Written answers

Tuesday, 16 June 2020

Department of Health

Health Services Provision

Johnny Mythen (Wexford, Sinn Fein)
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614. To ask the Minister for Health if temporary changes can be made to models of care to allow doctors or nurses administer intravenous drips in the residential care setting in order to keep patients out of hospital and reduce the risk of exposure to Covid-19. [11061/20]

Photo of Jim DalyJim Daly (Cork South West, Fine Gael)
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Administration of IV therapies comes within the scope of practice for every nurse. However, it is essential, as with any skill, that competency is maintained through regular practice and education.   Administration of Intravenous fluids or medication by nursing staff in any care setting is governed by local policy and should take account of the frequency any such therapy will require. The model of care is determined by the relevant National Clinical Programme.

Any patient or nursing home resident requiring IV fluid therapy is acutely unwell and will require other nursing care to support their illness. This care will require education and support as it is in addition to normal care requirements. 

A Community Intervention Team (CIT) is a specialist, health professional team that provides a rapid and integrated response to a patient with an acute episode of illness who requires enhanced services/acute intervention for a defined short period of time. This may be provided at home, in a residential setting or in the community as deemed appropriate, thereby avoiding acute hospital attendance or admission, or facilitating early discharge. 

One of the services includes administration of IV Antibiotic - via the Outpatient Parenteral Antimicrobial Therapy Program (OPAT). The OPAT national standards require that an infection specialist (Infectious disease/ Clinical Microbiologist) is consulted on the appropriateness of a prescription for IV antibiotics, the dose and duration, in order to ensure antimicrobial stewardship. CIT or OPAT nurses are available to facilitate a referral from the emergency department to avoid hospital admission, or from hospitals wards to facilitate early discharge and return to the person’s place of residence for the course of their IV antibiotics.  A pathway is in place for GPs to refer appropriate patients directly for IV antibiotics for cellulitis.

Finally, I wish to advise the Deputy that on foot of a National Public Health Emergency Team (NPHET) recommendation, on 23 May a COVID-19 Expert Panel on Nursing Homes was established, to examine the complex issues surrounding the management of COVID-19 among this particularly vulnerable cohort.

The purpose of the Panel is to examine the national and international responses to the COVID-19 crisis, and to examine the emerging best practice. The main objective of the Panel is to provide immediate real-time learnings and recommendations in light of the expected ongoing impact of COVID-19 over the next 12-18 months.  COVID-19 is a new disease, which can present atypically in the frail elderly, and new evidence and best practice in its management are constantly emerging.

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