and long, especially for the medical support staff unused to assessing capacity (I am not present every day). I amended the MCA forms from our electronic health record to a single page, which walks those unfamiliar with assessing capacity through the process, added a question as to whether there was anyone with a LPOA for Health and Welfare who could make the decision if the person lacked capacity or whether a best interests decision needed to be made.
I had not anticipated any of the above roles but, on reflection, I should have realised that my comfort zone is not everyone else’s and how anxious staff have become as they are re-deployed into unfamiliar roles. The majority of our vaccination programme support staff have come from non-patient facing roles or are glad to be able to spend some time not working from home; few had experience of working with older adults.
When on duty, I am based in the recovery room should anyone suffer an anaphylactic reaction, ( so I’m grateful that BLS is part of my annual mandatory training and that I’m up to date! So far no one has had an anaphylactic reaction; indeed during the 10-15 minute recovery period no-one has had any adverse effect. On arrival, any person identified as having memory issues is referred to me for a capacity assessment (<10% of the 250-300 over 75s, care home and red risk healthcare staff vaccinated each day). In the first 5 days, I have found only 2 individuals with dementia who truly lacked capacity and so were vaccinated as a best interests decision, in agreement with their accompanying family member. I have answered vaccinators’ queries regarding medication the older people are taking (the vaccinators are not used to polypharmacy and often do not know what the drugs are or what they are for) or any previous allergic reactions that those invited for vaccination may have had. I have reassured those to be vaccinated regarding their concerns about the vaccine; their medical issues; their medication, prior allergies or adverse reactions to medication and possible relevance to being vaccinated. Public Health England guidance specifies very few contraindications to COVID-19 vaccination. I have deferred vaccination in three people:one who had participated in the Oxford / Astra Zeneca trial; one who was still symptomatic from a urinary infection despite being on antibiotics; and one whose most recent INR was supra-therapeutic. I have access to the hospital electronic health record system should I need to cross-check any medical details. I have advised one person not to be vaccinated as they had a history of anaphylaxis and carried an epi-pen.
My discussions with care home staff, prioritised for vaccination, have found that many feel guilty that they are being vaccinated ahead of the residents of the care home. They have found it helpful to reflect how their residents,on the whole, do not go out and so the risk of getting COVID-19 is mainly through someone bringing it into the care home; hence, by being vaccinated, the care home worker is not only protecting themselves but also the people they care for. Hopefully they have taken this message back to their colleagues.
Overall, this has been a personally rewarding experience and good PR for the skillset of a geriatrician. The daily workload has not been onerous. I have also been pleased to meet several friends and retired colleagues aged over 75 as they have been vaccinated. Those vaccinated have overwhelmingly been grateful for the care and attention paid to them by all the vaccination team. Here’s hoping that the vaccination programme does eventually provide us with herd immunity and that some semblance of a normal life may return to us all.