Vaccinating Homebound Patients

Vaccinating Homebound Patients Posted By:
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How many of you have patients who are homebound? According to Trust for America's Health, there are between 2 million and 4 million homebound patients in the United States. A homebound patient is defined as someone who needs the help of another person or medical equipment—such as crutches, a walker, or a wheelchair—to leave their home, or whose medical provider believes that their health or illness could get worse if they leave their home, and thus the patient typically does not leave their home. With this in mind, my colleagues and I saw a need to let our governor know our concerns regarding homebound patients and vaccinations. We are not sure if our letter to the governor was the driving force, but we did see a change in who was eligible to receive the COVID-19 vaccinations.

The CDC recommends pre-vaccination planning for vaccinating homebound patients. Providers should pre-plan how they can most efficiently prevent vaccine waste and ensure safety for the patient. Pre-planning involves estimating how many doses you will need for the day; mapping out the travel route to ensure vaccine is utilized in the approved time frame; and providing information about the vaccine in different formats—including multiple languages, large font type, pictures/infographics, and American Sign Language. You will also need to monitor the temperature of vaccines between leaving the clinic and administering them to patients. Additionally, patients should be called 24-36 hours prior to scheduled administration to make sure that they are ready for the vaccine—especially because the patient may refuse the vaccine if their caregiver made the original arrangements. Also, if you know a patient has a history of allergic reaction or increased risk for anaphylaxis, consider whether they can/should be vaccinated in a setting where medical care is immediately available. If home is the only option, then they should be observed for 30 minutes after vaccination. Be sure to have at least 3 doses of epinephrine on hand when administering the vaccine. If you have a patient who is at higher risk for allergic reaction on your route, you will need to build this into your timeframe.

If you know that you have extra doses left in a vial, a dose may be offered to the caregiver as well to avoid waste.

In your state, how are you getting vaccines to homebound patients? I have read that in New York, Chicago, and Miami, fire department paramedics have gone door to door to administer COVID-19 vaccines; I also know NPs have delivered vaccines to homebound patients in Florida. Another challenge is presented by homebound patients in more rural areas—how do we get to them efficiently? I highly encourage everyone to check what their local health department is doing to reach these patients. As NPs and PAs, we can make a difference.

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Filed under: Preventive Medicine

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