COVID-19 Vaccination Delivery in Long-Term-Care using the CARD (Comfort Ask Relax Distract) System: Mixed Methods study of Implementation Drivers
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 L...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Taylor & Francis Group
2022-12-01
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| Series: | Canadian Journal of Pain |
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| Online Access: | https://www.tandfonline.com/doi/10.1080/24740527.2022.2115880 |
| _version_ | 1797986383801876480 |
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| author | Anna Taddio Katherine S. McGilton Nancy Zheng Lydia Yeung Benoit Lafleur Jollee S.T. Fung Noni E. MacDonald Melissa K. Andrew Chris P. Verschoor |
| author_facet | Anna Taddio Katherine S. McGilton Nancy Zheng Lydia Yeung Benoit Lafleur Jollee S.T. Fung Noni E. MacDonald Melissa K. Andrew Chris P. Verschoor |
| author_sort | Anna Taddio |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-04-11T07:32:58Z |
| format | Article |
| id | doaj.art-54defcc68ba14035997e4079ec041b35 |
| institution | Directory Open Access Journal |
| issn | 2474-0527 |
| language | English |
| last_indexed | 2024-04-11T07:32:58Z |
| publishDate | 2022-12-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | Canadian Journal of Pain |
| spelling | doaj.art-54defcc68ba14035997e4079ec041b352022-12-22T04:36:50ZengTaylor & Francis GroupCanadian Journal of Pain2474-05272022-12-016117318410.1080/24740527.2022.2115880COVID-19 Vaccination Delivery in Long-Term-Care using the CARD (Comfort Ask Relax Distract) System: Mixed Methods study of Implementation DriversAnna Taddio0Katherine S. McGilton1Nancy Zheng2Lydia Yeung3Benoit Lafleur4Jollee S.T. Fung5Noni E. MacDonald6Melissa K. Andrew7Chris P. Verschoor8Leslie Dan Faculty of Pharmacy, University of Toronto (UofT), Toronto, CanadaToronto Rehabilitation Institute, University Health Network (UHN), Toronto, Ontario, CanadaToronto Rehabilitation Institute, University Health Network (UHN), Toronto, Ontario, CanadaToronto Rehabilitation Institute, University Health Network (UHN), Toronto, Ontario, CanadaNorthern Ontario School of Medicine (NOSM), Sudbury, Ontario, CanadaNorthern Ontario School of Medicine (NOSM), Sudbury, Ontario, CanadaFaculty of Medicine, Dalhousie University (DU), Halifax, Nova Scotia, CanadaFaculty of Medicine, Dalhousie University (DU), Halifax, Nova Scotia, CanadaNorthern Ontario School of Medicine (NOSM), Sudbury, Ontario, CanadaObjectives 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.https://www.tandfonline.com/doi/10.1080/24740527.2022.2115880long-term carefrail elderlyimplementation scienceCOVID-19 vaccinationCARD systempain management |
| spellingShingle | Anna Taddio Katherine S. McGilton Nancy Zheng Lydia Yeung Benoit Lafleur Jollee S.T. Fung Noni E. MacDonald Melissa K. Andrew Chris P. Verschoor 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 long-term care frail elderly implementation science COVID-19 vaccination CARD system pain management |
| title | COVID-19 Vaccination Delivery in Long-Term-Care using the CARD (Comfort Ask Relax Distract) System: Mixed Methods study of Implementation Drivers |
| title_full | COVID-19 Vaccination Delivery in Long-Term-Care using the CARD (Comfort Ask Relax Distract) System: Mixed Methods study of Implementation Drivers |
| title_fullStr | COVID-19 Vaccination Delivery in Long-Term-Care using the CARD (Comfort Ask Relax Distract) System: Mixed Methods study of Implementation Drivers |
| title_full_unstemmed | COVID-19 Vaccination Delivery in Long-Term-Care using the CARD (Comfort Ask Relax Distract) System: Mixed Methods study of Implementation Drivers |
| title_short | COVID-19 Vaccination Delivery in Long-Term-Care using the CARD (Comfort Ask Relax Distract) System: Mixed Methods study of Implementation Drivers |
| title_sort | covid 19 vaccination delivery in long term care using the card comfort ask relax distract system mixed methods study of implementation drivers |
| topic | long-term care frail elderly implementation science COVID-19 vaccination CARD system pain management |
| url | https://www.tandfonline.com/doi/10.1080/24740527.2022.2115880 |
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