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Hi, it’s Patrik Hutzel from intensivecarehotline.com with another quick tip for families in intensive care.
Today, I have an email from Annette who says,
“Hi Patrik,
I wonder if you can give some advice. My husband has had a brain stem stroke. He has been improving slowly. However, he was placed in a nursing home. He had been there for 17 days. He developed a collapsed lung and chest infection.
He was admitted to the hospital in April and chest had been treated. He had several infections while in hospital. He also has a PEG (Percutaneous Endoscopic Gastrostomy) tube and he’s getting feeds and there seems to be an issue with the PEG feeding. He was not keeping the feeds down. So, they put the PEG further down on the lower bowel which he seems to be tolerating the feed now. He’s now ready to go back to the nursing home.”
Now, when a PEG tube isn’t working and feeds aren’t tolerated, then often a PEJ (Percutaneous Endoscopic Jejunostomy) tube is being used, which means the feeds are going into the small intestines, which is what’s happened here.
“The doctor of the nursing home says he will not accept him back unless the family signs a PEACE (Proactive Elderly Advance Care) document stating he is not to be admitted to hospital should he become unwell. We, as a family, have not agreed to sign this because everyone needs to be treated if they are unwell.
The family have now agreed to palliative care because they say he has long term medical issues and agreed to treat him at the nursing home first should he become unwell before going to hospital. He also has a tracheostomy.
I feel we are being pressured into signing this PEACE document. I don’t believe anyone should be pressured into doing this. Am I right on saying this?
From, Annette.”
Thank you, Annette for sharing your husband’s difficult situation. I’m very sorry to hear that he had a brain stem stroke.
I’m also very surprised to hear that he’s able to go to a nursing home with a PEG, PEJ, and the tracheostomy. Most nursing homes wouldn’t know what to do with the tracheostomy. Therefore, I’m also not surprised that they don’t want to do anything for him. They see him as palliative care, meaning if you keep him palliative care, they will remove the tracheostomy as soon as possible to let him die.
Now, I’m all in agreeance to not sign anything unless you want to sign something because you think it will be beneficial for you and for your husband. If you don’t think it’s beneficial, well, then don’t sign for it.
It’s also difficult to manage a PEG and a PEJ tube unless you have the skills and know how to manage PEG and PEJ, let alone a tracheostomy because tracheostomy is an artificial and unstable airway and needs to be managed by critical care nurses, 24 hours a day. It doesn’t look to me like they have the skills there, which once again is why I believe they’re pressuring you for palliative care.
Now, the next question is where to from here? You absolutely should get an advanced care plan here for your husband. You should be documenting that he needs to go to hospital when they think he’s deteriorating rather than him having treatment at the nursing home.
Now, I’m all for keeping him at the nursing home if the right care can be provided there, but if it can’t be provided, then he absolutely needs to go to hospital.
Another idea here is for you to look at Intensive Care at Home. You can find more information at intensivecareathome.com. Because with Intensive Care at Home, your husband can go home with critical care nurses, 24 hours a day, that can also manage the tracheostomy, the PEG and the PEJ, which again is not a common skill to have for people or for nurses in general. That’s why we employ critical care nurses with a minimum of two years critical care nursing experience exclusively.
Now, get an advanced care plan. Get it all documented what you want. Don’t sign anything unless you think it’s beneficial for you, your husband, and your family, and make sure he goes back to hospital if need be. Go and check out intensivecareathome.com for more information.
I have worked in critical care nursing for nearly 25 years in three different countries where I worked as a nurse manager for over five years and where I’ve been consulting and advocating for families in intensive care since 2013 here at intensivecarehotline.com.
I can confidently say that we have saved many lives with our consulting advocacy. You can verify that by going to intensivecarehotline.com. You click on the testimonial section or you go to intensivecarehotline.com and you click on our podcast section and you can verify the testimonials and in the podcast where we’ve done client interviews that we have saved many lives with our consulting and advocacy.
That’s one of the many reasons why we created the membership for families of critically ill patients in intensive care. You can become a member if you go to intensivecarehotline.com, you click on the membership link or if you go to intensivecaresupport.org directly. In the membership. you have access to me and my team, 24 hours a day in the membership area and via email and we answer all questions intensive care related.
In the membership, you also have exclusive access to 21 e-books and 21 videos that I have personally written and recorded sharing all my over two decades worth of intensive care nursing experience with you so that you can make informed decisions, have peace of mind, control, power, and influence, making sure your loved one gets best care and treatment and so that you can influence decision making fast.
I also do one-on-one consulting and advocacy over the phone, Zoom, WhatsApp, Skype, whichever medium works best for you. I talk to you and your families directly. I also talk to doctors and nurses directly and I ask all the questions that you haven’t even considered asking but must be asked when you have a loved one critically ill in intensive care. I also represent you in family meetings with intensive care teams. I handhold you through this once in a lifetime situation that you simply can’t afford to get wrong.
We also do medical record reviews in real time so that you can get a second opinion in real time. We also do medical record reviews after intensive care if you have unanswered questions, if you need closure, or if you are suspecting medical negligence.
All of that, you get at intensivecarehotline.com. Call us on one of the numbers on the top of our website or send us an email to [email protected] with your questions.
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Thank you so much for watching.
This is Patrik Hutzel from intensivecarehotline.com and I will talk to you in a few days.
Take care for now.
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