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Story from the Field

Name of Health Department/Agency: Seattle-King County Department of Health and Univ. of WA
State: WA
Date Added: 11/20/2009
Themes: Communications - Priority Groups,Vaccine Planning and Administration
Issue Summary: OB-GYNs outreach to pregnant women in Seattle, WA
Description of Issue(s): My two examples are related to some of the planning that we did with a couple of the hospitals.  We had proposed that hospitals play a large role in getting OB-GYN patients vaccinated. 
Actions taken to address the issue(s): •In the first example, a hospital that delivers about 4,000 babies a year agreed to sponsor a mass vaccination clinic for all the prenatal patients of OB staff on their medical staff. This was a centralized clinic and of course one of the first problems was that it took a while for us to get vaccine that was appropriate for pregnant women.
•Prior to that, the OB-GYN offices had phones ringing off the hook with women asking when they could get the vaccine.  So we do have the impression in Seattle from all the feedback that there’s tremendous demand among pregnant women. 
•The way that they arranged this clinic was pretty innovative.  There are five group practices and five solo practices that deliver at this hospital.  They each provided a list of their pregnant patients to the hospital.  The hospital in turn provided stamped postcards for the clinics to send to each one of their patients to advise them about the mass vaccination clinics, as well as to how to register.
•Immediately after the postcards were received, there was one voice mail line that had 1,500 requests for appointments. So they felt kind of overwhelmed from the very onset. 
•Since that time, they have actually managed to hold three mass vaccination clinics and administered about 900 shots.  They project that they will be giving up to 2,000 shots if not more, as vaccine becomes available.
•They schedule clinics by looking at how much vaccine they have for the day and they schedule three blocks of two-hour sessions.  Women wait in the auditorium, which has just been remodeled and is very comfortable.  They show a movie to entertain any children that come with their moms.  The average waiting time is about ten minutes.  They are asked to wait in the auditorium after they get their shot for another 10 minutes.  The women do seem very pleased with how it’s going and relieved finally to get their shots I think. 
•In the most recent clinic, they had only a six percent no show and they speculate that some of these women actually had shots elsewhere and that’s why they didn’t show up.
•Another hospital that has about 4,500 births each year decided that they wanted the individual OB clinics to give vaccine to their patients but they recognized that most of these clinics could not receive and store the minimum drop shipment of 100 doses.  So they agreed to provide receipt and storage of the vaccine and then allocate or deliver it to individual clinics. 
•There were a few more problems with this and this actually happened at another large hospital who decided to act as the distribution site.  The hospital had asked for each of the clinics to provide a total of vaccines that they needed but then that information did not go to public health.  So public health was kind of in the dark as to how many total should be in a shipment to the hospital and what percentage were actually for these clinics.  So when the hospital received its first shipment with the PIN number for the hospital, it assumed that it was for the hospital.  It did not realize that the clinic doses were subsumed in that total. So the clinics didn’t get any.  There was a lot of frustration and trying to work out the kinks in the system. 
•Finally, it started to work and the clinics were much happier. They have had tremendous demand from women.  Many of those clinics made a waiting list and prioritized who they called in first—the women in the later part of their pregnancy. 

Outcomes that resulted from actions taken: LESSONS LEARNED FROM 1ST HOSPITAL:
•They feel like it’s been a very successful process.  The hospital felt like it was going to be good PR.  They had an article on the front page of the local Eastside newspaper.  That was really good for the hospital’s reputation.
•There have been a couple of issues that were recognized could be done a little differently next time: (1) They did not think about how to prioritize women for the shot because many women signed up at the same time.  So they thought that next time, they would send out postcards to women in their third trimester first so they would get appointments first. (2) They noticed that even though the shots were available for the women, many of the OB clinic staff did not have access to the vaccine or they would refuse the FluMist, which was the first vaccine that was available.  They were going uncovered while they were delivering treatment to their patients.  I think that’s another glitch that needs to be taken care of next time.     
•It was a lot of work to do it this way.  The director of this clinic said that it was successful primarily because of the dedication of the staff, who really had to work extra hard and continue to do some of their routine duties in order to get these clinics done. 
•We need to stress that the single dose syringes need to be reserved at least initially until the supply loosens up for pregnant women because many of the OB providers would not even order anything except the thimerosal-free type because they did not want the hassle of having to talk about the safety issues. 
•Some clinics that were not related to pregnant women would order the single dose syringe type just for simplicity’s sake.  They thought it would be easier to give that.  But then of course the decision was made on the public health end that they would get multi-dose vials instead. 
•I think it’s really important that the participating clinics be involved in the planning and that there is some transparent way that everyone can see how the doses are being allocated because there have been some disgruntled clinics feeling they have been shortchanged. 
•Many of the clinics that have previously been involved in the VFC (Vaccine for Children) program actually know the ins and outs of managing vaccine—how to request more and how to account for it.  The hospitals really need to have a little more education in that vein. 
•We’ve learned a lot and we’re still learning.  We hope the vaccine supply loosens up even more because that’s probably been our biggest challenge and the basis of many of the problems that people experienced. 

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