Tips and shared experience from Dr Simon Bradley and Dr Dominique Thompson on delivering the Covid vaccine to the housebound
Preparation is key
The number of people on the housebound register can be dramatically reduced by calling patients in. We reduced numbers from 2% of our 15,000 list to 0.2%. Some made the extra effort to get in when we called them to arrange the home vaccination visit. The remainder were called again the day before the visit, by a trained admin worker who went through the consent/suitability questions, and they were given a window of time for when the vaccination team would visit.
They were asked to be dressed for quick vaccination, wear a mask and be in a well-ventilated space. We told the patients and their carers at every opportunity that the visit was only for vaccination – you must be timely to keep within the vaccine use time.
You should also ask if they can make it extra easy for you to find their home, and enquire about any problems you might experience in accessing it.
The paperwork can all be prepared beforehand.
Transporting the kit
We used a portable wheeled toolbox* for the kit. ‘Fat Stanley’ (our toolbox!) formed a stable and clean platform for vaccinating from, as well as holding all the kit we needed. We did not have to touch any surfaces in the patients’ homes, which reduced the risk of house-to house contamination.
It had a pull-out lower section which gave easy, fast access to the sharps box and clinical waste bag (taped open and attached to the box). Managing sharps in a confined space, quickly, is a risk – this reduces it.
The Oxford/AstraZeneca vaccine can be used outside of the cool chain (2C-25C) for six hours, so only take enough vaccine to use in this time window (allowing for delays). It’s much easier, safer and quicker if you draw up beforehand at the surgery. We’re not sure if the SOP allows for this – but it should!
Plan your route in advance
Use route planner software to work out the most efficient route between addresses. You don’t need to upload patient identifiable data to it.
We used this. It puts in a travel time and allows you to put in a specified time for your stop at the patient’s home. We allowed a 15-minute visit, but this was too long – we were completing our later stops in eight minutes.
The software also helps you to tell patients their likely time window for your visit. If you have two patients at one house, only put the address in once, as two at the same address confuses the software.
Make your first visit the furthest patient away geographically, and work back from there. This means that if you need to pop back to the surgery for a coffee or a pee, the journey time is shorter.
Patient contact details must be in full and up to date
Print out your list of visits, with times and addresses, but double check that the addresses are full and not abbreviated – we omitted a flat number in one block, which wasted significant time.
Make sure that the contact phone number is in the list- we forgot this and we needed it three times!
Add a column for recording the arm the vaccine is administered in – if you make the default left, you only need record right.
If there are two of you out vaccinating together have a column for who administers the vaccine, and, if you draw up, who has drawn it up.
Use a landscape print-out to fit all of a patient’s details on a single page.
Flag those patients who are on ‘blood thinners’.
Add an empty column for ‘other’.
On the day
We all know those things that make home visiting slower like poor light and poor visibility. Plan to complete your vaccinations in daylight hours and chose a day when it is not expected to be snowing or raining heavily. Poor weather not only makes finding the houses slower, but getting in and out of your car and waiting on doorsteps multiple times will mean getting cold and wet.
And if you wear glasses, you will steam up, which will make your day longer and more uncomfortable. Bring sandwiches and drinks!
One vaccinator or two?
We tried with both two and one vaccinator per visit. If you have the workforce, we recommend deploying two! You will certainly need two if you’re going to achieve eight minutes in the home, per vaccination.
It’s not only faster and more efficient, but it’s probably safer. Repeating the same information over and over again meant that we occasionally forgot what we’d advised. We had a particular problem remembering the advice ‘to maintain hands, face, space’ despite having the protection of vaccination’, and a prompt from my partner was welcome.
Separating the consenting and vaccinator role from that of vaccine prep, paperwork and post vaccination advice worked well for our little team.
We vaccinated all 36 housebound people registered with our practice in a day of vaccinating, and working as a team helped keep morale high, which is really important when everyone in general practice is working so hard.
These patients are the frailest of the frail. Several will be confined to bed in their own homes, others will have had strokes, be hearing-impaired, or have mild memory impairment. Communication may be impaired or unreliable. This is where the flag on your list for blood thinners comes into its own, as you will know at a glance who’s at most risk of bruising/ bleeding.
Expecting your patient to be able to keep pressure on the vaccination site is beyond the capability of many. Take some wide micropore tape and use it to apply firm pressure through a cotton wool ball to the vaccination site, as it reduces the risk of localised bleeding and haematoma for this group.
Mask top tip
In spite of being reminded to wear a mask and have good ventilation many won’t be ready or prepared. It will waste time and increase risk to both you and your patient to help them don a mask. We would advise your home vaccination team wear FFP3 masks, these will provide significantly better protection than simple surgical masks.
Buy your own, as we did, if the NHS won’t supply them. You won’t need many and then you don’t need to worry, and then can just get on with vaccinating.
Patient says ‘no‘
We had just one patient decline vaccination at the visit. It then took time and effort in having a dialogue to ensure that this was genuinely informed dissent. This patient happened to be the one whom we had repeatedly been unable to contact by phone.
Our takeaway from this is that you should not spend your time visiting unless provisional consent to vaccinate the patient has been obtained from them over the phone, in advance of any visit.
‘Whilst you’re here, doc…‘
You will be visiting just to provide vaccination against Covid, but many patients will have questions about other health-related issues. Some of these can reasonably be diverted to future contact, but some you will require action, and this is where the ‘other’ column on your visit list comes into its own. It will be here that you can make a note of any unexpected but future actions from the visit.
A really positive experience all round
We managed to vaccinate all of our housebound patients in one day. It was an amazing and positive experience for our team, but also for many of the patients we visited.
We’ll be back in around 12 weeks to complete their vaccinations, and to be honest, we’re quite looking forward to it!
Dr Simon Bradley and Dr Dominique Thompson are GPs in Bristol