CARD (Comfort Ask Relax Distract) for community pharmacy vaccinations in children: Effect on immunization stress-related responses and satisfaction

Abstract

Introduction: CARD (Comfort Ask Relax Distract) is a vaccine delivery program demonstrated to reduce pain, fear and associated immunization stress-related responses (ISRR) in children undergoing vaccinations at school. This study evaluated CARD’s clinical impact when integrated into community pharmacy–based pediatric vaccinations. Methods: This was a before-and-after CARD implementation study in 5 independent pharmacies offering COVID-19 vaccinations to children aged 5-11 years. No changes were made to practices in the “before” phase. CARD interventions were integrated in the “after” phase (e.g., children prepared a coping plan using a checklist, distraction toolkits were placed in waiting and vaccination spaces, vaccinations were performed with privacy, needles were obscured). Children self-reported ISRR, including fear, pain and dizziness during vaccination, and both children and parents/caregivers (herein, parents) compared the child’s experience to their last needle (better, same, worse). In the “after” phase, parents and children reported how much CARD helped (not at all, a little bit, a moderate amount, a lot). Results: The study was conducted between January 16 and March 20, 2022. Altogether, 152 children participated (71 before and 81 after CARD); demographic characteristics did not differ. Children’s self-reported fear was lower after CARD, when assessed continuously (2.5 vs 3.7 out of 10; p = 0.02) or dichotomously, using a cut-off of 0 vs >0 (58% vs 80%; p = 0.01). Pain was lower when assessed dichotomously (<2 vs ≥2; p = 0.03). There was no difference in dizziness. After CARD, children and parents reported more positive experiences compared to the child’s last needle ( p = 0.01, both analyses) and more children and parents reported that distraction and child participation in the process were helpful ( p < 0.001, both analyses). Overall, 92% of children and 91% of parents said CARD helped. Conclusion: CARD reduced children’s fear and improved vaccination experiences for children and parents when integrated in community pharmacy–based vaccinations.

Experiences of community pharmacists administering COVID-19 vaccinations: A qualitative study

“…For instance, new challenges have included administering vaccines in children aged 5 to 11 years, which takes more time and is more stressful for pharmacists than administering vaccines in adults. 19 , 33 Recent expansion in the delivery of COVID-19 vaccines in infants and young children, along with other expanded scope services (e.g., common ambulatory conditions) 34 that are taking place across the country are likely to place additional strains on pharmacists in their worklife in the ensuing months.…”

“…This study is part of a series included in this supplement to the Canadian Pharmacists Journal that together summarize the findings of a program of research funded by the Public Health Agency of Canada, examining community pharmacy vaccination services and integrating a vaccination delivery framework (Comfort Ask Relax Distract; CARD) to improve the experiences of vaccine clients and pharmacy staff. 15-22…”

Community pharmacists’ perceptions of the CARD (Comfort Ask Relax Distract) system for use during vaccinations

“…Some, however, routinely imposed coping interventions, which contrasts with CARD recommendations to invite patients to lead their preferred coping. 12 Pharmacists were willing to alter their approach to align with CARD recommendations. Some pharmacists mentioned that certain CARD interventions, however, were not always feasible.…”

“…In 2 subsequent studies informed from these results, we report on the impact of CARD when used as the framework for delivery of pediatric COVID-19 vaccinations in community pharmacies. 12,13 Then we examine the perceptions of pharmacy technician students to a CARD training e-module. 14 Finally, we provide a CARD guide to support implementation in community pharmacies.…”

Introducing CARD (Comfort Ask Relax Distract) as a vaccine delivery program for community pharmacy-based vaccinations

“…14 The third and fourth articles describe the clinical and implementation outcomes of a small-scale implementation project with CARD involving 5 community pharmacies. 15,16 The fifth article examines perceptions of pharmacy technician students regarding a new CARD training e-module included as part of vaccine injection training education. 17 The sixth article provides guidance for pharmacies and pharmacy organizations that want to implement CARD.…”