No place like home: A case study of a patient discharged from an Intensive Care Unit for end of life care at home

Smith, David C.; Hall, Donna; Parke, Geraldine; Lane, Rebecca; Gray, Alison

doi:10.1177/1751143717751324

Cited by 1 publication

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“…Cases reporting on the discharge of critically, but also terminally, ill patients are more limited and are still rare events in the United Kingdom . This is despite the fact that mortality in critical care is relatively high, and it is an accepted opinion that people would prefer to die at home .…”

Section: Introductionmentioning

confidence: 99%

Going home to die from critical care: A case study

White

2019

Nursing in Critical Care

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Much of the activity in critical care is complex but repetitive. In order to standardize care and maintain safety, delivery of care is often directed by protocols and care bundles. This case study will reflect on an instance where care transcended the standard protocol-directed path to be more individualized, creative and compassionate. Acts like these can be unique for the practitioners involved and require an element of positive risk taking, which happened here. It will look at the decision-making, planning and risk involved in preparing for a terminally ill patient, who was inotrope and highflow oxygen dependent, to go home to have treatment withdrawn there instead of in the hospital. This was to fulfil his wish to die at home. In unpicking the circumstances where this positive risk taking led to the desired outcome and the relationship between safety, uncertainty and risk, three themes arose. These were the journey to safe uncertainty; decision-making with uncertain outcomes; and the importance of robust human factors, particularly effective communication and inter-professional teamwork. If positive risk taking can result in enhanced outcomes for the patient, then the question of how this behaviour can be fostered and encouraged must be addressed. K E Y W O R D S critical care, decision-making, end-of-life care, human factors, safe uncertainty Mr SmithMr Smith was a 70-year-old man with metastatic cancer, whose care goals were palliative. He presented to accident and emergency with an acute onset of hypoxia and hypotension with a diagnosis of probable sepsis. The plan was to admit him to critical care for limited treatment of high-flow oxygen, antibiotics, fluids and inotropic support and then re-evaluate his condition in 24 hours. The following day, Mr Smith was on increasing inotropic support and very high levels of oxygen. Mr Smith was told the treatment had not resolved the sepsis, and his condition had deteriorated further. He told me he wanted to go home.

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Section: Introductionmentioning

confidence: 99%

Going home to die from critical care: A case study

White

2019

Nursing in Critical Care

View full text Add to dashboard Cite

show abstract

No place like home: A case study of a patient discharged from an Intensive Care Unit for end of life care at home

Cited by 1 publication

References 1 publication

Going home to die from critical care: A case study

Going home to die from critical care: A case study

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