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

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..

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.