The Vaccine Fridge Rota
Northgate Family Practice in Galway has three practice nurses - Aoife, Bernadette and Cian - and one phlebotomist, Dara. The vaccine fridge must be checked at 09:00 and 15:00 every weekday by a registered nurse who has completed cold-chain training. Only Aoife and Cian have completed it. Aoife works Monday to Wednesday mornings, 08:30–13:00. Bernadette works Wednesday to Friday, 08:30–17:00. Cian works Monday to Wednesday afternoons, 13:00–17:30, and all day Friday. Dara works 08:30–13:00 Monday to Friday and is not trained. A vaccine delivery is booked for Tuesday at 14:00, and practice policy requires a cold-chain-trained nurse to sign for it within 30 minutes of arrival. The Thursday 15:00 fridge check has been missed twice in the past month. The practice manager proposes moving Aoife's Wednesday morning session to Thursday afternoon so that Cian can leave early on Wednesday. On Tuesday at 13:40, Cian calls in sick.
1. List every weekday fridge check that currently has no trained nurse available, and explain your reasoning.
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At 15:00 the trained nurses available are Cian (Monday to Wednesday) and Cian again on Friday. Thursday has neither Aoife (mornings only, Monday to Wednesday) nor Cian (not rostered Thursday), and Bernadette, who does work Thursday, has not completed cold-chain training. The same logic applies at 09:00: Aoife covers Monday to Wednesday, Cian covers Friday, but on Thursday only Bernadette is present. So the uncovered checks are Thursday 09:00 and Thursday 15:00 - not just the 15:00 check the manager has noticed. The trap is to assume that any nurse in the building can perform the check. The training constraint, not the rota alone, determines the answer, and it must be applied separately to each time slot.
2. Evaluate the manager's proposal to move Aoife's Wednesday morning session to Thursday afternoon.
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The proposal moves a trained nurse, Aoife, from Wednesday morning to Thursday afternoon. Thursday 15:00 becomes covered, but Thursday 09:00 remains uncovered because Bernadette is untrained and Cian is absent. Worse, Wednesday 09:00 becomes uncovered: Aoife is no longer there, and Bernadette, though present, cannot check the fridge. The net result is that one gap is closed while two remain or are created, so the proposal fails on its own terms. It also assumes Aoife can exchange a contracted morning for an afternoon, which may not be permissible without agreement. A proposal of this kind should be tested against every affected check, not only the check that prompted it, and against the training constraint as well as the rota.
3. At 13:40 on Tuesday, Cian calls in sick. What should happen about the 14:00 delivery, and why?
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The only trained nurses are Aoife, who finished at 13:00 and is no longer on site, and Cian, who is now absent. Bernadette is not rostered on Tuesday and Dara is untrained, so nobody on site can sign within the 30-minute window. The correct response is to telephone Bernadette immediately and ask whether she can attend by 14:30. If she can, she signs and the cold chain is preserved. If she cannot, the practice should ask the supplier to retain the vaccine and re-deliver, record the refusal and the reason, and inform the manager. Letting Dara sign would breach policy and leave the practice unable to show that the cold chain was maintained. The decision and its rationale should be recorded contemporaneously, because the issue is not blame but traceability.