Pharmacist-driven 'trunk' system makes Winnipeg's COVID-19 vaccine supersites super-efficient

Until Toronto broke the North American record for COVID-19 single-day vaccinations—with 26,771 doses administered on June 26—the RBC Convention Centre vaccination supersite in Winnipeg was unparalleled in its speed and prolificacy. It’s still hard to beat, thanks to two pharmacists who came to support Manitoba’s mass vaccination rollout and ended up leading what’s considered to be the most efficient vaccine sites in the country. “There were only four pharmacists, including us, that had been hired on for the mass vaccination initiative and the clinic leads saw in the first few weeks how much more efficient we were,” recalled Arnold Chew, who was an associate pharmacist at a Winnipeg Shoppers Drug Mart until he retired in 2019 after 27 years of service. “So when we approached them with an idea for how we could do the clinic more efficiently, they said okay.” The site had launched in January with a desk system where an immunizer sat behind a desk and waited for each patient to approach. After getting their shots, patients were sent to an observation area. Chew and fellow Winnipeg pharmacist Carey Lai—who have both moved up to regional management roles within Manitoba Shared Health’s vaccine implementation task force— proposed switching over to a “trunk” system, with an immunizer, recorder and observer assigned to each trunk. Similar to the hockey hub model developed by the Grey Bruce County Health Unit in Owen Sound, Ont., and used successfully in Alberta’s COVID hotspot meat plants, the trunk system calls for patients to be seated in rows of chairs while an immunizer and recorder move along each row. The patients each stay in the same chair for the entire duration of their appointment. After they’ve received their shot, their trunk’s observer keeps a close eye for any potential reaction. A key difference between the hockey hub and trunk system is the latter’s use of rolling chairs and carts. “The immunizer rolls on the chair, going from client to client, while the recorder—who records vaccine lot numbers and expiry dates—pushes the cart, where the syringes are already prepped and lined up on a tray,” explained Chew. With the trunk system, the vaccination supersites boosted their results to as many as 900 injections an hour, to a total of between 9,000 to 10,000 shots a day. The day after Toronto’s record-setting day, Winnipeg’s RBC Convention Centre surpassed its own performance with 14,000 shots administered in a single day. “We opened up every trunk that day so that we had 20 trunks and a total capacity of 1,200 doses every hour,” said Chew. Since they joined Shared Health in January, Chew and Lai have moved up the organization’s hierarchy more than once. Both started as vaccinators and became clinical supervisors in April. By May, Chew had been promoted to regional manager, overseeing the RBC Convention Centre, and Lai was named the site’s clinic manager. Lai got bumped up again recently, to the role of regional manager for the city’s second COVID-19 supersite, at a soccer stadium. Being experienced pharmacists gave Lai and Chew a notable advantage over the other healthcare professionals who joined the immunizations task force, said Lai. They both knew how to deal with the day-to-day demands of a hectic business, and were comfortable managing people. The latter skill has been especially valuable at the vaccine supersites. “At any given time we’re managing between 100 to 130 multidisciplinary clinicians including doctors, nurses, nursing students, pharmacy technicians,” said Lai. “On top of that, you’ve got up 250 non-clinicians like the navigators who are there to direct people.” Their work as community immunizers also gave them first-hand insight into immunization best practices. Chew and Lai had both worked as part of the province’s focused immunization teams, which went to long-term care homes to administer flu shots. During these visits, the immunizers went from room to room with a rolling cart. “So that’s where the idea came from,” said Chew, who noted that the concept for the system itself might have originated in Israel. The vaccine task force continues to look for ways to do things better, said Chew. A continuous improvement team does “time and motion” studies to analyze workflow, which has been tweaked a few times. For instance, in the past immunizers had to sanitize their hands four times per patient because they were touching four different objects for each injection. “We eliminated the need for multiple sanitizing by ensuring that immunizers aren’t touching anything but the syringe and the patient,” said Chew. “Now they sanitize their hands only once, between injections, and when you count the number of seconds it takes to sanitize, that easily adds up to hours saved per day.”

Pharmacist-driven 'trunk' system makes Winnipeg's COVID-19 vaccine supersites super-efficient

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