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My name is Patrik Hutzel from intensivecareathome.com,  where we provide tailor-made solutions for long-term ventilated adults and children with tracheostomies at home, tailor-made solutions for long-term ventilated adults and children on Bilevel positive airway pressure (BiPAP), continuous positive airway pressure (CPAP) ventilation, at home, where we provide tailor-made solutions for tracheostomy adults and children without ventilation at home, home cough assist management, home ventilation weaning, home tracheostomy weaning when medically indicated.  Home total parenteral nutrition (TPN), home IV potassium, home IV magnesium, home intravenous (IV) fluids, home IV antibiotics infusions as well as central line,, PICC (Peripherally Inserted Central Catheter) line, Hickman’s line, port management at home, suprapubic catheter (SPC), indwelling catheter (IDC) management at home, percutaneous endoscopic gastrostomy (PEG), and percutaneous endoscopic jejunostomy (PEJ) tube management at home, Nasogastric tube, nasojejunal tube management at home, as well as palliative care management at home.

 

We are also providing level 2 and level 3 National Disability Insurance Scheme (NDIS) support coordination, as well as Transport Accident Commission (TAC) and WorkSafe case management

as well.

 

One of our clients recently had an incident, and because we provide 24-hour nursing care, we had an incident report from one of our staff. I want to share that with you today because it clearly highlights why 24/7 critical care registered nurses at home for ventilated and tracheostomy adults and children is non-negotiable, and I want to go through that nursing report and incident report in detail today to highlight that anything less than a critical care nurse is simply putting a client’s life at risk. As you all know, the Noah Johnston case from earlier this year, late last year, was a prime example that if 24-hour intensive care nurses are not funded, clients are at risk of dying.

 

Unfortunately, Noah Johnston passed away, but others have passed away as well in similar situations.

 

When critical care nurses are not funded 24 hours a day at home, similar to an ICU (Intensive Care Unit) when there’s ventilated tracheostomy clients, patients must be in an ICU, and if there would be support workers or general registered nurses, it would be the same in an ICU in a hospital, so why would it be any different in a home care environment?

 

Let’s now look at a real, unedited incident and shift report for one of our clients who’s ventilated with tracheostomy and is also still working during the day, and that is very remarkable.

 

This client is absolutely amazing. The client is still working during the day, from a home office job for a government agency, and it’s just an amazing client.

 

When the client’s next of kin, and also the client himself, heard about the incident, the client actually asked whether this report proves we need critical care nurses 24 hours a day, with the funding body, which in this case is the NDIS, or whether a general RN (Registered Nurse) or even a disability support worker could have managed this shift just as safely. The answer is a clear no, but I want to walk you through that exact report line by line, the way I would read it as a critical care nurse.

 

I have worked in critical care nursing for over 25 years in three different countries, where I worked as a nurse manager for over five years. I was part of successfully setting up intensive care at home services in Germany over 25 years ago, before I brought the concept to Australia in 2012, and that’s how long we’ve been operating here in Australia with Intensive Care at Home http://intensivecareathome.com/servicesbecause this single overnight shift is one of the clearest real-world illustrations of why ventilated tracheostomy clients need 24/7 critical care registered-level nursing.

 

It doesn’t matter whether it’s in ICU in a hospital or whether it’s at home withIntensive Care at Home. It can never go with a lower tier of care.

 

So here’s what our nurse wrote, documented for this client on a shift who sleeps on invasive ventilation with tracheostomy overnight, and needed to be fit to go to work the next morning, so it’s very important that this client has a good night’s sleep. It’s important for every client, it’s important for all of us as human beings to have a good night’s sleep.

 

Let’s look at the report: cough-assist is provided at the beginning of the shift. PRN suctioning — non-PRN means as needed. Tracheostomy dressing done, connected to a ventilator at 2200H. Woke up at 6:49 a.m. but had interrupted sleep from 2:00 a.m. to 3:00 a.m. as the ventilator was alarming low tidal volume. Cuff pressure checked. Cuff pressure sorted. Cleaning done and inner cannula tube changed. Cough deflated at 8 a.m. Tracheostomy dressing changed, and inner cannula changed. Client ready for the day.

 

On paper, to a layperson, that might read as a fairly uneventful night. To me, reading it as a critical care nurse, that report describes at least six separate clinical decision points in a single shift, any of which, handled incorrectly or handled too late, could have resulted in this client going to hospital, or even worse, and definitely not going to work the next morning, because without an airway that’s actually safe, he wouldn’t go anywhere at all besides maybe going back to a hospital, or worse.

 

Let’s break down the clinical picture event by event.

 

Number one, pre-sleep airway clearance, cough assist, and PRN suctioning. Before this client was even connected to a ventilator for the night, the nurse had to clear his airway using mechanical cough assist and as-needed PRN suctioning. That’s not a scripted task. PRN means the nurse has to independently assess airway secretions, work of breathing, and oxygen saturation, auscultate the lungs with a stethoscope to listen for any friction, for any secretions on the chest, and decide in real time whether suctioning is needed, how deep, and how often. Get that wrong, and you either leave secretions sitting on a compromised airway overnight, or you traumatize the airway with unnecessary, poorly performed suctioning. Either way, you might make or break a client’s night’s sleep, so your decision at that particular point in time is absolutely crucial in how that night for the patient unfolds.

 

Next, tracheostomy dressing and connection to the ventilator at 2200H. Before settling this client onto the ventilator for the night, tracheostomy dressing was done and he was connected at 2200H. During the day, the client is actually on a tracheostomy, doesn’t need ventilation for most of the time, but even with a tracheostomy, he needs a critical care nurse 24 hours a day. This is the point where a trained CCRN (critical care registered nurse) checks tube position, stoma condition, and ventilator settings match the prescribed mode before the client is unsupervised for hours in the dark, asleep with an artificial airway.

 

Number three, ventilator alarming for low tidal volume, 2 a.m. to 3 a.m. This is probably the single most important line in this entire shift report from the nurse, and it’s a line that on its own answers the question of whether this client needs a CCRN overnight. Even prior to this, clearly he needs a CCRN, but this is probably the most important point of this report.

 

A low tidal volume alarm on a home ventilator is not one problem, it’s a symptom that could mean any of the following five points. Number one, a leak in the ventilator circuit or around the tracheostomy cuff. Number two, partial or complete tracheostomy tube displacement. Number three, increased secretions partially occluding the tube or airway. Number four, a kinked, disconnected, or water-logged circuit. Number five, deteriorating lung compliance or a change in the client’s respiratory status, which could include new secretions, a pneumothorax, and so forth.

 

A CCRN doesn’t just silence the alarm, they systematically work through a differential, physically assess the client, check the circuit, check the cuff, check the tube position, and reassess ventilation, all while the client may be half asleep, potentially distressed, or unable to communicate. A general RN (registered nurse) without critical care ventilation training, and certainly a disability support worker, is not trained or credentialed to work through that differential. Their only safe option in that moment is to call someone else and wait, and with a compromised airway at 2 a.m., wait is not a safe word.

 

Let’s now look at the cuff pressure checked, because that was one of the first things our CCRN did, and that was exactly the right step to do. Tracheostomy cuff pressures have to sit in a narrow, safe range. If it’s too low, the client risks aspiration and an inadequate seal for ventilation, potentially leading to low tidal volumes. Too high, and you risk tracheal mucosal ischemia, and over time, tracheal stenosis or a tracheoesophageal fistula. Checking and adjusting cuff pressure is a specific, hands-on critical care nursing skill, not a checklist item a support worker or a general registered nurse is trained or permitted to perform.

 

Next, cough assist and inner cannula change overnight. Following the alarm events, the nurse performed cough assist again and changed the inner cannula, almost certainly because secretions were implicated in that low tidal volume episode. Changing an inner cannula on a ventilated client overnight, while managing an active respiratory event, is an invasive airway procedure that requires competency-based, ongoing critical care training.

 

Number six, cuff deflation, dressing change, and inner cannula change at 8:00 a.m. Come the morning, the cuff was deflated, the client was disconnected from the ventilator — a step that has to be timed and assessed correctly for a client who is about to start eating, drinking, talking, and going about his day — followed by another tracheostomy dressing change and inner cannula change, getting him genuinely ready for the day, not just physically present for it, because this client is actually going to work every day, five days a week, Monday to Friday.

 

This isn’t a client living quietly in bed. This is a client who’s ventilated with a tracheostomy overnight, is breathing with a tracheostomy during the day, and still goes to work every morning, which is exactly the kind of outcome I’ve spent my career fighting for — patient choice, dignity, and a real life, not just survival. That quality of life is only possible because the CCRN was in that room at 2 a.m. running a proper clinical assessment on a ventilator alarm, not just responding to a beeping noise.

 

If a general registered nurse without ventilation and tracheostomy competency, or a disability support worker, had been rostered on that shift instead of a CCRN, the realistic options at 2 a.m. were: ignore or silence the alarm, guess at the cause, or call an ambulance for an event that a properly trained CCRN can safely assess and manage in the home, and make or break a client’s night, sleep, and safety.

 

None of those are acceptable options for a client or a family who has been told their loved one can safely sleep ventilated at home.

 

I see this pattern of funding bodies and providers constantly trying to downgrade ventilated tracheostomy clients from CCRN care into cheaper general RN or support worker rosters. As I said, I’ve spent over 25 years in critical care nursing in three different countries, where I was part of successfully setting up intensive care at home in Germany, where home ventilation for conditions like motor neuron disease has been the standard of care for nearly 30 years, always with critical care nursing 24 hours a day, never with a downgraded workforce.

 

This overnight report is exactly the kind of evidence that shows why that standard exists, and for the clinical evidence base behind why home mechanical ventilation requires this level of nursing skill, I’d strongly encourage you to read our evidence-based mechanical home ventilation guidelines on our website at intensivecareathome.com.   I link to the evidence-based mechanical home ventilation guidelines in the show notes below the video.

 

Also, another advocacy tip: always get the full medical records, because if you’re a family member navigating a similar situation, whether through NDIS, TAC, WorkSafe, any other funding bodies, departments of health, private health insurance, DVA (Department of Veterans’ Affairs), etc., my advice is always the same — request the full contemporaneous nursing progress notes, medical reports, incident reports, not just a summary. Leave no stone unturned.

 

A report like the one above in the client’s own file is powerful, factual evidence of clinical acuity that you can use to advocate for the correct level of funded support. Vague or downgraded documentation makes it far easier for a funding body to argue a lower level of care is “adequate.”  Detailed CCRN documentation, like the report we’ve just gone through, tells the real story.

 

And if you’re dealing with these situations — a ventilator alarm, a tracheostomy complication, a care downgrade, or you’re simply not sure whether the nursing roster your loved one has is actually safe, whether your loved one’s care is actually safe, whether you’re in ICU or at home — I offer direct help here at intensivecareathome.com.  Just call me on one of the numbers on the top of our website, or if you’re in Australia, call me directly on 0410 942 230, and I can help you. Me and my team can help you.

 

This is exactly why the kind of care Intensive Care at Home is delivering and is built to provide. We are also Australia’s only intensive care at home nursing service that is third-party accredited specifically for intensive care at home nursing through ISO (International Organization for Standardization) 9001, 2015, as well as NDIS registered, and you can view our accreditation and quality credentials on our website at intensivecareathome.com/accreditation-quality.

 

We provide 24/7 critical care registered nurses, not general registered nurses, definitely not disability support workers, for invasive ventilation with tracheostomy, https://intensivecareathome.com/quality-life-nursing-services-adults-children-requiring-non-invasive-mask-ventilation-cpap-bipap-andor-high-flow-oxygen-therapy/  without tracheostomy, tracheostomy without ventilation, all for adults and children, all around Australia and all states and territories, in all major capital cities as well as in all regional and rural areas. It’s safe, competent, and without unnecessary hospital admissions, because all of our critical care registered nurses are trained to handle exactly the kind of overnight ventilator and tracheostomy events you’ve just heard about.  As a matter of fact, we are employing hundreds of years of critical care nursing experience combined in the community. No other provider in Australia can match that.

 

Here’s the bottom line. A single low tidal volume alarm at 2:00 a.m. on a client who’s ventilated with a tracheostomy and needs to be fit for work by the morning, is not a task for a general registered nurse or a support worker to manage alone. It requires the assessment skills, hands-on airway competency, and clinical judgment of a critical care registered nurse, every single day and night.

 

If this video or blog post resonates with your own family’s situation, please get in touch. You don’t have to accept a downgraded level of care, and you don’t have to navigate this alone. Reach out to us here at intensivecareathome.com. If you’re watching this in the US, in the UK, in Canada, or in India, reach out to us as well — we can help you there as well. Again, call us on one of the numbers on the top of our website, or book an appointment with me through the Schedule Appointment button, or send us an email to [email protected].

 

With all of that said, with Intensive Care at Home, we are currently sending our critical care nurses into the home 24 hours a day. Therefore, we are providing a genuine alternative to long-term stay in intensive care for:

 

• Ventilation
• Tracheostomy
• Home BiPAP (Bilevel Positive Airway Pressure) and CPAP (Continuous Positive Airway Pressure)
• Tracheostomy care without ventilation
• home TPN (Total Parenteral Nutrition)
• Home IV potassium
• Home IV magnesium
• Home IV antibiotics
• Home IV fluids

We’re providing:

• Cough assist management at home
• Ventilation weaning management at home
• central line, PICC (Peripherally Inserted Central Catheter) line, Hickman’s line as well as port management at home
• nasogastric tube, nasojejunostomy tube, PEG (Percutaneous Endoscopic Gastrostomy), PEJ (Percutaneous Endoscopic Jejunostomy) tube management at home
• IDC (Indwelling Catheter) and SPC (Suprapubic Catheter) management at home
• Palliative care services at home

We’re also sending our critical care nurses into the home for emergency department bypass services. We have done so successfully as part of the Western Sydney Local Health District’s In Touch program, saving approximately $2,000 per patient that we keep at home instead of them going into an emergency department.

 

That also means we’re in a position to cut the cost of an ICU bed by around 50%. An intensive care bed costs between $5,000 to $10,000 per bed day depending on location. Intensive Care at Home costs approximately 50% of that, and we’re freeing up the most sought-after bed in the hospital, which is the ICU bed. Most importantly, we’re improving the quality of life for patients and their families, which is a win-win situation for all stakeholders.

 

Our Coverage and Accreditation

With Intensive Care at Home, we’re currently operating all around Australia, in all major capital cities, as well as in all regional and rural areas. We are an NDIS approved service provider all around Australia, TAC (Transport Accident Commission) and WorkSafe in Victoria as well as the Department of Veterans Affairs all around Australia.

 

We’re also ISO 9001:2015 accredited. Our clients and we as a service provider have also received funding through public hospitals, private health funds as well as departments of health.

We are the only service provider in Australia that has achieved third-party accreditation for Intensive Care at Home nursing in 2025. We have been achieving this high level of accreditation since 2012. No other provider in Australia has achieved the Intensive Care at Home level of accreditation in the community and has created more intellectual property when it comes to Intensive Care at Home nursing than we have.

This puts us in a position to employ hundreds of years of critical care nursing experience combined in the community. No other service provider in 2025 employs a higher skill level in the community than we do. And that enables us to look after the highest acuity adults and children in the community in Australia safely.

 

If You Need Help

 

If you’re at home already and you’re watching this or you’re stuck in an ICU and you realize that you don’t have the right level of support, I can give you many examples where we helped clients with funding, how we advocate for funding. We had to advocate successfully for funding from our first case study to many other case studies where we had to advocate successfully for funding with the right evidence of course because it is crystal clear that disability support workers for example or registered nurses without ICU experience cannot look after ventilated clients at home whether adults or children with or without a tracheostomy and it’s simply dangerous and negligent.

There are plenty of examples where clients with support worker models or even RN (registered nurse) models without ICU experience have died at home and I have evidence to back up everything that I’m saying here because it’s a bit like flying the airplane with a cabin crew instead of the pilot and it could simply be deadly.

 

This can be avoided by having simply 24-hour critical care nurses at home because our clients are at high risk of medical emergencies or worse without critical care nurses 24 hours. This is actually also evidence-based in the community and is documented in our evidence-based Mechanical Home Ventilation Guidelines on our website at intensivecareathome.com.

Think about it: in an intensive care unit in a hospital, you wouldn’t have support workers or general registered nurses looking after a critical care patient on a ventilator with a tracheostomy. So why would anyone in their right mind do that in a home care environment where there are fewer resources?

Clients that have found us have been at home long-term predictably and permanently with critical care nurses. Their alternative would have been to either die or stay in ICU long-term, and our clients don’t go back to ICU. They stay at home permanently and predictably and the insurance bodies save half of the cost of an ICU. But it’s a win-win situation all around.

We can do the same for you if you’re stuck in ICU or if you’re not safe at home, which includes the advocacy for funding and the network that goes along with it. We have always successfully advocated for our clients or we have the network to successfully advocate for you and for your family member, otherwise we wouldn’t be in business. The same again is applicable for those stuck in an ICU which is similar to many of our, if not most of our cases.

 

Our Support Coordination Services

 

This is also why we are providing Level 2 and Level 3 NDIS support coordination. We have a team of experienced NDIS support coordinators, and they have a wealth of knowledge. We’re also providing TAC case management and WorkSafe case management in Victoria with Lucy McCotter.

If you’re an NDIS support coordinator or a case manager or a social worker from another organization or a hospital watching this and 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 how to advocate for it, what evidence to provide, I encourage you to reach out to us as well. We have the network to make that happen. We will help you with the right level of funding and with the right level of advocacy.

We’re also providing NDIS specialist nursing assessments done by critical care nurses with a legal nurse consulting background.

Join Our Team

 

If you are a critical care nurse and you’re looking for a career change and you want to join a very progressive, dynamic, successful, and high-performing team of critical care nurses in the community, we are employing hundreds of years of critical care nursing experience combined.

 

If you’re looking for a career change, we’re currently hiring for jobs for critical care nurses in Melbourne, Sydney, Brisbane, Albury-Wodonga, Bendigo, Geelong, Warragul, and also in Wyelangta in Victoria.

 

If you have worked in critical care nursing for a minimum of two years, adult ICU, pediatric ICU, ED and you have already completed a postgraduate critical care nursing qualification, we will be absolutely delighted hearing from you.

 

I have a disclaimer though: Because we are offering tailor-made solutions for our clients which includes regular staff, our clients do also want the same staff coming over and over again because they are so vulnerable and so special. That’s why we need regular, reliable staff.

 

If you’re looking for agency work where you can come and go, this will not be 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 and you’re really keen on building relationships with us and with our clients. Reliability is also a must.

 

For Medical Professionals and Healthcare Executives

If you’re an intensive care specialist or an ED specialist, we also want to hear from you. We’re currently expanding our medical team as well.

We can also help you eliminate your bed blocks in your ICU and in your 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 to take the pressure off your ICU and ED beds. In most cases, you won’t even pay for it. Even if you do pay for it, it is so much more cost-effective than what you’re paying for in ICU and ED settings, and you get the same level of care and simply more patient and family satisfaction because you also want to partner with your consumers.

If you are a hospital executive watching this, we can help you free up your ICU and ED beds.

 

International Support

 

If you’re in the U.S. or in the UK and you’re watching this and you need help, we want to hear from you as well. We can help you there privately with one-on-one consulting and with hiring nurses 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].

 

If you like my videos, click the like button, 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, and share this video with anyone who has a family member in intensive care long-term or needs to see this.

 

Thank you so much for watching.

 

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

 

Take care for now.