Impact of COVID-19 Immunization Standardized Procedures/Standardized Protocols Utilization at Two Ambulatory Care Health Centers

Purpose: This work compared the utilization of the newly developed and implemented COVID-19 immunization standardized procedures for registered nurses (RNs) and pharmacists (PharmDs) and standardized protocols for licensed vocational nurses (LVNs) and determined potential impact at two ambulatory care health centers in a large, municipal healthcare system. Participants will be able to describe the impact COVID-19 immunization SPs have on patients, staff, and organization.

Description: In response to the U.S. Food & Drug Administration’s COVID-19 vaccine emergency use authorizations, the CDC COVID-19 vaccination recommendations, and in accordance with the California Board of Registered Nursing standardized procedure guidelines (2011), the interdisciplinary practice committee (IDPC) developed COVID-19 immunization standardized procedures/standardized protocols (SPSPs) for RNs, PharmDs, and LVNs. These SPSPSs enable trained RNs, PharmDs, and LVNs to safely, efficiently, and appropriately order COVID-19 vaccines for a large diverse and vulnerable patient population.

The IDPC, consisting of RNs, physicians, and administrators, developed and implemented the SPSPs and corresponding workflows, order sets, forms, and training. While ordering immunizations is a provider function, SPSPs enable RNs to function at a higher complexity level in defined situations, allowing RNs to perform functions not usually within their scope of practice (Perris, 2020). Under the COVID-19 immunization SPSPs, designated staff screen patients, using fixed eligibility inclusion and exclusion criteria to determine if patients are eligible to receive the COVID-19 vaccine by SPSP. The SPSPs then provide staff with clear instructions and algorithm to use in determining the appropriate COVID-19 vaccine to order for eligible patients and steps to take for patients ineligible to receive the COVID-19 vaccine by SPSP.

Comparison and analysis of the following were performed: number of staff trained, number of COVID-19 vaccines administered, and proportion of COVID-19 vaccines ordered by SPSP at two health centers. A chi-square test was used to conduct statistical analysis.

Outcome: From January 1, 2021, to February 28, 2021, 78 staff (29 [37.2%] center “A”; 49 [62.8%] center “B”) were trained on the COVID-19 immunization SPSPs: 42 (53.8%) RNs, 6 (7.7%) pharmDs, and 30 (38.5%) LVNs. There was no difference in the number of RNs and LVNs trained at each site (X2 (1, N=72) = 0.2788, p= 0.597). A total 1,585 (.904) of the 1,754 COVID-19 vaccines at center “A” were ordered by SPSP and 169 (.096) by provider. In comparison, 1,298 (.77) of 1,685 COVID-19 vaccines at center “B,” were ordered by SPSP; 387 (.23) by provider. Combined, 2,883 (.838) of the 3,439 vaccines were ordered by SPSP and 556 (.162) by provider, demonstrating high SPSP utilization to order the vaccine. COVID-19 immunization SPSPs allow trained staff to function at the top of their scope, allow scarce provider resources to focus on managing the most complex patients, and decrease potential delay in patients receiving their COVID-19 vaccine by enabling trained staff to order the vaccine rather than waiting for the provider.

References
1) California Board of Registered Nursing. (2011). Standardized procedure guidelines. https://www.rn.ca.gov/pdfs/reg...
2)    Perris, K. (2020). Optimizing the RN role in ambulatory care with standardized procedures. AAACN Viewpoint, 40(4)3-7.