Hi it’s Patrik from intensivecareathome.com.au where we help long-term ventilated adults& children with Tracheostomy to improve their Quality of life and where we also help hospitals and Intensive Care Units to safe money and resources, whilst providing Quality Care!
In last week’s blog I was talking about “Why services for Long-term ventilated adults and children with Tracheostomy outside of Intensive Care in the community are becoming a vital necessity!” if you haven’t read it click on this link here https://intensivecareathome.com/why-specialized-services-for-long-term-ventilated-adults-and-children-with-tracheostomy-outside-of-intensive-care-in-the-community-are-becoming-a-vital-necessity/
In this week’s blog I want to talk about the perceived barriers that keep too many Long-term ventilated Adults& Children with Tracheostomy in Intensive Care and I also want to look at the guidelines of successful programs from overseas that can be easily adapted to the Australian Health care system and therefore either eliminate or work around some of those perceived and unnecessary barriers. More importantly, it gives ventilator dependent Adults& Children and their Families the care, the skills and the nurturing they need.
Care of Patients receiving Mechanical Home Ventilation is increasing across all countries all over the world , however different perceived barriers are standing in the way to actually transition more Clients back into the safety of their own home.
Let’s quickly look at those perceived barriers, to then quickly look at guidelines that easily eliminate those perceived barriers
- Lack of communication and lack of documented care map
- Perceived issues regarding clinical and operational governance
- Clinicians may lack experience or feel uncomfortable engaging in conversations about treatment options or palliative care for Long-term ventilated Adults& Children with Tracheostomy stuck in Intensive Care. Clinicians also may lack decisional authority if decisions are required at unexpected time-points or are required because of Clients and their Families wanting a different level of care in a home care environment
- Ethical challenges may arise. Lack of agreement on who should receive treatment and timing of end of life discussions. Rationalization of ICU care may be an issue
- Definition of transition points as well as positioning of individual patients on the transition continuum (as described above) may not be clearly communicated across teams and specialties
- Often a lack of perceived options for long-term ventilated Adults& Children with Tracheostomy outside of the Intensive Care is an issue as well
- Furthermore, we also need to finally admit and come to terms with that keeping a long-term ventilated Adult or Child in Intensive Care for months is far too resource intensive and again, doesn’t provide the Client and the Family with the Quality of Life they could be having at home and occupying a bed in Intensive Care long-term is only adding on to already long hospital waiting lists
So how can we overcome those perceived barriers and create something that creates a win-win situation for
- Long-term ventilated Adults& Children with Tracheostomy and their Families
- Hospitals and Intensive Care Units
- Health funding agencies such as Department of Health and/or Private Health insurances
The answer to this particular and important question is to establish guidelines. Those guidelines do already exist in countries where Intensive Home Care services have been successfully operating since the late 1990’s and a lot of ground has been gained in those countries, by developing successful models of Intensive Home Care nursing. Germany for example, has developed guidelines that are current and they have also proven to work in a home care environment. I have personally worked in the Intensive Home Care niche in Germany from 2001- 2003, almost in the pioneering days in hindsight.
I have attached those guidelines for Mechanical Home ventilation in a PDF here Guidelines Mechanical Home Ventilation PDF and the main solutions to some of the perceived issues are addressed in the document as follows
- page 643- 3.3 Launching Home Mechanical Ventilation
- page 643- 4 Establishing Home Mechanical Ventilation
- page 643- 4.1 Prerequisites for Discharge from Hospital
- page 644- 4.2 Out-of-hospital Care Team
- page 644- 4.3 Assistive and Professional Care
- page 644- 4.4 Management of the Transition Phase
- page 644- 4.5 Surveillance and Documentation of Home Mechanical Ventilation
- page 644- 4.6 Equipment Provider
you can also have a look on our website and follow this link and you can have a look at the guidelines there https://intensivecareathome.com/mechanical-home-ventilation-guidelines/
I also know that all of those guidelines are adhered to by INTENSIVE CARE AT HOME’s service model, as documented in our Quality Manual and those guidelines are therefore easily adoptable to the Australian Health care system.
What are your thoughts on those guidelines? Leave your comments and views below!
If you are a health professional in Intensive Care and you think you know a long-term ventilated Adult or Child with Tracheostomy and their Family who would like to improve their Quality of Life and/or their Quality of end of Life in their own home rather than in Intensive Care- even if it is to go home for a weekend- and if your organisation would also like to save money and resources along the way or if you simply have any questions, give us a call on 03-9939 7456 or simply reply to this email.
This is Patrik Hutzel from intensivecareathome.com.au and I’ll see you again in another update next week.