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COVID-19 Vaccination Delivery in Long-Term-Care using the CARD (Comfort Ask Relax Distract) System: Mixed Methods
Anna Taddio1,2, Katherine S McGilton3,4, Nancy Zheng3
1Leslie Dan Faculty of Pharmacy, University of Toronto (UofT), Toronto, Canada.
Insights
The Comfort, Ask, Relax, Distract (CARD) framework improved COVID-19 vaccine delivery in long-term care. Staff support and resident input facilitated implementation, despite challenges with resources and communication.
Area of Science:
- Healthcare delivery science
- Implementation science
- Geriatric medicine
Background:
- The Comfort, Ask, Relax, Distract (CARD) framework aims to enhance patient experience during vaccine delivery.
- CARD has not been previously implemented in long-term care (LTC) settings.
- This study focused on implementing CARD for COVID-19 vaccinations in an LTC facility.
Purpose of the Study:
- To evaluate the drivers of implementing the CARD framework for COVID-19 vaccinations in a long-term care setting.
- To identify facilitators and barriers to successful implementation.
- To assess the safety and impact of CARD interventions on residents.
Main Methods:
- A postimplementation interpretive evaluation was conducted.
- Qualitative interviews and quantitative surveys with eight participants were utilized.
- The Consolidated Framework for Implementation Research (CFIR) guided the analysis.
- Medical charts of 93 vaccinated residents were reviewed for adverse reactions.
Main Results:
- Eight CFIR constructs emerged as key implementation drivers.
- Staff perceived CARD as complex but were motivated by resident needs, adopting strategies like topical anesthetics.
- Facilitators included staff knowledge, commitment to person-centered care, and resident council involvement.
- Barriers comprised resource limitations, communication gaps, lack of CARD awareness, and misaligned external policies.
- Chart reviews confirmed the safety of CARD interventions, with a low rate of adverse reactions and no skin infections.
Conclusions:
- Positive and negative implementation drivers for the CARD framework in LTC were identified.
- Future research should explore expanded strategies and direct resident involvement.
- The study highlights the importance of staff support, resident engagement, and addressing systemic barriers for successful implementation of patient-centered care models.
Objectives:
CARD (comfort, ask, relax, distract) is a vaccine delivery framework that includes interventions to improve the patient's experience. CARD has not been previously implemented in long-term care (LTC) settings. This study evaluated drivers to implementation for COVID-19 vaccinations in an LTC facility.
Methods:
Postimplementation interpretive evaluation including qualitative interviews and quantitative surveys with eight participants. The Consolidated Framework for Implementation Research (CFIR) was used for analysis. Adverse reactions to vaccinations and CARD interventions, including local reactogenicity and systemic reactions, were abstracted from medical charts of residents.
Results:
Eight CFIR constructs emerged. Staff perceived CARD was complex because it added steps to vaccination delivery. Motivated to meet residents' needs, a receptive implementation climate of support among staff led to using strategies within CARD, such as administering topical anesthetics and omitting alcohol skin antisepsis prior to injections. Having an effective network like the residents council positively influenced implementation by allowing residents to voice their opinions. Facilitators to implementation included staff knowledge and beliefs and staff's commitment to their organization, which was focused on person-centered care. Barriers included lack of available resources (inadequate staffing), insufficient communication between management and staff and lack of awareness of CARD, and external policies not aligned with CARD. Chart reviews conducted for 93 vaccinated residents corroborated perceptions of vaccination and CARD intervention safety, revealing a low rate of local and systemic adverse reactions and no cases of skin infection.
Discussion:
We identified positive and negative implementation drivers. Future research is recommended to expand the strategies employed and involve residents more directly.
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