A 13-step process was developed and implemented for the Vote & Vax influenza clinic on Election Day 2010 at a community center in Prince George’s County, Maryland.
1. Conceptualize an Idea
The idea of implementing the Vote & Vax initiative in Maryland resulted from a discussion between a student pharmacist and her preceptor during a public health pharmacy practice experience at the University of Maryland School of Pharmacy. After reading about the Vote & Vax initiative, the student recruited a classmate with public health experience to discuss implementation of Vote & Vax and conduct a needs assessment with guidance from her preceptor.
2. Conduct a Needs Assessment
The first step in a public health program is to identify and assess a need in the community. The program’s goal was to improve vaccination rates through implementation of an influenza clinic that would provide free vaccinations on election day. Vaccination and polling site statistics were compiled for Maryland’s 23 counties and Baltimore City. Based on the Healthy People 2010 objective 22.241
and local statistics, Baltimore City and Prince George’s County were targeted because of their historically low vaccination rates.4
3. Convene a Student Core Planning Team
Once the unmet need for an immunization program was identified and assessed, a core planning team was formed on which students served as chief organizers, media contacts, site coordinators, liaisons for the city and county targeted, researchers, and a volunteer coordinator. Selection of a small core planning team was critical, as it allowed for frequent meetings and quick decision-making. To ensure sustainability, leaders from 2 of the university’s student organizations, the chair of the American Pharmacists Association Academy of Student Pharmacists (APhA-ASP) Operation Immunizations and the president of the Student Section of the Maryland Public Health Association (SMdPHA), were recruited to serve on the core planning team to facilitate communication and planning between student organizations.
4. Seek Guidance and Support
Along with a core team of students, a core group of faculty pharmacists and professional staff members with expertise and experience in immunizations, public health, external affairs, marketing, and communications were recruited. These included a professor of the school’s immunization course and advisor of APhA-ASP, a faculty member who was author of a book on immunization, director of the experiential learning program, book author/editor of the Pharmacists in Public Health,7 2 advisors of SMdPHA, and director of marketing and communications. The guidance and expertise of these individuals throughout the initiative were essential to its success. The dean provided support and served as a liaison to external stakeholders such as local health departments.
5. Collaborate With Local Organizations
Students identified potential sites in targeted communities with stakeholders’ help. Typically, Vote & Vax clinics are held at polling locations so voters can receive their influenza shots after casting their ballots. Students and faculty members reached out to local and state boards of elections with a letter template developed to express a uniform message of intent to improve public health through provision of vaccinations. Although some polling sites expressed interest in hosting the event, the Maryland State Board of Election decided that providing vaccinations at the polling site could be a conflict of interest in an election year when healthcare reform was a contentious subject. Consequently, the team agreed to select locations in close proximity to polling sites. The site coordinator and assistant for each target area contacted these sites to determine their willingness to host the clinic at no cost and to ensure the site had sufficient parking, space, tables, and chairs. The team was able to find appropriate clinic locations in Prince George’s County and in Baltimore City.
6. Collaborate With Local Health Departments
While working to identify and contact potential sites, the team also worked to identify and secure a sponsor who would provide the vaccines. The dean contacted the Deputy Secretary of the Maryland Department of Health and Mental Hygiene (DHMH) to request 250 doses of the influenza vaccine per site. Although DHMH committed to helping the group obtain vaccine from local health departments, it was also necessary to contact Prince George’s County and Baltimore City health departments to coordinate the logistics of vaccine delivery, supplies, and forms. Unfortunately, at this point, the core planning team was unable to address a legal issue regarding liability coverage that needed to be resolved before holding an event in Baltimore City. Pursuant to the collaborative relationship with Prince George’s County, participants were asked to join the Medical Reserve Corps (MRC) in Prince George’s County. Meanwhile, the county health department agreed to deliver the vaccines on event day, provide all of the required supplies (eg, needles, sharps containers, epinephrine), and retain the completed vaccination forms.
7. Address Influenza Clinic Protocols
The planning team informed the risk management office of the University of Maryland Baltimore campus about the purpose of the event and its specifics. Following the campus protocol to authorize student outreach events, the event had to be approved by legal counsel and risk management. As members of the MRC for Prince George’s County, participating pharmacist faculty members and student pharmacists were able to immunize pursuant to the influenza immunization protocol for that county, which included procedures for responding to emergency situations. If the health department could not have been the sponsor, it would have been necessary to obtain a standing order for influenza immunizations and emergency protocol from a physician.
8. Ensure Compliance With Legal and Liability Guidelines
Another key component of the planning process was the early involvement of the university’s legal office. University counsel was able to help obtain liability coverage and advise on local election laws regarding polling site boundaries. Acting as practitioners and representatives of the university, faculty pharmacists had additional credentials to provide immunizations as well as professional liability insurance. These credentials (ie, immunization-training and CPR certification) prepared faculty members to supervise the clinic, ensure appropriate communication, monitor documentation, and respond to complex issues. Students also had to meet a variety of legal and university requirements to be covered by the university-sponsored liability insurance. Within Maryland, students who have completed the appropriate immunizations training may immunize under the supervision of a credentialed pharmacist. Because liability insurance covers students’ actions performed as part of their experiential education, fourth-year students were designated to serve as student immunizers. Other students had important roles as outlined in Appendix 1
9. Promote the Initiative/Clinic
Under the guidance of the university’s news bureau director and the school’s marketing and communications director, the student serving as the primary media contact drafted a press release, which was then sent to local newspapers, radio stations, and the Associated Press 3 weeks prior to the event. In addition to contacting the press, the team also registered with the national Vote & Vax program so the event would be listed on the program’s Web site. Students helped in contacting the elected officials for the district where the event was held and encouraged them to come to the event. Students also used social networking sites and flyers at the clinic site for promotion.
10. Recruit and Train Volunteers
Approximately 1 month before the event, the student volunteer coordinator created a Web-based interactive sign-up sheet to recruit and organize student volunteers. Faculty members who were not directly involved with the initiative supported it by accommodating student volunteers when they had to be absent from class and/or having them watch recorded lectures online. All student volunteers were required to attend a 1-hour training session 5 days before the event. Students were given a review of immunizations and were briefed about what to expect on the day of the event, including the check-in process and media contacts.
11. Put it All Together
Throughout all the aforementioned planning steps, the core group of students worked closely with the core faculty advisors, county health department, and selected event sites to ensure successful implementation of this student-organized project. Students functioned as liaisons to assist and ensure all legal issues were addressed; confirm that DHMH would provide vaccine, syringes, needles, sharps containers, etc; and manage registration forms after the event. Additionally, students were responsible for scheduling and organizing meetings of the core planning group, including documenting and sending meeting minutes after each session. Finally, a student chief organizer conducted a site visit prior to the event to meet with the site manager and create a plan for set-up and workflow.
12. Implement the Clinic and Manage Last-Minute Challenges
On Election Day, the core team arrived 1.5 hours prior to the start of the immunization clinic to direct the set-up process for the site (immunization stations, registration, signage, post-immunization monitoring area, adverse reaction emergency station). Although site setup had been preplanned, the team was informed on the afternoon prior to the event that the county health department would be sending nurses to vaccinate children under the age of 18 years. This required the team to make last-minute changes to the site plan, but allowed patients of all ages to be immunized at the event. Throughout the day, the 2 chief organizers monitored the event to ensure stations had adequate supplies, answered questions from volunteers and the health department, and directed volunteers to areas where help was needed.
13. Follow-up and Evaluation
After the event was over, the chief organizers informed the school’s media director of the number of vaccinations provided so the information could be included in news articles about the event. A report for the Vaccine Adverse Event Reporting System was completed on a non-life-threatening adverse event experienced by 1 participant. Results from the brief exit survey instrument administered to participants to assess their experience and satisfaction were tabulated, and student volunteers were asked to provide feedback. The chief organizers also worked with faculty advisors to evaluate the program, including lessons learned, challenges to overcome, and opportunities to explore in preparation for future Vote & Vax events.