Life in the fast lane for Clare CIT during Covid

UNLIKE some health services that ceased during the Covid-19 pandemic, the workload for the Clare Community Intervention Team (CIT) increased dramatically for its ten staff members over the past 14 months.
Clare Community Intervention Team (CIT) is a specialist nurse-led health professional team, which provides a rapid and integrated response to a patient with an acute episode of illness who requires enhanced services for a defined short period of time.
This may be provided in the patient’s home, CIT clinic and in both public and private nursing homes.
The aim of the CIT is to support patients in their own homes and promote hospital avoidance. It also facilitate the early and prompt discharge from hospital.
It provides a quick response to a medical need and can provide a fast track nursing service from 8 to 8.30pm seven days a week that is not available in the generic community service.
Some of the key services it provides are IV antimicrobial therapy referrals from acute hospitals, IV anti viral therapy, male and female urethral and suprapubic catheterization, nursing monitoring following fracture falls, older people support and palliative care.
Other health services include diabetic care and BS monitoring, respiratory care including nebulisation and pulse oxcymetry, medication management including monitoring and administration of parental medications and heparin bridging, central venous catheter care, venepuncture and disconnection of chemotherapy pumps.
The Clare CIT team has six nurses – Ann Marie O’Looney, Catherine McInerney, Noeleen Kelly, Noelle Roche, Eva Power, Aoibhinn Donnellan, three health care attendants – Noreen Gilligan, Mary Rodgers, Teresa Conlon and an administrator, Alish O’Reilly.
It has been expanded to include a physiotherapist and an occupational therapists in the last few months.
After working for 20 years in University Hospital Limerick, Carrigaholt nurse, Ann Marie O’Looney came to the primary care hub in 2017.
She recalled staff in the neurology service at Ennis Hospital were redeployed so this resulted in the CIT team taking on a lot of additional catheter work, prioritising those most in need.
She remembered providing additional social care assistance to a man who could speak but couldn’t write English and wasn’t aware of the Pandemic Unemployment Payment (PUP), as there was no community services available that could come out to him.
She said some families were afraid of disclosing they had Covid-19 or were close contacts for fear of losing the service.
Nurse, Noeleen Kelly, who is from Laois and has worked in the primary care hub for ten years, admitted there was an initial fear about whether they would pass on the virus to patients or family members.
“It was unclear at the start whether we were supposed to wear masks and stay one or two metres from people. We led it ourselves and started to wear masks to protect our patients.
“The service continued the only difference was we wore Personal Protective Equipment.
“We didn’t have time to navel gaze, we just had to get on with providing a service. We completed training to put on and take off PPE correctly.
“We have to ring every patient the night before their clinic appointment. People stay in their car in the car park and we ring them to come in.
“Every clinic visit that was 15 minutes now takes about 30 minutes because we have to prepare and disinfect the room when the patient has left.
“When we sent home we didn’t go near our family until we had a shower and washed all our clothes to keep everyone safe.”
Ann Marie said the team benefited from good prior planning and preparation for Covid-19 in February 2020 under the guidance of manager, Catherine Ryan because they are a demand-led service.
“Our biggest challenge was ensuring no one in the team got Covid-19, which would have had implications for the service. We implemented social distancing at work.
“No one in the Clare team got Covid-19 but recently 40% of our team stood down for ten days because they were close contacts. It had a huge impact when you are trying to maintain a service.
“We did a combination of house and clinic visits where it was deemed appropriate.”
After spending 14 years in St Joseph’s Hospital, Ennis, Doonbeg native, nurse, Catherine McInerney started working in the Clare CIT team in 2017.
For a person who is on IV antibiotics that could spend up to eight weeks in hospital, Catherine explained this can be reduced to just two weeks once they are managed effectively by the team.
Catherine said oncology patients comes to the team to get their bloods done, which spares them a long trip into University Hospital Limerick or Galway University Hospital that is very beneficial for people from West and North Clare.
They also disconnect chemotherapy pumps for cancer patients that spares them another journey into an oncology centre.
The provision of palliative care for cancer patients at home by the CIT team proved a major boost for local families who were able to see their loved ones at their end-of-life stage without the same level of Covid-19 restrictions that were administered in nursing homes.
Catherine said they have seen cases of Long Covid-19 where people are still suffering from fatigue months after contracting the virus.
Ann Marie said the team works very closely with public health nurses and any other service that is necessary to reduce hospital stays.
During the pandemic, she recalled people’s mindset changed and they wanted to avoid going into hospital, which resulted in the team working more closely with local general practitioners.

By Dan Danaher