New model for patient care- Hospital at home - page 2

by paradiseboundRN | 2,103 Views | 13 Comments

This new model of patient care (explained at clinicallyhome.com) allows patients who have easily treatable diseases such as pneumonia, DVT, asthma and cellulitis to stay home under the program called "Hospital at Home". They... Read More


  1. 0
    Quote from lovinlife11
    I actually don't watch tv or movies, even as a kid. Interesting info though!
    First one that came to mind. See: 42.00 onwards about the infant with pneumonia.
    SMASH UP The Story of a Woman (1947) Susan Hayward - Eddie Albert.avi - YouTube
  2. 0
    Quote from DoGoodThenGo

    You've never seen those old films were someone became very ill and you knew things were critical when a physican was summoned and then came the whole schabang of equipment. Oxygen tents, O2 canisters, etc.. and a nurse in starched whites with cap who was "engaged" to provide care.

    Have long since chucked them away, but when I was younger older relatives who were nurses and or others gave one tons of old nursing text books from the 1940's through 1960's. In most there were sections about providing what would be called "home care" today. Then it was more commonly known as "private duty" and could involve anything from new mother and infant to end of life (COPD, cancer, etc..) care. One book had a chapter on what to do once a patient expired (sorry, appears to no longer to be breathing), up to and including preparing the body for the undertakers to take away. Got as far as plugging up various orifices and quickly moved on.

    When you think about it modern hospitals exsist mainly to provide skilled professional nursing care. If one has the funds equip one's home and hire the staff there is much that could be done in that setting.

    Saw a French program a few months back where local hospitals in France are sending out nurses to provide care for patients in their homes, rather than have them go to hospital. One patient covered in the show was a young boy with cancer who receives his chemo and other treatments at home via nurse visits. His mother stated her son was much more comfortable with the arrangement then when they had to go to hospital. IIRC the government is trying this out as a cost cutting move but also to see if it provides better patient care.
    ^This!!!

    It is the past and the future; and a lot of us who may not have experienced this or talk to relatives who saw physicians and nursing in the home, and ONLY went to the hospital if you "were going to DIE, or don't want to DIE" (my late grandmother's words), I can see this happening.

    I was a HH nurse for 5 years, and the collaboration, advocation and education of the pt and family gives you great tools when working with the complex pt in the home. There are tons of people who do choose to stay at home and in their communities while receiving complex care.

    IMO, I can see more multidisciplinary involvement in the community seething and nursing teams similar to acute care occurring in the home. With infusion nursing, wound care nursing, pt's wearing remote home monitoring and wound vacs in the community (I had one during a significant health event and it was portable-able to go out and get air, and move around per nursing orders to help me in recovery, and run errands); this is possible that our pts birth to older adult are able to be a part of the community and stay active.

    When I tell nurses that are ambivalent about home health at my current job how I wasn't just "in the home" with pts; I would go to Drs appointments, out to the park, or at least outside so they could get sun and air, engage in games, activities, to keep my pts active and involved in their own way. This model is coming back; we will still need acute care nursing; yet we will need highly skilled nurses of all disciplines to help complex healthcare pts in the best way possible, even in the home.
  3. 0
    I was amazed and kinda shocked when the child of a friend, who had suffered a severe ruptured appy and was on TPN/Lipids for a time, was sent home with a PICC. Her parents were instructed how to clean the port, plug in the pump, and infuse antibiotics a couple of times a day! The parents said they were uncomfortable with this but they felt pressured by insurance and doctors to agree to it. There was no nurse involved- they were to take the child to a clinic to change the dressing. The child ended up suffering toxicity from one of the antibiotics because her labs were not being watched as closely as they would have been in the hospital. She was okay in the end, but it really made me think about all the potential risks of things going very bad.

    We have several patients who have home PICC lines who have come in, and 9 times out of 10 the dressings look awful. The broviacs are not coiled up totally under the dressing, the dressing is half-off or soiled with stool, and the child is coming in for a fever. Hmmm . . . ? I am told in some cases that a home nurse comes once a week to change the dressing-- but apparently the dressings are not inspected daily in between.
  4. 1
    Quote from anon456
    I was amazed and kinda shocked when the child of a friend, who had suffered a severe ruptured appy and was on TPN/Lipids for a time, was sent home with a PICC. Her parents were instructed how to clean the port, plug in the pump, and infuse antibiotics a couple of times a day! The parents said they were uncomfortable with this but they felt pressured by insurance and doctors to agree to it. There was no nurse involved- they were to take the child to a clinic to change the dressing. The child ended up suffering toxicity from one of the antibiotics because her labs were not being watched as closely as they would have been in the hospital. She was okay in the end, but it really made me think about all the potential risks of things going very bad.

    We have several patients who have home PICC lines who have come in, and 9 times out of 10 the dressings look awful. The broviacs are not coiled up totally under the dressing, the dressing is half-off or soiled with stool, and the child is coming in for a fever. Hmmm . . . ? I am told in some cases that a home nurse comes once a week to change the dressing-- but apparently the dressings are not inspected daily in between.
    ^That really should have not happened.

    There should've at least been an company still assisting and advocating to make sure that labs were drawn, if the dressing got soiled in any way that a culture can be obtained and a dr's appointment made right away. That is usually the protocol on pt's going home with a central line or long-term abx therapy; they are still monitored; whether the insurance company (telehealth and HH division), hospital (their HH division), or HH agency is involved, there is ALWAYS someone able to do a visit and get out to make sure that the complications are minimized.
    Not_A_Hat_Person likes this.


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