Hi, it’s Patrik Hutzel, from INTENSIVE CARE AT HOME, where we provide tailor made solutions for long term ventilated adults and children with tracheostomy by improving their quality of life and where we also provide tailor made solutions to hospitals and intensive care units to save money and resources by providing quality care.
In last week’s blog, I answered another question from one of our readers where the reader asked
You can check out last week’s blog here.
In this week’s blog I want to talk about
How to get evidence based care and treatment at home for long-term ventilated patients with tracheostomy and other medically complex patients!
All of our clients at intensive care at home without exception would have been either in ICU or PICU in a hospital for extended periods because of their ventilation and/or tracheostomy needs.
We also look after some clients at home that are not ventilated but still have spent extended and prolonged periods in ICU/PICU for significant medical complexities that warrants for them to have a team of ICU/PICU nurses 24/7 at home. They often have neurological conditions with seizures that require unstable airway management at times.
Unstable airway management is a skill that only critical care (ICU/PICU/ED) trained doctors or nurses have.
In order to improve our clients and their families quality of life/quality of end of life quickly, the only way is to get them out of intensive care back home with the same level of skills and expertise than they get in ICU/PICU.
In essence, intensive care at home provides an evidence based intensive care substitution service with the primary goal to improve our clients and their families quality of life.
This also achieves many other goals that our other stakeholders want to achieve
- It frees up in-demand and highly sought after ICU/PICU beds
- It frees up in demand ICU/PICU staff to look after other critically ill Patients in ICU/PICU
- It reduces the cost of the most expensive hospital bed by approximately 50%. The $5,000-$6,000 per bed day ICU/PICU now only costs half by sending ICU/PICU nurses into the home.
- It gives long-term ICU/PICU patients and their families choice
In order to provide such highly specialised ICU/PICU care at home we have developed and created a 3rd party accredited (ISO 9001/2015 and NDIS) quality system that enables us to deliver a high quality intensive care nursing service in the home.
The quality manual is not only 3rd party certified and accredited, it is also evidence based.
For example, whilst intensive care at home is a relatively new concept in Australia, we have not reinvented the wheel.
Since the late 1990’s and the early 2000’s long-term intensive care patients have been going home in Germany on a regular basis.
Current estimations are suggesting that approximately 25,000 patients are at home on life support with ventilation and tracheostomy in Germany keeping ICU/PICU empty for more acutely unwell patients needing critical care.
Because Germany is still the leading country in the world when it comes to intensive care at home services, a lot of thought and research has gone into the model of safe service delivery.
It is of no surprise that the only way services can be safely delivered at home for long-term ICU/PICU patients is with ICU/PICU nurses with a minimum of two years ICU/PICU experience, ideally with a postgraduate qualification.
This is documented and evidenced by the mechanical home ventilation guidelines. The mechanical home ventilation guidelines is a result of over 20 years intensive care at home services in Germany. We have published the mechanical home ventilation guidelines on our website here
We therefore rigorously apply those high quality standards to our service, enabling us to deal with ICU/PICU directly as a genuine alternative to a long-term stay in ICU/PICU.
Given that intensive care at home is still a reasonably new but rapidly growing care model in Australia, it’s very important to establish and maintain high care standards just like in intensive care in a hospital.
Good processes, good leadership, good policies and procedures and great ICU/PICU nurses are needed to establish and maintain those standards.
This is similar to ICU and PICU where staff need to go through training, bed side exposure, mentoring etc to look after some of the most vulnerable patients in a hospital that are critically ill and life support dependent.
There is no room for shortcuts.
It’s the same in the community. There is no room for shortcuts. Whenever patients are long term ventilated with tracheostomies or are medically complex where they are at risk of spending time in ICU/PICU the only way to safely manage those patients at home is with evidence based care.
It therefore boggles my mind that there are some organisations that are offering to look after ventilated and tracheostomised patients at home with disability support workers or general RN’s.
Here is an excerpt from a job ad that is looking to employ disability support workers to look after basically intensive care patients.
“We are currently seeking casual support workers to work at xxxxxx. We are seeking candidates with the following qualities: respect, empathy, passion, integrity and to be a team player.
The successful candidate will be specifically trained to work within this role via online modules & hands on learning.
Ventilator and Tracheostomy care
Skills and experience
Certificate III or IV in Disability, Individual support or Aged care. Alternatively, someone with support work experience/history.
First aid certificate
National police check
Have you ever wondered what it would be like getting on an airplane and the baggage handler would fly the plane instead of the pilot?
This is exactly what is happening in this situation.
It’s the baggage handler that’s flying the airplane so to speak.
Imagine if intensive care units would start looking for disability support workers to look after their patients on life support. The general public would go up in arms and rightly so.
If you look at the job ad more closely it suggests that learning about ventilation and tracheostomy- which is a skill that takes years of training and practical exposure in ICU/PICU- can be learned online in a quick session.
The job ad also suggests that a disability support worker can handle clinical notes.
Once again, managing and documenting clinical notes for ventilated and tracheostomised patients takes years of training as a critical care registered nurse in intensive care.
The above job ad makes any intensive care professional shiver and cringe.
It probably also makes any family member that has lost a loved one at home on a ventilator because of disability support workers providing inadequate care to an intensive care patient bring tears to their eyes.
Having disability support workers or non ICU trained registered nurses looking after long-term ICU/PICU patients at home is not evidence based, otherwise there would be reference to it.
Intensive care at home is not blind to what is happening in the community with some ventilated patients with tracheostomy. We are well aware that some of those patients are being looked after by disability support workers or non ICU trained RN’s that have literally no clue in what they are doing and it’s dangerous.
Having disability support workers or non ICU trained general registered nurses looking after ventilated and long-term ICU/PICU patients at home is not only dangerous, I believe it’s a criminal act.
Just like it would be a criminal act if the baggage handler was to fly the airplane…
Also, a long-term ventilated or medically complex patient has a medical condition first and foremost and the disability is a result of the medical condition and not the other way around.
Therefore a disability support worker can only ever be a compliment to support a critical care trained or ICU/PICU nurse on 24/7 roster to enable the intensive care substitution service in the home.
Again, just like in Intensive care in a hospital, you wouldn’t just pick random people to look after medically complex patients that are life support dependent, and/or medically complex.
Intensive care at home is determined to bring high quality standards into the community that gives long-term ICU/PICU patients the option to leave intensive care and go home with the care that they need, deserve and that is evidence based.
Anything else is just simply dangerous and just a short term money making scheme for business people that have no morals or ethics and it puts some of the most vulnerable people in our society and their families at risk.
INTENSIVE CARE AT HOME
If you have a loved one in intensive care with long term ventilation, and tracheostomy needs or any other medical complexities, you should also contact me on one of the numbers on the top of our website, or just simply send me an email to [email protected]
And if you are an intensive care nurse or a pediatric intensive care nurse and you’re looking to get out of the craziness of an intensive care unit and work for us in a much nicer and more holistic and client centric family environment, you should contact us as well and should check out our career section on our website here
We currently have vacancies for experienced ICU and pediatric ICU nurses in Melbourne, on the Mornington peninsula, in the northern suburbs in Melbourne and also in Sunbury. So really all across the Melbourne metropolitan area, including country Victoria, and you can escape the hustle and bustle of intensive care and work in a much nicer and much more family friendly and holistic environment.
You can also have a look at our service section where we detail exactly how we deliver services or tailor made services for our clients and their families. But also for hospitals in intensive care units.
We have also been part of the Royal Melbourne health accelerator program in the past for innovative health care companies. Thank you so much for tuning into this week’s vlog and I’ll talk to you in a few days.
This is Patrik Hutzel from intensive care at home and I’ll talk to you in a few days.