COVID-19 Hospital (Inpatient) Vaccination Orders
Alberta Health Services (AHS) and Covenant Health support COVID-19 immunization of eligible acute care patients who wish to be immunized while in hospital as part of Alberta's COVID-19 immunization program. All acute care in-patients should be considered for immunization during their hospital stay (first or second doses).
A most responsible healthcare provider (attending prescriber) confirms that proposed patient(s) are medically stable, fit for immunization, and more than 14 days post any other immunization.
Informed of COVID-19 immunization risks and benefits, patients or their alternate decision-makers are informed of COVID-19 immunization risks and benefits and indicate a (verbal) wish to receive inpatient vaccination.
Inpatient vaccination should focus on patients who experience or are likely to experience barriers to timely community vaccination, such as impaired mobility, functional limitations or vaccine hesitancy.
Inpatient COVID-19 vaccines are administered by Acute Care Immunization teams or AHS Public Health teams, depending upon Zone and site.
The inpatient vaccination process does not require use of online tools or HealthLink.
Available vaccines may vary but usually include Pfizer-BioNTech or Moderna preparations.
A significant adverse reaction to one vaccine type (e.g., mRNA) may merit a switch to another type (e.g., AstraZeneca) for the second or additional booster.
COVID-19 vaccines may be co-administered with, or at any time before or after other vaccines (including live, inactivated, adjuvanted or unadjuvanted vaccines). There is not a requirement to space between vaccines. This includes influenza vaccinations, which can be co-administered.
Inpatient clinical staff provide instruction about how to book a second dose.
AHS Transition Services can facilitate second dose arrangements when needed.
Those who have received an mRNA vaccine (Pfizer or Moderna) as a first dose should have the same vaccine for their second dose whenever possible and as early as 3-4 weeks after their first dose.
Those who received an AstraZeneca/Covishield vaccine as a first dose may choose to have a second dose of AstraZeneca or an mRNA vaccine. Second doses are recommended at 8-12 weeks (regardless of second dose product type) for the highest level of protection, but can be given as soon as 4 weeks after the first dose.
Any two doses of COVID-19 vaccine are considered a valid, safe and protective series.
Additional (Booster) Doses
Inpatient booster vaccines can be administered 8 or more weeks after a second dose, with the same vaccine combination considerations as a second dose, as long as one or more of the following conditions applies:
transplant recipients, including solid organ and hematopoietic stem cell transplants
malignant hematologic disorders and non-hematologic malignant solid tumours
chronic kidney disease on dialysis
receipt of chimeric antigen receptor (CAR)-T-cell therapy
primary immunodeficiency (e.g., DiGeorge syndrome, Wiskott-Aldrich syndrome)
advanced untreated HIV infection and those with acquired immunodeficiency syndrome
active treatment with the following categories of immunosuppressive therapies:
anti-B cell therapies (monoclonal antibodies targeting CD19, CD20, CD22 and CD52),
high-dose systemic corticosteroids,
tumor-necrosis factor (TNF) inhibitors, or
other agents that are significantly immunosuppressive
Booster vaccines can be administered to double-vaccinated residents of seniors' supportive living facilities 5 months or more after their second dose.
Inpatient COVID-19 vaccination workflows have four parts, each with specific requirements:
Screening for Eligibility
Inpatient care teams (e.g., at Rapid Rounds or multidisciplinary team rounds) identify inpatients who have stabilized and await discharge or transition of care.
Fit for Immunization
The attending prescriber confirms medical fitness for immunization, together with the patient's (or designated decision-maker's) verbal ask to receive inpatient vaccination.
It is important to determine whether a first COVID-19 vaccine dose has already been administered and, if so, what type, at what time and with what possible adverse effects, using an official immunization record (patient held), Netcare immunization record and/or Connect Care immunization record.
If helpful, an information handout can be provided to the patient and/or designated decision-maker to facilitate decision-making. Written consent is not required.
Clinical unfitness or patient or decision-maker refusal should be documented (Consent Navigator >> Consent Notes >> New Consent Note with .COVIDNOTFITFORVACCINATION SmartPhrase).
A "COVID-19 Vaccine" order set (it is important to use the order set, not individual vaccine orders), with local awareness of the specific product(s) available, is used to place vaccination orders in the Connect Care inpatient chart.
The order contains a link that automatically generates appropriate documentation of patient eligibility (use F2 key to affirm that each requirement has been met). The documentation link must be used, and the note signed, in order for an inpatient to receive COVID-19 vaccination.
Signed orders are "signed and held" for the attention of nursing to release. This allows the timing of vaccination to aligned with vaccine availability.
Nursing staff cannot proceed with the vaccine administration workflow if prescribers have not completed BOTH the vaccine order and linked requirements documentation.
Once a sufficient number of immunization orders accrue, arrangements are made for a group of patients to be vaccinated. If a patient's condition has changed, the immunization may be deferred with a reason documented in the medication administration record (MAR).
An appropriate entry in the patient's Connect Care immunization record is automatically created. Key information is automatically forwarded to provincial immunization information systems.
An immunization record is produced for the patient and/or alternate decision-maker.
Adverse Effect Surveillance
Patients are provided with information about possible side effects of vaccination, also included in a discharge "After Visit Summary".
The attending prescriber is responsible for reporting any serious adverse effects, allergies or intolerances.
COVID-19 Vaccination SmartLink
Increasing numbers of patients receive initial or second COVID-19 vaccinations during an inpatient or outpatient encounter where Connect Care is the record of care. Clinicians may want to rapidly document this information in consult, discharge, transfer or other notes. A dedicated SmartLink makes this easier:
".IMMCOVIDP" pulls in recent COVID-19 vaccination information in a prose-friendly format