A Team Approach to Compassionate Extubation in the Home

Topic: Innovative Clinical Interventions

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A Team Approach to Compassionate Extubation in the HomeThe integration of palliative care into the home that would otherwise typically be performed in the hospital empowers patients and families by allowing for more choices when facing difficult end of life decisions. Compassionate extubation, also known as palliative extubation, is the withdrawal of mechanical ventilation. This is performed to alleviate suffering while avoiding the prolongation of death. Compassionate extubation in a non-ICU setting requires seamless collaboration amongst the interdisciplinary team. The logistics of such a process generally requires an inpatient setting. In the case of a 27 year old patient with cerebral palsy, multiple medical complications resulted in ventilator dependence and a subsequent decline in quality of life, ultimately prompting hospice enrollment. Discussion surrounding end-of-life issues, particularly involving the withdrawal of mechanical ventilation, can be especially difficult if the patient's family are in unfamiliar surroundings. In an effort to meet his mother’s goal for compassionate extubation at home, the Mayo Clinic Hospice team formulated a new procedural guideline to facilitate the process. Through collaboration with physicians, nurse practitioners, nurses, pharmacists, respiratory therapists, social workers and home infusion specialists, the patient was removed from mechanical ventilation and died peacefully at home surrounded by his family. This outcome resulted in an high level of satisfaction for the patient’s family and helped bring them peace as they began their journey through grieving the loss of their loved one. Team debriefing after the case contributed to further refinement of the process and the hospice team can now confidently offer compassionate extubation at home as an option for patients and families in the future.

Author

  • Emily Black, NP
  • APRN, CNP
  • Mayo Clinic
  • 200 First St SW
  • Rochester, MN 55960
  • (507) 284-4002

Co-authors

  • Maureen Bigelow, RN

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