Oakdale Nursing home on the Laois Offaly border in Portarlington has received nursing help from Portlaoise hospital but the hospital's clinical and nursing directors say acute care must come first
All nursing homes in Laois were told in the middle of April that hospital consultants and senior nurses would be on hand to guide them in detail through the care of their Covid-19 patients, the directors of nursing and medicine at the Midland Regional Hospital Portlaoise have said.
While not against the redeployment of hospital nurses to private nursing homes, the chief doctor and nurse in Portlaoise also insist that it will only be done if staff volunteer and, if life or death patient care at the hospital is not compromised due to a shortage of staff which they add has already been experienced during th pandemic.
Dr John Connaughton, Clinical Director and Ms Sandra McCarty, Director of Nursing, addressed the issue of support provided to nursing homes in an interview with the Leinster Express .
Upwards of 80 nursing homes were contacted by the hospital.
“On April 14 we sent out communication to the nursing homes about our nursing home liaison support team. We have recognised the requirement for supporting our colleagues in residential care facilities and nursing homes and in the best interests of the residents there and their care plans,” said Ms McCarthy.
Dr Connaughton and Dr John Fleming were the two consultants on the team which was also made up of two senior nursing staff. Consultants in palliative care, psychiatry and later life were also available to help. Ms McCarthy said dedicated mobile number was made available seven days a week.
“The essence of this was to provide clinical expertise advice to these, predominately nurse-led services. In the absence of GP going to these nursing homes, we recognised that there was a void on their part in terms of the clinical decision,” said Ms McCarthy.
Some of the homes got in touch immediately, others have yet to reply to the offer.
Ms McCarthy said the help provided involves daily video conferencing involving the GP attached to the home, staff at the home regarding the individual needs of patients. Detailed discussion take place around care.
“We left it up to the nursing homes to decide what patients they wanted advice on. A nursing home that has a dedicated number of GPs was very easy to deal with. We were able to talk with these GPs in the conferences,” said Dr Connaughton.
He says the process resulted in very few patients having to be transferred to hospital. Where homes had liaised with the hospital, Dr Connaughton said a care plan was ready if admission happened.
His nursing counterpart said the liaison team worked.
“The aim was always to try and reduce the requirement to transfer to the acute setting (hospital) because it is their home and for as long as we could, we would care for them there,” Ms McCarthy said.
While she adds that the message is getting through and relationships are now being built. not all facilites operate as advised.
“Our experience has been that it hasn’t always been like that. We have had admissions just arrive (from the nursing homes with no prior contact,” she said.
This is something that upsets Dr Connaughton.
“Transfer has occurred during the night. Sometimes I get quite emotional about it. I think it is a crazy situation. It has improved,” he said.
Dr Connaughton says a lot of nursing homes do not appear to have any Covid-19.
“There is obviously a terrible fear both for the relatives of the people who've been living there for years if they hear about a case but what's amazing about Covid is some people survive with illness.
“They're identified as being positive and they remain perfectly well, you discuss with them day-in day-out and they seem to be getting better without any intervention.
“Then, there are others who go through a sticky patch, weather the storm and recover do very well and may not even require oxygen,” he said.
Both directors urge families with loved ones in nursing homes to understand that their relatives are in the best setting to deliver care. They also want them to know that the hospital is available to assist the nursing homes.
Redeploying nurses has been proposed nationally and locally. Ms McCarty says there is 'limited scope' to do so. She points to many issues that have to be considered.
These include: many hospital staff on Covid leave, existing vacancies, internal redeployment to expand the ICU and set up a designated Covid Emergency Department (ED/A&E) alongside the existin ED. She says the hospital must also provide 24 hour paediatrics and maternity care.
Neither Ms McCarty or Dr Connaughton rule out redeployment
“It’s a voluntary redeployment,”says Ms McCarthy.
“We have to be very careful about that. But we can only redeploy, subject to our own capability to maintain safe services in an acute environment. So if I'm looking at it day-by-day and if I can do it, I can deliver a safe service today then I'm in a position to ask for a voluntary redeployment.
“But if I am down nurses and I have two ED departments to run and procedures going on in the theatre department with pediatrics and maternity. It wouldn't be safe (for nurses) to leave this service. So I suppose the reassurance for the public is that if they come to our ED department we want to be able to make sure that we can look after them if it a matter of life or death,”she said.
Ms McCarthy belives nursing homes have scope to deliver but different ways. She also urges them to follow public health advice and keep staff quite segregated.
“I think that's where they ran into difficulty with staffing numbers,” she said.
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