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Today, I want to talk about standards in the community, once again, for long-term ventilated adults and children with tracheostomies and if you want to know more about it, stay tuned. I’ve got news for you.

My name is Patrik Hutzel from intensivecareathome.com. Today, I want to talk about quality standards in the community when it comes to long-term ventilation and tracheostomy for adults and children.

So, when you look on our website at intensivecareathome.com, you will find the section where it says the Mechanical Home Ventilation Guidelines. On those guidelines, you will see that only critical care nurses with a minimum of two years critical care nursing experience are able to safely look after long-term ventilated adults and children with tracheostomies at home. That is 24 hours a day, not 3 hours a day, not 5 hours a day. 24 hours a day, similar to an intensive care unit.

Now, on top of that, the Mechanical Home Ventilation Guidelines will also say that for BIPAP, CPAP ventilation, it requires a critical care nurse, 24 hours a day, as well as for tracheostomy care without ventilation, it requires 24/7 critical care nurses. Those critical care nurses need to have a minimum of two years critical care nursing experience.

Now, by the way, the Mechanical Home Ventilation Guidelines are evidence-based and are therefore best practice. Anything less than what the Mechanical Home Ventilation Guidelines say and are implemented on the lower standards have caused lives and people have died because of either general registered nurses or worse support workers, were not able to look after the intensive care patient at home safely.  So, that’s the background.

Now, one of the physiotherapists that we’re working with actually sent me an email this week and followed up with a phone call that there is more evidence about that only critical care nurses can look after ventilated and tracheostomy clients, whether it’s in a hospital or at home.

Here is why, the Thoracic Society of Australia and New Zealand have also put out guidelines and they’re actually clinical practice guidelines. They call it swimming between the flags. It says oxygen guidelines for acute oxygen use in adults.

OXYGEN GUIDELINES FOR ACUTE OXYGEN USE IN ADULTS PDF

Now, interesting, it’s mainly talking about oxygen use, but there’s also a very important section where it says on page 3, section 11,

“It is recommended that patients receiving ventilatory support are located in an area such as an HDU, ICU, a close observation unit or monitored bed unit, where there are adequate numbers of staff experienced in ventilatory support to provide an appropriate level of monitoring and titration of therapy.”

Well, what does that tell you? It tells you that, thankfully, other organizations are wanting to maintain standards as well because the biggest risk for NDIS (National Disability Insurance Scheme) participants at the moment is that the NDIS is trying to get support workers to basically do intensive care nursing work in the community, which is absolutely dangerous, and people have died because of it. So, I’m glad that other credible organizations are happy to support what we’ve been saying for over a decade since 2012, that the only way Intensive Care at Home for ventilation, tracheostomy can be applied is with critical care nurses with a minimum of two years critical care nursing experience.

I can tell you that we are thankfully in a position to employ hundreds of years of critical care and nursing experience, we are very fortunate in that regard. But that is also thankfully to our framework and our framework is Intensive Care at Home nursing. We are actually the only provider in 2024 in Australia that is actually accredited for Intensive Care at Home nursing. That means we are the only provider in Australia in 2024 that has actually built the policies, procedures, the intellectual property to provide Intensive Care at Home nursing.

So, with Intensive Care at Home, we are providing 24 hours critical care nursing at home, and that is evidence-based such as with the Mechanical Home Ventilation Guidelines. We provide a genuine alternative to long-term stay in intensive care for mechanical ventilation, tracheostomy, Home BIPAP (Bilevel Positive Airway Pressure), Home CPAP (Continuous Positive Airway Pressure), ventilation without tracheostomy, tracheostomy without ventilation, Home TPN (Total Parenteral Nutrition), and home IV potassium infusion, home IV magnesium infusions. We’re also providing central line management, PICC (Peripherally Inserted Central Catheter) line management, as well as Hickman’s line management, and port-a-cath management. We’re also providing nasogastric tube management and PEG (Percutaneous Endoscopic Gastrostomy) tube management.

We’re also sending our critical care nurses into the home for emergency department bypass services. We’ve done so successfully as part of the Western Sydney Local Area Health District, their in-touch program, saving approximately $2,000 per patient that we keep at home instead of letting them go to ED. 

We’re also in a position to cut the cost of an intensive care bed by around 50%. An intensive care bed costs around $5,000 to $6,000 per bed day. Our service costs between $2,500 to $3,000 per bed day and we’re freeing up a much-needed and in demand ICU bed and we’re improving the quality of life for patients and their families so that it’s a win-win situation all around.

With Intensive Care at Home, we are currently operating all around Australia in all major capital cities as well as in all regional and rural areas. We’re an NDIS approved service provider all around the country, TAC (Transport Accident Commission) and WorkSafe in Victoria, iCare in New South Wales, NIISQ (National Injury Insurance Scheme in Queensland), Department of Veteran Affairs all around the country. Our clients and we, as a provider, have also received funding through public hospitals, private health funds, as well as departments of health.

Like I said, we are the only service provider in Australia that has achieved third-party accreditation for Intensive Care at Home nursing in 2024 and we’ve been achieving this level of accreditation since 2012. So, no other provider has achieved this high level of accreditation in the community and has created more intellectual property for Intensive Care at Home than we have. That puts us in a position to employ hundreds of years of critical care nursing experience combined in the community.

If you’re at home already and you’re watching this, and you realize that you don’t have the right level of support, I will give you a very tangible example here. One of our first clients about 10 years ago was a client who was at home on a ventilator with a tracheostomy, with a support worker model. Of course, support workers, just like I said, can’t keep a patient at home on a ventilator with a tracheostomy. That’s like flying the airplane with the cabin crew instead of the pilot because this client, like many other clients, was at high risk of dying and he was going in and out of ICU because support workers simply don’t have the skills, the experience, and knowledge, how to look after a ventilator and tracheostomy client. It’s an intensive care and critical care nursing skill, full stop.

Eventually, the client found us, and we were proving our concept with this client very fast. When we worked with the client and we sent him intensive care nurses, 24 hours a day, he never ever went back into ICU ever again and he was safe. We can do the same for you if you’re not safe at home, including the advocacy that goes along with it to get the relevant funding. We have always successfully advocated for our clients, otherwise we would not be in business.

That is also why we’re providing Level 2 and Level 3 NDIS Support Coordination. We have a team of NDIS Support Coordinators, and they have a wealth of knowledge. I will put into the written version of this blog to an interview that I’ve done with Amanda Riches, who’s one of our NDIS Support Coordinators. We’re also providing TAC case management, WorkSafe case management in Victoria.

If you’re an NDIS Support Coordinator or a case manager from another organization watching this, you’re looking for nursing care for your participants, please reach out to us as well.

If you’re looking for funding for nursing care for your participants and you don’t know how to go about it and what evidence to provide, I encourage you to reach out to us. We can help you with the right level of advocacy. We can also provide NDIS specialist nursing assessments done by critical care nurses with a legal nurse consulting background.

If you’re a critical care nurse and you’re looking for a career change, we’re currently hiring for jobs for critical care nurses in the home in Melbourne, Sydney, Brisbane, in Albury, Wodonga, in Bendigo, in Geelong, and in Warragul in Victoria. If you have worked in critical care nursing for a minimum of two years, pediatric ICU, ED, and you have already completed a postgraduate critical care nursing qualification, we will be delighted hearing from you.

I do have a disclaimer though because we are offering a tailor-made solution for our clients, which includes regular staff, our clients want to have the same staff coming over and over again because they are so vulnerable and so special and that’s why we need regular staff.  So, if you’re looking for agency work where you’re coming and going, this is not the right fit for you. We’re looking for consistency and our clients are looking for consistency. So please, only apply with us if you can give us regular and consistent availabilities for shifts. If you’re really keen on building relationships with us and with our clients, you’re welcome to apply. Otherwise, it’s not going to work.

If you’re an intensive care specialist or an ED specialist, we also want to hear from you. We are currently expanding our medical team as well. We can also help you eliminate your bed blocks in ICU and ED for your long-term patients or for your regularly readmitting patients with our critical care nursing team at home. We’re here to help you take the pressure off your ICU and ED beds and in most cases, you won’t even pay for it. Even if you do pay for it, it’s much more cost-effective than what you’re paying in ICU or ED for.

If you’re a hospital executive watching this and you have bed blocks in your ICU, ED, respiratory wards, please reach out to us as well. We can help you there fast and privately as well.

If you’re in the U.S. or in the U.K. and you’re watching this, and you need help, we want to hear from you as well. We can help you with that privately.

Once again, our website is intensivecareathome.com. Call us on one of the numbers on the top of our website or simply send us an email to [email protected]. That’s [email protected].

If you like my video, subscribe to my YouTube channel for regular updates for families with Intensive Care at Home and intensive care, click the like button, click the notification bell, share this video with your friends and families and leave your comments below what you want to see next, what do you think about today’s topic and what insights you have from this video.

Thank you so much for watching.

This is Patrik Hutzel from intensivecareathome.com and I will talk to you in a few days.

Take care for now.