Ventilator-Associated Pneumonia in the Home Care Setting

2007 ◽  
Vol 28 (8) ◽  
pp. 910-915 ◽  
Author(s):  
Carol E. Chenoweth ◽  
Laraine L. Washer ◽  
Kumari Obeyesekera ◽  
Candace Friedman ◽  
Karolyn Brewer ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Home Care ◽  
Care Setting ◽  
Care Service ◽  
First Episode ◽  
Ventilator Associated Pneumonia ◽  
Home Setting ◽  
Incidence And Mortality ◽  
Antacid Therapy ◽  
At Home

Objective.To describe the rate of infection, associated organisms, and potential risk factors for ventilator-associated pneumonia (VAP) in patients receiving mechanical ventilation at home.Design.Retrospective cohort study.Setting.University-affiliated home care service.Patients.Patients receiving mechanical ventilation at home from June 1995 through December 2001.Results.Fifty-seven patients underwent ventilation at home for a total of 50,762 ventilator-days (mean ± SD, 890.6 ± 644.43 days; range, 76-2,458 days). Seventy-nine episodes of VAP occurred in 27 patients (rate, 1.55 episodes per 1,000 ventilator-days). The first episode of VAP occurred after a mean (±SD) of 245 ± 318.07 ventilator-days. VAP was most common during the first 500 days of ventilation. Rates of VAP were higher among patients who required ventilation for longer daily durations, compared with those who required it for shorter daily durations. There was no association of VAP with age, sex, underlying disease, reason for ventilation, antacid therapy, or steroid use. Microorganisms isolated from 33 episodes of VAP with available culture results included Pseudomonas species (17 isolates), Staphylococcus aureus (11), Serratia species (7), and Stenotrophomonas species (5). Eight patients died during the study; no deaths were attributed to pneumonia.Conclusions.Although the organisms associated with VAP in the home setting are similar to those associated with hospital-acquired VAP, the incidence and mortality is much lower in the home care setting. Interventions to reduce the risk of VAP among patients receiving home care should be focused on patients who require ventilation for longer daily durations or who are new to receiving mechanical ventilation at home.

scholarly journals Connected care for endocarditis and heart failure patients: a hospital-at-home programme

2021 ◽  
Author(s):  
J. van Ramshorst ◽  
M. Duffels ◽  
S. P. M de Boer ◽  
A. Bos-Schaap ◽  
O. Drexhage ◽  
...  
Keyword(s):  
Heart Failure ◽  
Home Care ◽  
Nurse Practitioners ◽  
Care Group ◽  
Proof Of Concept ◽  
Home Setting ◽  
Curative Care ◽  
Care At Home ◽  
Hospital At Home ◽  
At Home

Abstract Background Healthcare expenditure in the Netherlands is increasing at such a rate that currently 1 in 7 employees are working in healthcare/curative care. Future increases in healthcare spending will be restricted, given that 10% of the country’s gross domestic product is spent on healthcare and the fact that there is a workforce shortage. Dutch healthcare consists of a curative sector (mostly hospitals) and nursing care at home. The two entities have separate national budgets (€25 bn + €20 bn respectively) Aim In a proof of concept, we explored a new hospital-at-home model combining hospital cure and nursing home care budgets. This study tests the feasibility of (1) providing hospital care at home, (2) combining financial budgets, (3) increasing workforces by combining teams and (4) improving perspectives and increasing patient and staff satisfaction. Results We tested the feasibility of combining the budgets of a teaching hospital and home care group for cardiology. The budgets were sufficient to hire three nurse practitioners who were trained to work together with 12 home care cardiovascular nurses to provide care in a hospital-at-home setting, including intravenous treatment. Subsequently, the hospital-at-home programme for endocarditis and heart failure treatment was developed and a virtual ward was built within the e‑patient record. Conclusion The current model demonstrates a proof of concept for a hospital-at-home programme providing hospital-level curative care at home by merging hospital and home care nursing staff and budgets. From the clinical perspective, ambulatory intravenous antibiotic and diuretic treatment at home was effective in safely achieving a reduced length of stay of 847 days in endocarditis patients and 201 days in heart-failure-at-home patients. We call for further studies to facilitate combined home care and hospital cure budgets in cardiology to confirm this concept.

Considerations in the Treatment of Acquired Immunodeficiency Syndrome Patients at Home

1990 ◽  
Vol 3 (1) ◽  
pp. 60-65
Author(s):  
Sandra A. Matsumoto ◽  
Mary Frances Seideman
Keyword(s):  
Home Care ◽  
Acquired Immunodeficiency Syndrome ◽  
Health Care Professionals ◽  
Opportunistic Infections ◽  
Treatment Options ◽  
Home Setting ◽  
Extended Care ◽  
Acquired Immunodeficiency ◽  
Immunodeficiency Syndrome ◽  
At Home

The rapidly growing acquired immunodeficiency syndrome (AIDS) population faces frequent, expensive hospitalization due to the debilitating sequelae of the disease. Home care offers these patients an opportunity to receive or complete their therapy in comfortable surroundings, allowing them to realize the psychosocial and financial benefits of outpatient care. A myriad of sophisticated drug therapies has been successfully administered in the home setting. Therapy for frequently occurring opportunistic infections often requires treatment with highly toxic drugs such as amphotericin, pentamidine, and ganciclovir. With thorough patient training and diligent monitoring by the home-care pharmacist and nurse, these agents can be safely administered at home. Conventional and investigational chemotherapy and immunomodulator therapy, such as interferon or erythropoeitin, can also be administered at home. Providing total parenteral nutrition to AIDS patients is a controversial treatment modality, but if indicated, it can also be accomplished at home. Outpatient pain management has allowed many patients with terminal or chronic illnesses to minimize time spent in hospitals or extended care facilities, and it can offer the same advantages to patients with AIDS. The psychosocial ramifications of AIDS and its impact on patients and health care professionals must be understood in order to effectively provide total patient care at home. The challenge to the homecare pharmacist is to acquire and maintain a comprehensive knowledge of the treatment options currently available for the management of AIDS.

scholarly journals Invasive Home Mechanical Ventilation: 10-Year Experience of a Pediatric Home Care Service

2020 ◽  
pp. respcare.07406
Author(s):  
Eliza Fernanda Borges ◽  
Laerte Honorat Borges-Júnior ◽  
Antônio José Lana Carvalho ◽  
Hyster Martins Ferreira ◽  
Wallisen Tadashi Hattori ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Home Care ◽  
Care Service ◽  
Home Care Service ◽  
Home Mechanical Ventilation

How much psychological distress is experienced at home by patients with palliative care needs in Germany? A cross-sectional study using the Distress Thermometer

2016 ◽  
Vol 15 (2) ◽  
pp. 205-213 ◽  
Author(s):  
Stefanie Küttner ◽  
Johannes Wüller ◽  
Tania Pastrana
Keyword(s):  
Palliative Care ◽  
Home Care ◽  
Karnofsky Performance Status ◽  
Care Service ◽  
Performance Status ◽  
Significant Proportion ◽  
Palliative Care Service ◽  
Distress Thermometer ◽  
Related Factors ◽  
At Home

AbstractObjective:The aims of the present study were (1) to describe the prevalence of psychosocial distress in palliative care patients living at home and the related factors, and (2) to test implementation of the Distress Thermometer (DT) within a home-based palliative care service.Method:Ours was a 15-month prospective study beginning in September of 2013 in western Germany with consecutive patients cared for by a home care palliative care service. The research was implemented during the first visit by the home care team. Patients were excluded if they were under 18 years of age, mentally or physically unable to complete the assessment questionnaires as judged by their healthcare worker, or unable to understand the German language. During the first encounter, the Distress Thermometer (DT), a Problem List (PL), and a structured questionnaire for evaluation were applied and sociodemographic and medical data collected.Results:A total of 103 patients (response rate = 70%; mean age = 67; female = 54%; married = 67%; oncological condition = 91%; Karnofsky Performance Status [KPS] score 0–40 = 34%, 50–70 = 60%, >80 = 6%) were included. The incidence of distress (DT score ≥4) was 89.3% (mean = 6.3 ± 2.5). No statistical association was found between level of distress and sociodemographic or medical factors. The five most reported problems were “fatigue” (90%), “getting around” (84%), “eating” (63%), “bathing/dressing” (60%), and “sleep” (57%). The number of problems reported correlated with level of distress (ρ = 0.34). The DT was comprehensible, and 80% considered its completion as unremarkable, while 14% found it “relieving.”Significance of results:A significant proportion of patients treated at home reported symptoms of distress. The most oft-mentioned problems were physical and emotional in nature. The findings of our study highlight the importance of creating new concepts and structures in order to address the psychosocial needs of patients in home care with palliative needs.

Considerations in the Treatment of Patients With Acquired Immunodeficiency Syndrome at Home

1992 ◽  
Vol 5 (3) ◽  
pp. 158-163
Author(s):  
Sandra A. Matsumoto ◽  
Mary Frances Seideman
Keyword(s):  
Home Care ◽  
Acquired Immunodeficiency Syndrome ◽  
Health Care Professionals ◽  
Opportunistic Infections ◽  
Treatment Options ◽  
Home Setting ◽  
Extended Care ◽  
Acquired Immunodeficiency ◽  
Immunodeficiency Syndrome ◽  
At Home

The rapidly growing acquired immunodeficiency syndrome (AIDS) population faces frequent, expensive hospitalization due to the debilitating sequelae of the disease. Home care offers these patients an opportunity to receive or complete their therapy in comfortable surroundings, allowing them to realize the psychosocial and financial benefits of outpatient care. A myriad of sophisticated drug therapies has been successfully administered in the home setting. Therapy for frequently occurring opportunistic infections often requires treatment with highly toxic drugs such as amphotericin, pentamidine, and ganciclovir. With thorough patient training and diligent monitoring by the home-care pharmacist and nurse, these agents can be safely administered at home. Conventional and investigational chemotherapy and immunomodulator therapy, such as interferon or erythropoietin, can also be administered at home. Providing total parenteral nutrition to AIDS patients is a controversial treatment modality, but if indicated, it can also be accomplished at home. Outpatient pain management has allowed many patients with terminal or chronic illnesses to minimize time spent in hospitals or extended care facilities, and it can offer the same advantages to patients with AIDS. The psychosocial ramifications of AIDS and its impact on patients and health care professionals must be understood in order to effectively provide total patient care at home. The challenge to the home-care pharmacist is to acquire and maintain a comprehensive knowledge of the treatment options currently available for the management of AIDS.

Palliative sedation for cancer patients included in a home care program: A retrospective study

2014 ◽  
Vol 13 (3) ◽  
pp. 619-624 ◽  
Author(s):  
Claudio Calvo-Espinos ◽  
Estefania Ruiz de Gaona ◽  
Cristina Gonzalez ◽  
Lucia Ruiz de Galarreta ◽  
Cristina Lopez
Keyword(s):  
Home Care ◽  
Lung Tumor ◽  
Family Members ◽  
Care Program ◽  
Tumor Location ◽  
Palliative Sedation ◽  
Cross Sectional ◽  
Home Setting ◽  
Diagnosis And Prognosis ◽  
At Home

AbstractObjective:Palliative sedation is a common treatment in palliative care. The home is a difficult environment for research, and there are few studies about sedation at home. Our aim was to analyze this practice in a home setting.Method:We conducted a retrospective cross-sectional descriptive study in a home cohort during 2011. The inclusion criteria were as follows: 18 years or older and enrolled in the Palliative Home Care Program (PHCP) with advanced cancer. The variables employed were: sex, age, primary tumor location, and place of death. We also registered indication, type, drug and dose, awareness of diagnosis and prognosis, consent, survival, presence or absence of rales, painful mouth, and ulcers in patients sedated at home. We also collected the opinions of family members and professionals about the suffering of sedated patients.Results:A total of 446 patients (56% at home) of the 617 admitted to the PHCP between January and December of 2011 passed away. The typical patient in our population was a 70-year-old man with a lung tumor. Some 35 (14%) home patients required sedation, compared to 93 (49%) at the hospital. The most frequent indication was delirium (70%), with midazolam the most common drug (mean dose, 40 mg). Survival was around three days. Rales were frequent (57%) as well as awareness of diagnosis and prognosis (77 and 71%, respectively). Perception of suffering after sedation was rare among relatives (17%) and professionals (8%). In most cases, the decision was made jointly by professionals and family members.Significance of Results:Our study confirmed the role of palliative sedation as an appropriate therapeutic tool in the home environment.

When Technology Enters at Home: The Challenges of Home Health Care Providers in a Developing Country

2021 ◽  
Author(s):  
Maryam Esmaeili ◽  
Nahid Dehghan nayeri ◽  
Fatemeh Bahramnezhad ◽  
Samrand Fattah Ghazi ◽  
Parvaneh Asgari
Keyword(s):  
Health Care ◽  
Mechanical Ventilation ◽  
Home Care ◽  
Health Care Providers ◽  
Home Health Care ◽  
Invasive Mechanical Ventilation ◽  
Home Health ◽  
Care Providers ◽  
Care Agency ◽  
At Home

Abstract Background: The number of patients with chronic diseases requiring invasive mechanical ventilation at home is increasing. Family caregiving for patients with home mechanical ventilation (HMV) is associated with a particularly heavy workload. Thus, identifying the challenges of this valuable type of care can be an elective step for achieving health-related goals. This study was carried out to determine the challenges faced by home health care providers.Methods: 15 participants (9 family caregivers, 3 home nurses, and 3 home care attendants) were selected. Data were collected through semi-structured interviews and structured observation. All the interviews were recorded, transcribed, and then analyzed using qualitative content analysis and Max Qualitative Data Analysis 2010.Results: Three themes emerged from the data analysis: (1) Hospital-based challenges with two subthemes the family unpreparedness for home care and the lack of continuous education, (2) Home health care agency challenges with two sub themes. Home health care workers and the deficiency in organizational policies, and (3) Economic challenges.Conclusions: Three themes of hospital-related challenges, home health care agency challenges, and economic challenges emerged in the study showed that support from the insurance system, improvement of home care agency policies, and holistic care for patients through a multidisciplinary team approach are essential for addressing the current challenges of home care for patients under invasive mechanical ventilation at home.

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