Dover Vaccination Centre Marshal Duties

Sat, May 1st 2021 at 12:00 am- Thu, May 27th 2021 - 1:34 pm

Update of Marshalling Duties: 17th May 2021


16.05.2021 Version18  Dover Vaccination Centre – Marshals’ Duties

All Marshals

 First Marshals on duty - ask Health Centre staff which vaccine is being used that day, as this will change some procedures and marshalling duties. Vaccines may change across the week, dependent on supply. As the age of the vaccination cohorts reduce for first vaccinations, or increases for second, at the direction of the GP Supervisor, you may be asked to change or instigate new procedures that are not outlined below. You must follow his directions. 

Sign in on arrival at the Office and sign out at the end of your shift. Sanitise your hands, on entry to the building and regularly through your shift. Hand sanitisers are located at various points through the building.

 Most patients who require a wheelchair, or mobility aid, arrive with their own. However, the Health Centre has one wheelchair available for emergency use, e.g., if patient requires medical assistance post-vaccination or on arrival. Once used, the Marshal needs to ensure it is cleaned with alcohol wipes and return to the Waiting/Observation Area ready for next use. 

However tempting and well-intentioned, please do not re-organise the procedures, patient routes or fixtures and fittings as you may create unexpected problems or hazards. For example, chairs should not be moved (unless to accommodate a wheelchair user and then should be returned to original position once space vacated), or additional seating provided in any area, in order to maintain the 2m social distancing requirement and sound infection control.

 In respect of sanitiser gel, procedures vary between NHS settings and there is no single right answer for the Vaccination Clinic as is so often the case with complex issues especially as both the use of sanitiser gel and social distancing maintenance are both key elements of infection control. The alternative approaches and their most appropriate applications so that so that each Marshal can make an informed decision about how best to minimise the risk to themselves, the patients that they are dealing with and any accompanying children, as follows:

 • Direct patients to dispense hand sanitiser themselves, as hitherto, when the patients are solo adults without additional needs that render them at enhanced risk of eye contamination if self-dispensing. This is the default procedure;

 • If patients are likely to be unable to dispense sanitiser safely themselves or have accompanying children, marshals should dispense sanitiser, or wipe a patient’s wheelchair, for them taking care not to splash the gel into anyone’s eye whilst remembering the important role of social distancing in infection control. This is the exceptional procedure.

  The guiding principle is… 

        HANDS                               FACE                           SPACE

                                                                                 …and please don’t touch your face. 

• Be aware that the Vaccination Centre organiser, Channel Health Alliance (CHA), is responsible for your safety and welfare whilst you are working on or adjacent to their premises;

 • Follow the instructions of the Vaccination Centre CHA Manager if different from, or additional to, these instructions;

 • Report any problems in the first instance to the CHA staff but, if unresolved, advise the volunteer administrator robindodridge@gmail.com

 First and Last Team on Duty

Signage 

At the start of the day, the two signs should be placed in the following positions – (See photos at the beginning) -

At the end of the day, please return to the path opposite the rear exit, at the side of the wooden slope. 

Non-attendance of a Marshal

This may be due to unforeseen circumstances. Although difficult if the clinic is busy, Marshals should work together to cover the position in the centre. To arrange a replacement, telephone – 

Robin Dodridge: (Home) 01304 830812 (Mobile) 07774 167347

 Dave Smith: (Home) 01304 331848 (Mobile) 07908 777199

 Andrew Eberlein: (Mobile) 07712 864186 

Clinical Waste Bags 

Marshal 1 and 2 to place an orange clinical waste bag on the trolley at the front door and one in the bin in the Waiting/Observation room. All wipes used to sanitise chairs after each use should be put in the clinical waste bags and not litter bins lined with black sacks.

 End of Day Routine 

An hour before the centre closes, the GP Supervisor indicates to vaccinators that they are going into the ‘end of day routine.’ This is to ensure that no vaccine is wasted.

 • Marshal 2 may be asked to hold patients back in the Waiting/Observation Room 

 • Marshal 3 – ensure patients awaiting vaccinations queue on the black circles facing the mixing room

• a vaccinator will take the vaccination card, go to the mixing room, obtain a vaccine and then take that patient to their room

 • move the patients down the queue 

• ask vaccinated patient to use hand sanitiser and exit via rear door

 Patients exempt from wearing face coverings

Marshal 1 may encounter some patients who are exempt from wearing face coverings, but accept the offer of a face shield, which are available on the clinical trolley. If a patient refuses the offer of a face shield, they are not to enter the building - ask them politely to wait in the lobby. Request Dr Mead’s assistance via the Receptionist.

 Patients with children

 As the age group for vaccination eligibility reduces, you may find that parents are accompanied by children, a range of ages, some possibly in buggies. Children are the responsibility of parents at all times and should remain with the parent throughout the process. Do not allow unaccompanied children to wait in the lobby, entrance or any area, or offer to mind them until the parent returns post-vaccination.

 Patients with accompanying adults

 Additional adults should be with the patient to fulfil some supporting role and not there just to provide company. For example - 

• patient’s carer

 • parent 

• translator

 • support for those with needle phobia

 Marshal 1 should check the need for an accompanying adult and include that person in the screening procedure in the lobby before admittance to the building. They should be kept together and moved through the vaccination process as a complete unit, and not be separated. If not required, explain that the exit for the patient will be at the rear of the building and suggest they meet them in the car park. 

Patients with additional needs

 Some patients have additional needs and find the prospect of the vaccination distressing. Their arrival time and specific needs are usually known to Health Centre staff. However, they may be very vocal or not understand social distancing rules. They may need an alternative, quieter route into the vaccination rooms. Seat them in the entrance area and notify the GP Supervisor that a patient with additional needs has arrived and needs support. Follow the GP Supervisor’s advice re alterations to set procedures, in order to accommodate them. This may include, temporarily holding patients on arrival in the lobby; shutting doors to corridors, or accessing the vaccination rooms via the internal door in the entrance area.

 Patients Arriving for Other Clinics

 Having asked the question, ‘Are you here for a vaccination?’, on a weekday, Marshal 1 may have to manage patients who have arrived for appointments with other services such as Podiatry; Speech Therapy; Dentistry; Dermatology; CAMHS, Castleside Clinic; Abdominal Aortic Aneurysm Screening (AAA) and prescription collection. Ask them to wait to one side in the lobby and direct them to the board with telephone contact numbers for their services and inform them that someone will come and collect them. If there are any queries, ask the Main Receptionist for help.

 Some of these patients may ask to come into the building to use the lavatory. This is permissible. Go through the four screening questions and ask them to use the hand sanitiser on entry to the building. They should return to the lobby to await their appointment and not remain in the Reception Area. For some very frail or elderly patients, the wait can be long and they may require a chair in the lobby. Provide one, but once vacated, bring back into the Entrance Area and wipe down.

 Please note, that a queue of these patients in the lobby may cause patients arriving for the vaccination clinic to falsely assume that they are ahead of them, resulting in them queuing 16.05.2021 V18 5 outside the main entrance. This can cause delays for the vaccinators. Ask those waiting if they can see a queue forming outside. Also, even if no patients are in the lobby, go and look outside the main entrance on a regular basis. This is especially important with the removal of Marshal 4.

 Patients Arriving Without an Appointment for the Vaccination Clinic 

Dealing with queries can be time consuming and slow the flow of patients through to the vaccinators, especially if there is only one Receptionist on duty. Therefore, Marshal 1 has been asked to provide telephone contact details to these patients. This is printed on a slip of paper, and a supply can be found at the Main Reception desk.

 However, if dealing with a confused, vulnerable or very irate person, or a partner has come along as s/he had the first vaccination at the same time but has not been called for the second one, seek further advice from the Vaccination Centre Receptionist about whether they can come and speak to her about the problem.

 Monitoring of Gazebo 

Following windy or rainy weather, the gazebo may require some attention before it can be used by patients. Rain collects on the roof, causing it to sag. If this is the case, please report to Dr Mead, who will attend to it.

Dogs 

Patients on arrival with dogs, may need a polite reminder that only assistance dogs are allowed into the Health Centre building.

 Fire or other emergency in the building

Establishment and management of the evacuation plan, provision and testing of alarms, marking of exit routes etc. is the responsibility of the premise’s owner. In this regard, Marshals have no more responsibility than any member of the public, although we must expect, simply because you are wearing hi-vis, that other members of the public will look to you for guidance.

 Consequently, correct actions to take either on discovering a fire, or on hearing the alarm -

 • Shout: ‘This is not a test! Follow me to the car park now!’ as you leave the via the safest available route building without delay, 

• Report to the fire marshal designated by the premises owner’s evacuation plan and offer administrative assistance such as with head counts and name checks.

 Marshals with, or with possible symptoms of, Covid 

Do not attend the Health Centre,

• Advise volunteer administrator Robin Dodridge by phone 07774 167347 or if no reply then by email to robindodridge@gmail.com as soon as possible, who will liaise with Health Centre staff and arrange a replacement Marshal,

 • Arrange a test,

 • Follow Government Guidelines. 

Regular Covid Testing 

The Government recommends that everyone without symptoms should get tested every 2 weeks, especially if you're leaving the house for a necessary reason such as going to work, shopping for essentials or, of course, volunteering as a Marshal. It’s said that around 1 in 3 people with COVID-19 have no symptoms, so do please get tested regularly to make sure you are not unknowingly spreading the virus.

 Test centres are being superseded by the introduction of free lateral flow test kits for people without symptoms, which can be picked up from your local pharmacy or they can be ordered online for delivery to your home. The link for ordering for delivery is https://www.gov.uk/order-coronavirus-rapid-lateral-flow-tests 

and the link for booking symptom-free tests, available 7 days a week is:

 https://www.kent.gov.uk/social-care-and-health/health/protect-kent-and-medway/test-and-trace/symptom-free-testing

 Marshal Instructions for PFIZER and ASTRAZENECA Vaccines 

On weekdays, patients for other health care services may arrive and need to book in at the main reception or wait in the lobby area until the health professional comes to collect them. Ask them to wait in the lobby area, but away from the patient(s) awaiting vaccination.

 During inclement weather, you may need to mop the floor in main entrance and through to the Reception desk. A blue-headed mop and bucket can be obtained from Dr Mead. 

Please position yourself so that you are in full view of arrivals through the main door whenever possible. It is important to remain by the automatic door, in order to keep the patient(s) in the outer lobby until the following checks and questions have been completed. After greeting them -

 • Ask them if they are here for a vaccination – remember face coverings obscure your mouth which makes it harder for hearing impaired patients to communicate,

 • Ask what time their appointment is – if the patient is very early and the clinic is very busy with queues forming, you may have to ask them to go away and return nearer their appointment time,

 • Check patient’s face covering is worn correctly (over mouth and nose),

 • Provide face covering if patient does not have one from clinical trolley i.e., medical masks and face shields (available for those who are exempt for health and disability reasons.) If the patient refuses to wear a face shield, ask them to remain in the lobby and request Dr Mead’s assistance via the Receptionist.

 Ask the patient (and any accompanying person) the following four screening questions - 

1. ‘Do you have any symptoms of a cough, cold or sore throat?’ 

2. ‘Do you have a temperature?’ 

3. ‘Are you feeling unwell today?’ 

4. ‘Any loss of the sense of smell or taste?’ 

• If the response is ‘No’, direct the patient to sanitise hands using the sanitiser positioned on the clinical trolley in the entrance area

 • Direct patient(s) to observe the 2m distancing (and observe) by means of the black stickers on the floor

 • Direct patient(s) to register at the Reception desk

 • If the response is ‘Yes’, or the patient is unsure, ask them to remain in the outer lobby. Advise the Receptionist. The GP Supervisor/Medical Professional will then assume responsibility for that patient 

 • GP Supervisor/Medical Professional will advise you if this patient is allowed admission

 NB whichever vaccine is in use patients will usually exit from the rear of the building. However, there will be some who choose to return via the main entrance.

 • Carer may need to accompany patient or wait on seat in entrance area (seating and social distancing permitting) 

• Fob for internal door to allow access to accessible toilet is located at the Reception and should be returned there after each use

 • Wipe down used chair (arms, seat and back) with alcohol wipe once vacated

 At busy periods, Marshal 1 may need to assist Marshal 2 by directing patients to book in at the Reception.

 Marshal 2 • Receive patient(s) from Reception desk(s), hold at doorway

 • If appropriate, remind patient to have vaccination card ready 

• Direct requested number of patients to Marshal 3 in vaccination waiting area

 • Manage flow of entering and exiting patient(s) from vaccination area, maintaining social distancing

 Pfizer Vaccine

• Receive vaccinated patients from Marshal 3

• Direct to chair and ask to wait for length of time specified by the vaccinator – patient needs to self-monitor time (some wish to leave straight away)

 • Observe patients – report any feeling unwell to Medical Staff in vaccination area. However, if the patient becomes distressed, ask other patients to observe the situation while you seek immediate medical assistance

 • Check patient is feeling OK before leaving

 • Direct patient to rear exit

 • Wipe down used chair (arms, seat and back) with alcohol wipe once vacated

 • Fob for internal door to allow access to accessible toilet is located at the Reception and should be returned there after each use

 NB – the GP Supervisor may bring the gazebo into use as an additional waiting area for patients post vaccination. This is accessed via doors in the Waiting/Observation Area. Allow patients to choose whether to wait inside or in the gazebo, where social distancing rules need to be maintained. Wipe down used chair (arms, seat and back) with alcohol wipe once vacated. 

Please note, that when the gazebo is in use, Marshal 2 will need to be particularly proactive and anticipatory.

AstraZeneca Vaccine

Dr Mead may set up an additional screened space which can house up to two vaccinators, in the Waiting/Observation Area, accessible to the patients from both ends. The vaccinator, will come and indicate their availability.

 Patients will have been advised by vaccinators that there is no need to stay and be observed, however, they should wait for length of time specified by the vaccinator before driving home. 

 Some post-vaccination patients may choose to remain in the Waiting/Observation Area because:

 • They do not drive

 • did not come by car

 • came by car on their own 

• live on their own

 • their carer/relative is waiting in the entrance area or lobby for them and want to ensure they feel well before they leave.   Therefore,

 • Receive vaccinated patients from Marshal 3 

  • Direct to chair and indicate where the clock is in the room

 • Observe patients – report any feeling unwell to Medical Staff in vaccination area

 • Check patient is feeling OK before leaving

 • Wipe down used chair (arms, seat and back) with alcohol wipe once vacated

 As the exit route is now via the rear door, assist Marshal 3 as patients coming out of the first vaccination room may need direction as there is no signage. 

• Ask patient to use hand sanitiser, and direct them to the rear exit

 • Explain that the door opens automatically when the pad with the hand symbol is touched, or patient’s hand is near to it 

• Remind them to wait in car for length of time specified by the vaccinator before driving home

 • Direct patient to the left on exiting the door, into the main car park

 • Direct vaccinated patients who wish to remain, to chairs in Waiting/Observation Area and observe

 Marshal 3 

Vaccinators have been asked to come to the door of their room to indicate when they are ready for the next patient.

 Please note that occasionally the chairs are removed from this corridor, dependent on the vaccine being used and the age group being vaccinated.

Pfizer Vaccine

Line patients up, in order of arrival, on the black stickers on the floor

 • Advise patients to remove outer garments

 • Liaise with vaccination staff

 • Direct patient to next available vaccinator with belongings

 • Direct vaccinated patients to Marshal 2

 • Signal to Marshal 2 indicating the number of patients required

 Also, chairs may be used for patients who are waiting for their specified amount of time

 • Receive vaccinated patients ask them to wait for length of time specified by the vaccinator

 • If a post-vaccination patient becomes distressed/unwell, seek immediate medical assistance from Medical Staff in vaccination area

 • On departure, ask patient to use hand sanitiser, and direct them to the rear exit 

• Explain that the door opens automatically when the pad with the hand symbol is touched, or patient’s hand is near to it

 • Marshal 3 may need to collect patients for vaccination from the Reception, if Marshal 2 is manning the Waiting/Observation Area and the gazebo

 AstraZeneca Vaccine

Line patients up, in order of arrival, on the black stickers on the floor

 • Advise patients to remove outer garments

 • Liaise with vaccination staff

 • Direct patient to next available vaccinator with belongings

 • Signal to Marshal 2 indicating the number of patients required

 • Receive vaccinated patients

 • Ask patient to use hand sanitiser, and direct them to the rear exit

 • Explain that the door opens automatically when the pad with the hand symbol is touched, or patient’s hand is near to it 

• Remind them to wait in the in their car for length of time specified by the vaccinator

 • Direct patient to the left on exiting the door, into the main car park

 • If patient wishes to remain, direct to Marshal 2

 Reasons for Update to Version 18

Ongoing changes to Marshal Duties under the direction of GP Supervisor

 • Removal of Marshal 4 position – Appendix 1

 • Addition of third contact number for non-arrival of a Marshal

 • Marshal 1 – patients arriving for other weekday clinics

 • Marshal 1 – patients arriving without a vaccination appointment

 • Marshal 1 – clarification of screening procedure

 • Marshal 2 – additional vaccinator screened space in Waiting Area

 • Monitoring of gazebo

 • Changes to symptom-free testing arrangements

 Appendix 1 

Marshal 4 duties have been moved to Appendix 1 in order to enable them to be reinstated should the position be required.

 Marshal 4 

Be prepared for outside duties as Marshal 4, by having appropriate clothing for current weather conditions, hi-vis tabard and a mobile phone available.

 Position by car park pay station nearest to the Health Centre. As most cars arriving follow the one-way system, they will naturally go near you, wind their window down and talk to you. Be aware that during weekdays patients arrive for other services. Greet patients, many of whom are elderly and will appreciate a friendly face.

 Ask the following questions – 

• ‘Are you here for a vaccination?’ 

• ‘What time is your appointment?’ 

• If Pfizer vaccine is in use, ask patient to wait in car until 10 minutes before their appointment time, because of the number of patients needing to wait in the centre after their vaccination

 • If AstraZeneca vaccine is in use, dependent on the length of the queue outside the entrance and volume of arrivals in the car park, and the patient is more than ten minutes early, ask them to stay in the car until five minutes before their appointment time. Remember to monitor the queue, as some patients arrive on foot, taxi or public transport and have no need to enter the car park 

• ‘Please follow signage to the building.’ Give directions to the entrance of the Health Centre by the safest route, which is the path by the hedge. Discourage crossing over the kerb/grassed area between car park and the staff car park 

• Inform patients that main entrance door is automatic and that they should go right up to the main door in order for it to open

 • Periodically, walk up to the corner of the Health Centre to observe length of queue forming outside the main entrance, at least every 15 mins (see ‘own welfare’ below)

 • Dependent on need, it may be necessary to offer a patient wheelchair access entrance to the centre via the rear door. Please ask them the same questions as Marshal 1 before entry to the building, and ask them to sanitise their hands before taking them thorough to Reception to book in

 • Be aware that the footpath is prone to puddling – sweep away regularly with the broom (stored outside rear entrance to Health Centre)

 • Guide patients to follow the same safe route on their return NB – whichever vaccine is in use patients will usually exit from the rear of the building. However, there will be some who choose to return via the main entrance

 • Watch over the car park and report immediately, by radio if available, any incidents such as slips and falls to the Health Centre Staff to arrange first aid

 • Report periodic hazards such as ice/lack of gritting to Health Centre staff 

• Be aware of your own welfare

 o Walk to the front door and let Marshal 1 know you’re OK

 o Use the panic alarm attached to the large torch if you find yourself in difficulty

 o Go into the Health Centre to warm up or get a hot drink if you’re cold

 Cones 

Please check that the cones adjacent to Maison Dieu Road are in the correct place. The cones should be along the modified roadside kerb opposite where the path from the car park meets the Maison Dieu footpath. They are there to dissuade drivers from trying to drive up the footpath when spotting the Health Centre and executing an immediate right turn, assuming that the path leads to the car park, especially if they see a queue or, worse still, a person in a yellow tabard organising the queue.

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