Hi, it’s Patrik Hutzel from intensivecarehotline.com with another quick tip for families in intensive care.
So at the moment, we’re working with a client who has been in intensive care for about six weeks after cardiac arrest and hypoxic brain injury . Our client’s family member is not waking up, has been slowly weaned off the ventilator now, but their Glasgow coma scale (GCS) is pretty low, probably around a 6 at the most, which means they’re very unconscious and they’re not doing any purposeful movements. But nevertheless, the family wants to push on and fulfill their loved one’s wishes, which is to carry on for now, which is something they have discussed with their loved one prior to him becoming very ill.
So now he has been weaned off the ventilator, but he’s still having a tracheostomy and he needs to go to the ward. He is ready for discharge to ICU, and there are delays to get into a hospital ward. And I’m not surprised that after I have worked in intensive care, I’m well aware of that, sending someone to the ward with a tracheostomy, even without a ventilator is very difficult and very challenging because there are not many nursing staff on the ward that are qualified to look after tracheostomies. It takes years of intensive care nursing experience to be proficient looking after a tracheostomy, changing dressings, changing, inner cannulas, knowing when to start a nebulizer, most importantly, knowing what to do in an emergency.
And you know, most patients in ICU, if not all patients have a one-on-one or one to two nurse to patient ratio whereas on the ward, it’s often a one to five, sometimes a one to ten. And if there’s a tracheostomy patient in the mix, it can be quite dangerous. And again, we have seen patients dying on the ward because they didn’t have the right skill mix when looking after patients with a tracheostomy, because again, it is a very specialized skill.
So the family or our client in this situation, we’ve advised them to ask the intensive care team, but also the ward team, what are the qualifications of the staff looking after their father then on the ward? Is it safe? Can they come back into ICU? Do they have an ICU outreach or ICU liaison team looking after the patient on the ward? So those are all the questions you need to ask. And other questions you need to ask if you are at that stage is, can their father come back into intensive care in case he deteriorates? Who keeps an eye on the tracheostomy and not only from a nursing level, but also from a medical level? So you really got to cross the t’s and dot the i’s when someone is going from intensive care to a hospital ward with a tracheostomy.
So that is my quick tip for today.
If you are in a similar situation or you have a loved one in intensive care, I urge you to check out intensivecarehotline.com and call us on one of the numbers on the top of our website, or simply send me an email to [email protected].
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This is Patrik Hutzel from intensivecarehotline.com and I will talk to you in a few days.