FEATURE: COVID-19 Vaccine Q&A

COVID-19 VACCINE Q &A

By Jordan Foster APA Director of Communications

In December 2020, as COVID vaccines slowly began to trickle into the state, Arkansas pharmacists stood ready to administer not just the much-anticipated vaccine but also a dose of hope that “normal life” or something close to it would return soon. Within weeks, the number of pharmacies receiving shipments of vaccines soared from double to triple digits, but the supply wasn’t nearly enough to keep up with the astronomical demand. It was clear early on that pharmacies would need to innovate their practices to adapt to such an unprecedented event. APA asked five pharmacies across the state to share their stories of change and how they adapted to a brand new world.

Strike Team Pharmacy

Woodsprings Pharmacy, Jonesboro

Describe Woodsprings involvement as a strike team pharmacy.

Lacey Hoggard: Woodsprings Pharmacy was asked to be a strike team pharmacy to distribute vaccine to 12 hospitals around the state. We made over 30 deliveries to hospitals for their front line workers. We are proud to have been asked to be a member of this initial team in distributing vaccine to Arkansas. We have enjoyed being a part of history as we helped coordinate with ADH and APA to come up with a distribution plan.

What made you decide to become a strike team pharmacy?

LH: When we were asked to be a strike team pharmacy, the answer was immediately “yes!” The world was enduring a pandemic and we were given a chance to help with the beginning of the solution, so we were eager to help in any way we could. We had previously purchased an ultra cold freezer when we heard that the Pfizer vaccine would require one for storage, so we were excited to be able to put it to use. Small and medium sized hospitals needed a way to be able to receive vaccine in smaller quantities that were less than a whole Pfizer tray so we were thrilled to be able to help front line workers have access to the vaccine!

The strike team strategy involved an unprecedented level of collaboration between pharmacies. Are there any lasting effects from that collaboration?

LH: Absolutely! When you have spent hours on calls and exchanged hundreds of text messages collaborating and planning strike team distributions, you have built relationships. We have reached out to several other strike team pharmacies multiple times since then about various COVID vaccine related questions (billing issues, mass clinic strategies, etc.) and also about other pharmacy related questions. It has been helpful to hear perspectives of other pharmacies and what is working well so we can see how we might adapt to better serve our patients and community.

What do you know now that you wish you had known when you got your first shipment of COVID vaccines?

LH: We knew that this was an unprecedented time in pharmacy and regulations/strategies were changing on a daily basis, but I think we underestimated how drastically the pharmacy dynamic would really change almost immediately. Woodsprings Pharmacy has been serving the Northeast Arkansas community for over 40 years and we were committed to still providing the best care to our patients and their medicine needs, even while taking on the new role of being a strike team pharmacy

to serve hospitals, then as a HUB to provide vaccines to other pharmacies in our area, and also vaccinating members of our community. The new dynamic was challenging to provide excellent care to your patients, while fielding hundreds of calls each day about COVID vaccine questions. We are extremely proud of our staff who have risen to the challenge and put in a lot of extra time at night, weekends, etc. in order to make sure that everything was taken care of. were doing 50 or 75 shots in the pharmacy itself, our frontend sales were tremendous. When we got to more than 100 a day and decided to open our offsite clinic, we lost out on some of the opportunity to show people what a great service we offer in the pharmacy and maybe converting some of those vaccine patients to prescription patients or to OTC patients as well.

Off-Site COVID Clinics

The Pharmacy at Wellington, Little Rock

How did your workflow change when you first started receiving the COVID vaccine?

Brittany Sanders: When we first started receiving vaccine as a striketeam pharmacy, we did our immunizations off site, going to various hospitals across the state to immunize healthcare professionals, so it impacted us only in that we had fewer people in the store because part of our staff was gone offsite giving immunizations - so it just made things a little thinner in the store. Once the vaccine became available for people in the community, we quickly noticed that with the volume of vaccine that was going to be required and having people wait that 15 minute timeframe, it was going to be difficult due to space constraints in the store. We felt like people were on top of each other and us all day long and we knew we were going to need more space, so we began looking for an offsite space that could accommodate the vaccine part of our business.

Are there any changes that you have made - getting ready for the COVID vaccine and for the clinic - that you think will carry over into the pharmacy on a permanent basis?

BS: I think we will still do a lot of vaccines on an appointmentbased model and offer that for flu season where we can have people sign up for an appointment time for a flu vaccine. The patients have really liked that, we have some predictability in terms of staffing and scheduling, so that's been a bonus. We've not done that in the past. Also, we've purchased additional laptops and scanners and things like that, and we will definitely take those off site with us to flu clinics in the fall to make those clinics easier. Our immunization operation has been incredibly streamlined.

Scheduling & Strategy

Collier Drug Stores, Northwest Arkansas

Describe the scheduling software Colliers uses and the benefits it provides to Colliers.

Looking back now that it has been open for a while, what do you see as some of the pros and cons of having this specific offsite clinic?

Brenna Neumann: We made the decision to subscribe to a scheduling software early in the Phase 1A process due to the thousands of phone calls our stores were fielding. It was clear within the first week that a manual process for scheduling would not work as it had in the past for other vaccine services. The scheduling software enabled me Woodsprings Pharmacy's role as a striketeam pharmacy meant they would deliver vaccines to manage dose alotment across the company. I determined a weekly base to smaller hospitals in the early days of the alottment and appointment schedule BS: It was wonderful in terms of reducing stress in the pharmacy itself. Everybody vaccine's availability. Above, Lacey Hoggard and Dylan Dulaney prepare a delivery. for each store based on their staffing and demand. Then, as more groups of could focus on their specific role. We could focus on filling people became eligible for the vaccine, we utilized the prescriptions in the pharmacy and then in the clinic we software to manage larger mass clinics. could focus on providing great care with the vaccines and getting people through safely and efficiently. Everybody Will this new scheduling strategy be a permanent fixture for had a clear role and there was no overlapping in terms of Colliers and if so, how will you use it in the future? what we needed people to do.

The cons were taking people out of the actual pharmacy itself. During 2020, we hadn’t had people in the stores consistently so when we started giving the vaccines and BN: Collier's has decided to continue utilizing an online scheduling program for vaccine services. In addition, we plan to utilize the scheduling platforms for other pharmacy services such as compliance packaging requests, POCT,

Collier's pharmacist Jeremy Veteto administers a vaccine to John Luther of the Washington County Office of Emergency Management at a Collier's vaccine clinic at Central EMS during Phase 1A. Woodsprings pharmacist Rian Snell answers questions from a KAIT News reporter. Television reporters across the state sought out pharmacists for several stories regarding the progression of COVID vaccination in Arkansas. Collier's Centerton pharmacist in charge Kathryn Stark and student pharmacists Tiffany Withrow and Matt Calhoun prepare vaccines for a COVID clinic.

and pharmacogenomic testing.

Implementing a new system for one pharmacy is difficult enough but you had to implement it across multiple locations. What was it like creating this new tool for all the Colliers stores and having to do it as quickly as possible?

BN: The pharmacists and myself were overwhelmed with managing the clinical aspects of the program it wouldve been impossible for us to manage setting up a scheduling system. Luckily we have an administrative team that was able to manage the scheduling aspects. Amie Collier researched various platforms and selected SimplyBookMe as our primary scheduling software for in store appointments. The technician and pharmacy managers were trained on how to manage their store's appointments. We initially utilized a centralized scheduling system where the administrative staff managed appointments for all the stores working off of our waitlist. However, at the end of April as the waitlist was cleared the stores assumed responsibility for scheudling their own weekly appoitnments.

Doctor's Orders Pharmacy, Pine Bluff

You had a different strategy when it came to scheduling patients for COVID vaccines by scheduling in groups instead of individually. Describe that strategy.

Sarah Stephenson: After speaking with Brittany Sanders in December, we decided to use Acuity for our online scheduling tool. We developed a group scheduling system by creating classes that were specific to the current eligible phase. Our classes were scheduled every 10 minutes throughout the day. Each 10 minute interval had a specific number of appointments available. We then worked with Allie Staton to develop questionnaires that pertained to the current phase. The questionnaires were attached to the classes and required to complete before the appointment could be booked.

After the patient completed the appointment registration, a confirmation email was sent that clearly told the patient what was needed to prove their inclusion in the current phase, digital consent forms, and details about their appointment. By using class grouping, it allowed us to have better control of our scheduling without having to use our resources to maintain it. We later taught our scheduling process to the Arkansas Dept of Health and together we used it in mass clinics around the State.

What made you decide to use this scheduling strategy for your COVID vaccinations and how did it change your workflow?

SS: We knew an online scheduling system was necessary to lower our call volume so we could better use our resources to vaccinate more people. We also added volunteers to our call center to help those without internet access to schedule appointments as well.

What do you see as the pros and cons of using this method?

SS: The system is wonderful for allowing us to use our resources for vaccinating rather than scheduling. When we had the snow storm this winter, we needed to reschedule over a thousand people. We used the email addresses we had requested in the initial registration through Acuity to send mass emails to patients allowing us to inform them of their new appointment times. We ran a report for the classes that were scheduled that day, exported to Excel, and created a single email for each day that needed to be

rescheduled. It took less than an hour to reconfigure the schedule and alert all of our patients.

The downside of using online scheduling is that many people do not have internet access. For this reason we added volunteers to our call center to schedule these patients.

Vaccination Success

Rison Pharmacy, Rison

Cleveland County has consistently been one of the most successful counties in Arkansas for COVID vaccination. For a long time, it was the county with the highest vaccination rate in the state and it has stayed at or near the top of the list. What did you and your staff do to contribute to the county’s leading vaccination rate?

DH & LW: At the beginning it felt like our workflow was complete chaos. We knew that we would be receiving the vaccine, but I do not think anyone could be prepared for the abrupt changes that began in January. When we initially began giving covid vaccines, we were giving them in the store during and after business hours. We quickly realized this would not be sustainable, and an off-site clinic was the best answer to increase the number of vaccinations we were able to provide each week. Diana came on board in April 2020 in anticipation that I would be spending more time in our Fordyce location and have more flexibility for time off. Without that change, we would not have been able to conduct off-site vaccination clinics during business hours.

Are there any changes you made within your pharmacy to prepare and adapt to the COVID vaccine that you expect to keep in place?

Before we started giving covid vaccines, we completed the Diana Hill & Lynn Wilson: In the beginning, our county process with our software vendor to allow direct reporting numbers were really helped out by the number of residents to Arkansas’s WebIZ. Without this in place, our entire in our county who are healthcare workers and were able process would have been much more difficult. to get their vaccine at local hospitals. We are the only I do not know that there are any specific changes pharmacy in our county, and we started taking names down that we will make in our day-to-day pharmacy operations. on a waiting list a couple We have been fortunate of months before we to have a location where received our first vaccine. we can hold mass We called these patients vaccination clinics offas they were eligible to site, so that there is schedule vaccination minimal disruption to the appointments. We also pharmacy workflow. teamed up with our local Every person on our staff paper and our local county has really stepped-up medical officer, Dr. Mark during these hectic timesAttwood, to help get the there is not one person word out that we were on our staff who has not giving vaccines. come into work early or

As different patient stayed late to get the job populations became done. As we’ve learned eligible, we contacted local businesses to inform Congressman Bruce Pharmacy, and staff Cleveland County. Westerman presents Lynn Wilson, with a "Hometown Hero" award for owner/pharmacist of Rison their role in vaccinating to streamline vaccine paperwork and reporting, them of their eligibility. other vaccines that we I really believe that our reaching out to these different administer in the future will seem like a piece of cake. patient populations have helped our vaccination rates. Our vaccination rate is helped by the fact that our county is What are you seeing as the biggest hurdle to a higher very small, and we received the same allotment as some vaccination rate overall? other counties.

We have a significant portion of our population that are DH & LW: The biggest hurdle to a higher vaccination rate elderly, and a large population who do not have internet currently is vaccine hesitancy in a large portion of the access. I believe that it helped that we never utilized an population. We feel the problem to primarily be misonline platform for scheduling appointments in these information on social media and other internet platforms. particular populations. We pass on any questions that we receive to our county health officer, who works to provide accurate information How did your workflow change when you first started receiving with references to patients who have concerns about the COVID vaccine? vaccine safety and efficacy. §

Looking Back

What moments from the past few months stick with you?

Diana Hill & Lynn WIlson, Rison Pharmacy: I gave a patient a shot who immediately started crying tears of joy after receiving her shot. She told me that she had quit her job at the beginning of the pandemic to care for her elderly mother. She had hardly left her house in almost a year. Stories like this really stick with me. We have so many patients who finally felt like they could see their family again, our own families included.

Sarah Stephnson, Doctor's Orders: I recently gave a vaccine to a young women. After the vaccine, she began to cry. I first thought she had anxiety about the vaccine, and I tried to comfort her. She took a minute and then told me that her mother and brother had both died from Covid-19 and this vaccine meant so much to her. I feel beyond honored to provide this service for our community. I am reminded daily the impact Covid has had on us all and how we are blessed to have a vaccine.

Brenna Neumann, Collier Drug Stores: Aside from vaccinating thousands of Arkansas residents, probably the most memorable aspect of the pandemic vaccination efforts has been becoming integrated into the emergency services community. We have forged relationships with County Emergency management, local ADH units, nursing groups, physicians that previously did not exist. I have enjoyed working out in the community every week side by side with paramedics, fire departments, city and county officials, nurses and other community volunteers. I have learned so much about our counties in NWA that will be of benefit for years to come.

Brittany Sanders, The Pharmacy at Wellington: We have one patient, she's a longtime regular patient with us, and she absolutely had not left her home in over a year before the vaccine was available. She waited her turn and was just so excited to be there and to be vaccinated that she broke down in tears. She was so happy to give me a hug. There’s been a feeling of relief that people get to finally be headed to a place where they don’t have to be afraid and it was such a great feeling to be part of getting her life back to normal.

Lacey Hoggard, Woodsprings Pharmacy: We have had countless patients in tears because they were so excited to be vaccinated. Many have had jobs where they are highly exposed on a daily basis and were thankful for another level of protection, and many were thrilled to be able to visit a loved one who they have not been able to see during the pandemic. We did whatever we could to make the vaccine easily accessible to members of our community, including giving vaccinations in cars to make it easier for those with mobility issues and making in home visits for those who are confined to their homes. The countless kind words and thank you notes we have received remind you that the long hours are worth it and vaccination distribution efforts are providing hope to those around us.

What do you know now that you wish you had known when you got your first shipment of COVID vaccines?

Lacey Hoggard, Woodsprings Pharmacy: We knew that this was an unprecedented time in pharmacy and regulations/ strategies were changing on a daily basis, but I think we underestimated how drastically the pharmacy dynamic would really change almost immediately. The new dynamic was challenging to provide excellent care to your patients, while fielding hundreds of calls each day about COVID vaccine questions. We are extremely proud of our staff who have risen to the challenge and put in a lot of extra time at night, weekends, etc. in order to make sure that everything was taken care of.

Diana Hill & Lynn WIlson, Rison Pharmacy: Our biggest concern when we first started giving vaccines was that there might be an availability issue for second doses. As second doses began arriving and clarification was given during multiple zoom meetings, those fears subsided. The entire process has been a learn as you go experience. The association has been tremendously helpful with their zoom meetings and updates.

Brittany Sanders, The Pharmacy at Wellington: How quickly demand would fall off. When we first started, we thought ‘we will still be vaccinating through the summer, maybe even in December we would still be getting those tail end groups of people with their first set of COVID vaccines.’ But then, around the first of April, demand really just hit a wall. And I think there are several pharmacies that were left with larger quantities of vaccines because demand went from 100 to 50 overnight and then from 50 to 25 the next day.

Brenna Neumann, Collier Drug Stores: I wish we had the foresight to realize we were going to need to utilize a scheduling program so we could've planned and strategized ahead of supply. I knew pharmacy would play a key role in the adminsitration of Covid-19 vaccines in the state, I had no idea as to the scale! Absolutely blew my mind and do not think the implications willl fully be realized for months to come. I also wish I had a clue of the scale so I could have planned for increased staffing needs.

Sarah Stephnson, Doctor's Orders: This is a hard question to answer because we knew basically nothing when we started. This had never been done before. As with most pharmacies, we learned from our mistakes and adapted as we went. We all worked 70-80 hour weeks striving to do better. The process was ever evolving and no one knew what to expect week to week. That all being said, I would do again in a heartbeat.