There once was a patient on a ventilator whose family wanted to bring home. He was put on Hospice. A hospice nurse waited at the home for the transfer in order to ensure meds were available for the short duration of life on arrival. Paramedics did the transfer with the order to terminally extubate on arrival to the home. With every terminal extubation that I had been ordered to do, it is important for the nurse and all caregivers on site to do a huddle in order for this to be seemless. For example I would not want to extubate until the nurse did a RASS score and appropriately medicate. We frequently talked with the ordering physician to understand the circumstances and discussed any objections firsthand.
You tell us that you are a nurse practioner working in palliative care. So I am thinking you are on the front lines in some of this end of life care, perhaps with better access to info than we have. We sure could use more explanation, because this ultimately can be said of any car trip.
Are you speaking of bringing home a person to end his or her days in hospice at home? Can you recall car trips when you were young, falling asleep in back with your parents murmuring softly, feeling safe, transported, cared for? Would that be a terrible time or way to go?
Given the little you tell us to go on I would discuss with social workers at the facility you are transferring your loved one FROM as to your fears/specific concerns and whether you should order ambulance transport.
I hope this goes well for you. I wish you the very best.
Yes, we need to know why because this sounds like there isn’t enough insurance in the world to cover this privately not to mention potential legal issues such as kidnapping charges etc.
You’ll have to excuse us for going dark and illegal so quickly, but we have read some things over the years…..
I think you’re asking this, because you want to remove LO from hospital AMA (against medical advice). If the doctor agreed, then you would have access to an ambulance bringing LO back home. So I’m guessing the doctor didn’t agree with removal, and you want to remove AMA.
1. Make sure the decision you’re making is in the best interests of the LO. Make sure LO would want to be brought home, even if they might die. If LO can’t voice their opinion, make sure you’re doing this, thinking LO would want this.
2. How to do it? Only you know LO’s medical needs. You must transport as carefully as possible.
3. Make sure it’s legally allowed. Under some circumstances, removal AMA, can be considered attempted murder.
This is a nurse practioner in palliative care, so I am hoping your guess is wrong, Venting. If one isn't POA this could be something amounting to loss of licensure. I surely do HOPE you are wrong.
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With every terminal extubation that I had been ordered to do, it is important for the nurse and all caregivers on site to do a huddle in order for this to be seemless. For example I would not want to extubate until the nurse did a RASS score and appropriately medicate. We frequently talked with the ordering physician to understand the circumstances and discussed any objections firsthand.
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Are you speaking of bringing home a person to end his or her days in hospice at home? Can you recall car trips when you were young, falling asleep in back with your parents murmuring softly, feeling safe, transported, cared for?
Would that be a terrible time or way to go?
Given the little you tell us to go on I would discuss with social workers at the facility you are transferring your loved one FROM as to your fears/specific concerns and whether you should order ambulance transport.
I hope this goes well for you. I wish you the very best.
You’ll have to excuse us for going dark and illegal so quickly, but we have read some things over the years…..
Please give context.
1. Make sure the decision you’re making is in the best interests of the LO. Make sure LO would want to be brought home, even if they might die. If LO can’t voice their opinion, make sure you’re doing this, thinking LO would want this.
2. How to do it? Only you know LO’s medical needs. You must transport as carefully as possible.
3. Make sure it’s legally allowed. Under some circumstances, removal AMA, can be considered attempted murder.