Dramatic changes needed to address vaccine plan
With the smallpox vaccination program, your emergency department’s (ED) operations will be affected dramatically. ED managers are scrambling to be sure that staff are fully informed, while figuring out how to avoid scheduling nightmares.
Here are important steps to take now:
• Make sure the entire ED staff understands the risks of the vaccine.
Take steps to help staff learn more about the vaccine, including adverse effects and contraindications, advises Ann Stangby, RN, CEM, emergency response planner at San Francisco (CA) General Hospital.
"When the decision has to be made about whether or not to be vaccinated, health care workers will need all the facts so they can make a truly informed consent," Stangby says.
Hold inservices using downloadable materials and video presentations from the Atlanta-based Centers for Disease Control and Prevention web site, she suggests. (See "Resources" section at end of article.)
• Address risks of inadvertent transmission.
There is a concern about the virus being transmitted from a vaccinated individual to a patient, so consider carefully whether vaccinated staff should care for immunocompromised patients.
"This is the big question from a liability standpoint," says Robert Suter, DO, FACEP, senior consultant for Dallas-based Texas Emergency Physicians, an ED physician practice group.
It’s safest to give vaccinated staff paid leave until they are no longer infectious, Suter argues. "Otherwise, they should steer clear of known immunocompromised patients," he says.
The vaccine is contraindicated for individuals with weakened immune systems or those living with someone with a weakened immune system, says Katherine Haddix-Hill, RN, MSN, director of emergency services at Brandon (FL) Regional Hospital. "We would not place an immunocompromised patient under the care of a nurse who [recently] received the vaccine," she says.
However, since this status is not known when patients walk in the door, vaccinated staff should not work triage while potentially infectious, Suter says. "The data say that the barrier bandage system works, but remember that most of our experience with this is from when the population as a whole was vaccinated," he says.
If staff must work, the safest strategy is to keep newly vaccinated staff out of triage and prohibit them from caring for any patient until a screen for immunocompromising conditions is completed in a confidential environment, Suter says.
The government must provide liability protection if the vaccine program is to be a success, Suter argues. "If anyone gets vaccina, I’m sure the trial lawyers will come knocking," he says.
• Determine, to the best of your ability, who will be vaccinated.
At Suter’s facility, the plan is to have 10-20 vaccinated ED staff members divided among shifts.
The program is voluntary, so you will not be able to pick exactly who you want to be vaccinated, and you may not be able to choose at all unless you have too many volunteers, he emphasizes. "In this event, distribute them among shifts, and try to vaccinate personnel that you usually like to have at triage," he advises.
Begin working with your local health department and employee health and infection control officers to identify appropriate numbers of staff, says Haddix-Hill.
"Hospitals will receive a limited amount of vaccine based on the size of their hospital," she says.
At William Beaumont Hospital in Royal Oak, MI, a decision has been made to offer the vaccine to every ED staff member, says Val Gokenbach, RN, MBA, director of emergency services and observation.
"We realized that it would be a logistic nightmare if we didn’t have enough people vaccinated because of the scheduling issues," she says. "So we have identified all the staff in the ED as candidates to be offered the vaccination." The physicians, security staff, critical care nurses, and floor nurses also will be offered the vaccine, Gokenbach says. "We have tried to broaden the net and identify as many people as possible who would be willing to do this," she says.
All of the ED’s 300 staff members are being asked to sign a consent form stating whether they decline or accept the vaccine, says Gokenbach. "That doesn’t mean that they can’t change their mind, but this gives us at least somewhat of an idea who we will be starting with," she says.
• Collaborate with the local health department.
Know who is leading the planning in your community, Stangby advises. In San Francisco, every hospital has been asked to designate a smallpox liaison to the local health department, she says. But if your ED doesn’t have a solid rapport with this important community resource, now is the perfect time to start, she says. "The link is most likely already there; it just may need to be cultivated," Stangby says. "Make the contact, pick up the phone, and find out what is already being planned."
[Editor’s note: For updated information on liability protection for injury or death arising from administration of the smallpox vaccine, go to the American Hospital Association’s web site (www.aha.org). Click on "Advocacy Resources," "Resources," and "Guidance for the Healthcare Community Concerning Section 304 of the Homeland Security Act." Also, click on "Disaster Readiness," "Advocacy and Representation" and under "Government Reports & Policy Materials," click on "Disaster Readiness — HHS Agrees with AHA on Smallpox Liability."]
Resources
For free educational resources on smallpox visit the Atlanta-based Centers for Disease Control and Prevention website (www.bt.cdc.gov/agent/smallpox).
With the smallpox vaccination program, your emergency departments (ED) operations will be affected dramatically. ED managers are scrambling to be sure that staff are fully informed, while figuring out how to avoid scheduling nightmares.
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