“We figured out it takes one minute per dose. That, along with the fact that we have six hours once the vial is opened before we have to get each dose in a patient’s arm.” - Michelle Corriveau

Michelle Corriveau
UVM Medical Center Pharmacy Oncology Manager Michelle Corriveau

Six Hours and Counting

CELSIUS AND FAHRENHEIT WERE Kevin Smith’s steadfast companions when ushering the COVID-19 vaccines from UVM Medical Center’s loading docks to the COVID-19 vaccine clinic at the Champlain Valley Expo in Essex.

The process began on Thursday evenings, when Smith, the Pharmacy Operations Manager at UVM Medical Center, received an email from the Vermont Department of Health detailing how many doses of vaccine the hospital would expect the following week, and what type. The list was split by dose (first or second) and where it was coming from (the vaccine manufacturer or Vermont Department of Health).

In this case, the vaccine arrived from Pfizer. The timer started ticking right away: Smith and his team quickly unpacked it, moved it to a special freezer, verified that the shipping container maintained the appropriate temperature during transport, and logged in the inventory.

“I’m mostly behind-the-scenes,” Smith said, “but, like the rest of our pharmacy team, I’m thrilled to be able to use my expertise for this effort.”

Part of that expertise was knowing how critical it was to keep the vaccine at the right temperature: The Pfizer vaccine must be kept between minus 112 degrees Fahrenheit and minus 76 degrees Fahrenheit for long-term storage. Fortunately, it didn’t need to be kept nearly as cold for the short trip to the Expo.

There, the painstaking process of compounding—or creating the vaccine mixture—began, a process dictated by temperature and time. Different vaccines require different temperature limits to remain effective, and the clock starts ticking the second a vial is opened; if they aren’t used within a given amount of time, they aren’t effective.

The trick is to prepare vaccine doses in advance of patient arrival, but not too far in advance, explained Michele Corriveau, the UVM Medical Center Pharmacy Oncology Manager. The number of appointments each day had to be closely calibrated with the time it took a pharmacist to prepare each dose.

“We figured out it takes one minute per dose,” says Corriveau. “That, along with the fact that we have six hours once the vial is opened before we have to get each dose in a patient’s arm.”

The process began when the pharmacist or pharmacy tech inverted the vial exactly 10 times to ensure that the suspension in the vial was well mixed. It was then inspected for color and clarity, the cap removed, the stopper swabbed with an alcohol wipe, saline added and air removed. Again, the suspension was gently inverted 10 times and again inspected, an onerous process that only a chemist could love.

“No waste,” said Smith. “That’s our daily challenge.”

To help ensure that goal, each syringe was labeled: type of vaccine, volume, manufacturer’s lot number and the “beyond use” date, the time after which the vaccine could no longer be administered.

A pharmacist can compound between 8 to 10 vials per hour, so these calculations dictated the workflow each day at the vaccine clinic. One key technique to ensure that every bit of vaccine was extracted involved using a needle with a small ‘hub’ (the plastic end that attaches to the syringe tip). Needles with larger hubs tend to have ‘dead’ space, in which small volumes of vaccine can pool after the injection, potentially wasting vaccine.

Promptly at 4:30 p.m., the unopened vaccine vials were transported back to the UVM Medical Center loading dock where the unopened vials were returned to refrigerators and freezers. Smith set about the work of preparing to start all over again in 12 hours.

“To be able to help people feel like they’re going to get through this?” he said. “It’s just such a privilege."


Web Extra
  • Read the complete series of stories about the vaccination clinic from the UVM Health Network.
  • Watch a video from the UVM Health Network titled "How Vermont Beat Back COVID, One Shot at a Time

Todd Young

UVM Health Network Director of Telehealth Todd Young


Scaling Up

IT MIGHT SEEM LIKE A BIG LEAP— from milking cows to leading the University of Vermont Health Network’s Telehealth Services—but Todd Young says working on his grandfather’s farm taught him one important lesson: how to work hard. Over the past year, he’s brought his work ethic to an unprecedented array of challenges: A pandemic, a cyberattack and, most recently, the mission of setting up complex IT systems to support the COVID-19 vaccination clinic at the Champlain Valley Expo in Essex.

As the pandemic descended upon Vermont, seemingly overnight video visits became the primary means for people to see their health care providers. Young and his team from IT oversaw the UVM Medical Center’s transformation from conducting 1,000 telehealth visits per year to 1,000 video visits each day during the height of the pandemic.

Then a cyberattack hit, and Young’s team had to build systems—some digital, some so manual they involved sorting papers into cardboard boxes—to get the UVM Medical Center through the worst days. Still reeling from that effort, Young was asked to help with the Essex vaccination effort.

One of their first assignments was to help build a system that would allow patients to schedule their vaccination appointments themselves.

“Initially, the team had to consider varying timeframes for different vaccines, and Pfizer requires three weeks between doses; Moderna requires four,” explains Young. “They had to build processes to not only address this factor, but to make sure that the Expo staff could document the timing easily and efficiently. “It was all about building quality and efficiency into the systems we developed,” he says.

Next, rather than a paper sign-in processes, the team provided the technology that allowed the staff to be sure that patients’ vaccinations were properly documented.

“It’s an important patient safety and quality issue,” Young says.

Ultimately, the many systems the team put in place allowed a rapid increase in vaccinations.

“For the people who work here it’s amazing to know we went from a few dozen doses to more than 1,000 per day,” says Stephyne Burke, R.N., the manager of the clinic. “I don’t think the patients coming in even realize it, because the process is so smooth.”

“This work proved we can change the experience for our patients and our people when we unite around a common cause,” Young says. “It connected me to the community more than anything else I’ve ever done.”

These stories were originally published by the UVM Health Network. Read the complete series.