hospice patients on ventilator

[nursechris1]

Have any of you done hospice with patients on the ventilator? We admitted one today, in a nursing facility. The M.D. would like to tak the patient off the vent, but the family is not ready. I think the Doc thinks we can help them prepare for this. The Doctor and the facility staff feel that Hospice is very appropriate, the patient is declining, no longer tolerating tube feedings, nonresponsive. I am getting some negative response at my office though, about whether or not it is appropriate to do hospice in this situation. Any feedback?

[renerian, BSN, RN]

Yes I have seen patients in hospice on vents.

renerian

[Wren]

I think Hospice is the perfect place for the patient to be (financial issues aside) because who better to help the family understand and accept the upcoming death? You will also be a terrific advocate for the patient with your skills at assessing for and providing comfort measures. I think MORE terminally ill patients in the ICU should be referred to Hospice with the goal of getting them to a more appropriate level of care. Good luck!

[aimeee, BSN, RN]

Couldn't have said it better myself, Wren!

We go through this too when we take on patients who are still getting more aggressive measures too. Staff don't like dealing with the technology because it is time-consuming and they are uncomfortable with it. They also don't like it because the families are often difficult because they are not "in the hospice mode". But they are the ones who are struggling the most and need us the most.

[kids]

I worked on an 18 bed subacute/longterm vent/trach unit for several years. We pretty much did everything: from palitive care and terminal weaning to pulmonary rehab and extubation to providing a "home" for stable vents that needed to much to be at home.

Some families (and staff) have a hard time getting into "hospice mode" because of the vent, (I think) the vent contributes to hope for recovery..."as long as they are breathing". A down side was that due to reimbursement issues we were limited to "Hospice Consults"...the upside was that many of us were able to do an unpaid sort of intenship with Hospice so that we gained some experience in medication management and psychosocial/spiritual support.