COVID-19 Vaccination Delivery in Long-Term-Care using the CARD (Comfort Ask Relax Distract) System: Mixed Methods study of Implementation Drivers

Anna Taddio; Katherine S. McGilton; Nancy Zheng; Lydia Yeung; Benoit Lafleur; Jollee S.T. Fung; Noni E. MacDonald; Melissa K. Andrew; Chris P. Verschoor

doi:10.1080/24740527.2022.2115880

COVID-19 Vaccination Delivery in Long-Term-Care using the CARD (Comfort Ask Relax Distract) System: Mixed Methods study of Implementation Drivers

Anna Taddio, Katherine S. McGilton, Nancy Zheng, Lydia Yeung, Benoit Lafleur, Jollee S.T. Fung, Noni E. MacDonald, Melissa K. Andrew, Chris P. Verschoor

Medicine

Research output: Contribution to journal › Article › peer-review

2 Citations (Scopus)

Abstract

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.

Original language	English
Pages (from-to)	173-184
Number of pages	12
Journal	Canadian Journal of Pain
Volume	6
Issue number	1
DOIs	https://doi.org/10.1080/24740527.2022.2115880
Publication status	Published - 2022

Bibliographical note

Funding Information:
was provided to AT by the Public Health Agency of Canada Immunization Partnership Fund (2021-HQ-000220) and to MKA by the Maria and Walter Schroeder Institute for Brain Innovation and Recovery. There is no fund number associated with this award. We thank Dr. Janet McElhaney, geriatrician and vaccine scientist, for her contributions, which included introducing CARD to the participating centre, assisting with development of the study protocol, obtaining project approval, and leading information sessions for staff, residents, and essential caregivers. Dr. McElhaney was passionate about providing quality care to the LTC population and died during the conduct of the study. We also thank all of the individuals that participated.

Publisher Copyright:
© 2022 The Author(s). Published with license by Taylor & Francis Group, LLC.

ASJC Scopus Subject Areas

Anesthesiology and Pain Medicine

PubMed: MeSH publication types

Journal Article

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1080/24740527.2022.2115880

Cite this

Taddio, A., McGilton, K. S., Zheng, N., Yeung, L., Lafleur, B., Fung, J. S. T., MacDonald, N. E., Andrew, M. K., & Verschoor, C. P. (2022). COVID-19 Vaccination Delivery in Long-Term-Care using the CARD (Comfort Ask Relax Distract) System: Mixed Methods study of Implementation Drivers. Canadian Journal of Pain, 6(1), 173-184. https://doi.org/10.1080/24740527.2022.2115880

@article{833bdbf4181d447ea22810bee878c405,

title = "COVID-19 Vaccination Delivery in Long-Term-Care using the CARD (Comfort Ask Relax Distract) System: Mixed Methods study of Implementation Drivers",

abstract = "Objectives: CARD (comfort, ask, relax, distract) is a vaccine delivery framework that includes interventions to improve the patient{\textquoteright}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{\textquoteright} 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{\textquoteright}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.",

author = "Anna Taddio and McGilton, {Katherine S.} and Nancy Zheng and Lydia Yeung and Benoit Lafleur and Fung, {Jollee S.T.} and MacDonald, {Noni E.} and Andrew, {Melissa K.} and Verschoor, {Chris P.}",

note = "Funding Information: was provided to AT by the Public Health Agency of Canada Immunization Partnership Fund (2021-HQ-000220) and to MKA by the Maria and Walter Schroeder Institute for Brain Innovation and Recovery. There is no fund number associated with this award. We thank Dr. Janet McElhaney, geriatrician and vaccine scientist, for her contributions, which included introducing CARD to the participating centre, assisting with development of the study protocol, obtaining project approval, and leading information sessions for staff, residents, and essential caregivers. Dr. McElhaney was passionate about providing quality care to the LTC population and died during the conduct of the study. We also thank all of the individuals that participated. Publisher Copyright: {\textcopyright} 2022 The Author(s). Published with license by Taylor & Francis Group, LLC.",

year = "2022",

doi = "10.1080/24740527.2022.2115880",

language = "English",

volume = "6",

pages = "173--184",

journal = "Canadian Journal of Pain",

issn = "2474-0527",

publisher = "Taylor and Francis Ltd.",

number = "1",

}

TY - JOUR

T1 - COVID-19 Vaccination Delivery in Long-Term-Care using the CARD (Comfort Ask Relax Distract) System

T2 - Mixed Methods study of Implementation Drivers

AU - Taddio, Anna

AU - McGilton, Katherine S.

AU - Zheng, Nancy

AU - Yeung, Lydia

AU - Lafleur, Benoit

AU - Fung, Jollee S.T.

AU - MacDonald, Noni E.

AU - Andrew, Melissa K.

AU - Verschoor, Chris P.

N1 - Funding Information: was provided to AT by the Public Health Agency of Canada Immunization Partnership Fund (2021-HQ-000220) and to MKA by the Maria and Walter Schroeder Institute for Brain Innovation and Recovery. There is no fund number associated with this award. We thank Dr. Janet McElhaney, geriatrician and vaccine scientist, for her contributions, which included introducing CARD to the participating centre, assisting with development of the study protocol, obtaining project approval, and leading information sessions for staff, residents, and essential caregivers. Dr. McElhaney was passionate about providing quality care to the LTC population and died during the conduct of the study. We also thank all of the individuals that participated. Publisher Copyright: © 2022 The Author(s). Published with license by Taylor & Francis Group, LLC.

PY - 2022

Y1 - 2022

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=85140214099&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85140214099&partnerID=8YFLogxK

U2 - 10.1080/24740527.2022.2115880

DO - 10.1080/24740527.2022.2115880

M3 - Article

C2 - 36278249

AN - SCOPUS:85140214099

SN - 2474-0527

VL - 6

SP - 173

EP - 184

JO - Canadian Journal of Pain

JF - Canadian Journal of Pain

IS - 1

ER -

COVID-19 Vaccination Delivery in Long-Term-Care using the CARD (Comfort Ask Relax Distract) System: Mixed Methods study of Implementation Drivers

Abstract

Bibliographical note

ASJC Scopus Subject Areas

PubMed: MeSH publication types

UN SDGs

Access to Document

Other files and links

Fingerprint

Cite this