Extubation in the home hospice setting

[Claudia322]

I am a case manager and last year I had a patient whose wife wanted him to pass at home. In order to do that, he would need to be transported vent dependent and extubated at home.

Has anyone successfully accomplished this and still been able to ensure a safe and peaceful passing for your patient?

Long story short, the patient was extubated at the hospital.

I am anxious to hear your opinions and experience regarding this.

Thanks so much.

Claudia322

[SoCalRN1970]

Done it with the support of a fantastic hospice I worked for. It went just as you explained. But, some hospice companies will not do this as it's a negtative for them. It's costs more to provide the service vs. doing what the family and patient wanted.. Family was so very appreciative. They really were. It was the patient's wish to die at home..

[ErinS, BSN, RN]

Our hospice will no longer do this. However, we have had patients come home under care of our home health, and then the hospice MD and RN will go and do the withdrawal. We have had some fiascos, so we just don't do this under our hospice anymore. It has been a long time since we did this.

[tewdles, RN]

I have participated in this process several times. In all cases the patients and families really appreciated it and hospice goals were met.

I would do it again with the proper support...

[Claudia322]

Were there any insurance issues w/ the critical care ambulance prior to hospice? Who did the extubation? Did you have to use any IV push meds at home? MD or RN did that? My concerns are that I know of no clinicians seasoned in this procedure so I am most uncomfortable regarding the goal of a peaceful passing.

[tencat]

In my situation the patient would have to be extubated in the hospital, and if he/she survived, then transported home, though my company probably wouldn't do it as they would have to pay for an ambulance to get the patient home.

[tewdles, RN]

Were there any insurance issues w/ the critical care ambulance prior to hospice? Who did the extubation? Did you have to use any IV push meds at home? MD or RN did that? My concerns are that I know of no clinicians seasoned in this procedure so I am most uncomfortable regarding the goal of a peaceful passing.

The EOB was obtained in the hospital in all cases. The patient was transported home with a secure airway (intubated) paid by hospice. There were no insurance issues. Who extubated varied...I did in several cases. In others the MD extubated.

I used IV and inhaled medications to make the patient comfortable in the immediate post extubation phase. I then transitioned the patient to SL/po meds prior to my departure. In at least 2 of the cases the patient survived 2+ days and in all of my cases the patient survived at least 12 hours. They died comfortably in their homes with their families at their sides free from a respirator and ETT. As far as I know the hospice goals of the patients and families were met in all cases...I know they were for my patients.

I agree that not every hospice case manager would be comfortable with this. I have the benefit of a lengthy career with heavy critical care experience to give me the tools to help these patients.

If you are a hospice clinician, the goal of a peaceful passing should be most comfortable for you...regardless of the technology.