Do any of your home hospice programs do extubations in home??

Specialties Hospice

Published

Hello I'm new to the site and have been gathering data about extubation patients at end of life in their homes.. I have taken home 2 patients in the last month from the ICU with grim prognosis who have wanted to die in thier own homes.. With the family's advocating, hospice was called in. I am a liason in a large hospital and arranged for the patients wishes to happen, I found 2 people one a parametic and one a RN on the critical transport team who actually performed the extubation in the pt home.,(Patient may not have lived if extubated then transfered home). The 2 experiences were beautiful in the home, alot of work to get everyone on the same page,, and alot of nay-sayyers...politics...liability issues..etc.. Please tell me if anyone else has done this and how it was handeled in your area, I cannot find any documentation of this happening... Per my instutuion they said only one time previous in it's 100 yr history has it been done, and a MD accompanyied the patient home.. I went with both patients to give the proper dosing of medication . Any feed back or leads to information would be very helpful...thank you ..Sue Hospice from New York

Specializes in Hospice, BMT / Leukemia / Onc, tele.

hello, sue. i can't say we've had it happen yet, but it was attempted. unfortunately the patient died at the hospital waiting for transport to his home. we've been doing lots of things "outside the box" for our agency in the past couple of years. i know this is something that will come up again.. it's just few and far between. usually our patients we are admitting that are on the vent we go and meet with the family before and discuss the options they have.. most will keep the patient in the hospital though.. i'm sure it would be a beautiful experience for teh family, but lately our vent patient families haven't been the type to be comfotable with this sort of thing at home. i'm sure with your experience you understand what i'm trying to say..

Specializes in Hospice and Palliative Care, Family NP.

Recently, we admitted a 54 year old with who was in ICU and wanted to go home on our Hospice. He knew, and the family knew, that once he was extubated he could pass quickly. We arranged for a squad to be there at the hospital, he was placed on the gurney and extubated and immediately taken home. He did survive the trip home and lasted for 24 hours. What is really really weird is, the next morning when one of our nurses went to see him, the man's Lab (who was 14 years old) was laying on the bed with him. What they did not know was, the lab had passed away!!!! The man died later that day himself.

Another instance, we had a 30 year old MD patient who had been vent dependent for years. We had to have an order to extubate him after he passed. We would not have been able to do that without a doctor's order even though his heart had stopped beating.

Seems like we have about 1 or 2 a year like this. We arrange for the nurse and the medical director to meet the ambulance on arrival at the home and have roxanol and ativan on hand. We also have continuous care staff on standby in case the patient does not die immediately as expected. They often survive longer than predicted.

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