Father with pneumonia refusing hospital admission, how to get IV antimbiotics at home?

[falstaff1980]

My 83 year old father can't stand hospitals, and we spent most of the day in A&E a few days ago and my dad was told after all the tests that he had serious pneumonia and needed hospital admission and IV antibiotics. He flatly refused and signed a form that he was rejecting this advice. They at least gave him some oral antibiotics, and he's not got any worse since. I did ask if he could get IV antibiotics at home from a district nurse, and they said there were complicated criteria that my father did not fulfil to get that. Is that it then? Is it no possible to get them even privately?

In a word no. However hopefully the oral antibiotics are doing something ,is he still managing to eat and drink ?

Otherwise there are others that can be tried and there is a once daily injection usually given in the buttock / thigh which should also do the trick. Big needle though and will hurt.

You wouldn't usually get IV antibiotics at home no. Where would the IV pump come from? Who would set it up & check it? You wouldn't even normally have a cannula in at home.

Where I worked a few years ago we used to have people come to a treatment area on the Medical Assessment unit to have IVs , so it may be worth asking if they do something like that . It would of course mean someone has to take him up there .

He could go in on a day ward, if his hospital runs a scheme like that. You turn up at 9am, spend the day getting your drugs and sitting in a chair and you go home at 5ish. I found it awful as I just wanted to lie down but it might be more palatable to him than overnight stays.

Depending on where you live there are community IV services

I'd probably try and get him into Same Day Emergency Care though at the hospital- treated during the day and home at night

In my area there is an Acute Clinical Team who prevent people going into hospital if they can be managed at home. It's short term care and they do set up iv antibiotics for patients in their homes and they do lots of other things.

thanks for all the kind messages everyone, I will see if they do daily out-patient IVs and try to persuade him, the trouble is he's had bad experiences at hospitals and wants nothing to do with them. I do sometimes have dark thoughts that he actually wants this pneumonia to take him, he's got other health problems and these last few years he's not been able to do the things in life he always enjoyed.

I hope you can get something sorted out for him.

We do IV antibiotics in the community. A nurse would go to the house and administer it. Very common practice where I work.

That was actually what I was thinking. Unless he's not of sound mind it's out of your hands. I will likely be the same at his age, it's only because I'm 50 I'm still having treatments (numerous illnesses) but if I was in my 80's......

Very common practice to have IV antibiotics at home where I am. Its not through DNs but a specialist IV therapy team. Ask GP or out of hours GP.

I was a District Nurse for many years, administering I.V. antibiotics was a routine part of our job. No problems at all, seems to depend on where you live.

When DD2 was 6 weeks old she needed IV antibiotics every 12 hours for a couple of days. Rather than admit us, they put the cannula in, wrapped it up well, and had us come in to the day surgery unit to have them administered. Maybe they could do something like that, if that's practical? We only live 5 mins from the hospital so for us it was simple.

Me too but it no longer happens around here now ☹️, so many DN-led roles have stopped.

I’m sorry for your fathers poor health op, it’s a very stressful time.
I think I’d listen to what he’s saying/not saying and make the priority now that he be as comfortable as possible and respecting his wishes to be at home. Spend as much time as you feel able to be near to him.

We used to have this service but it is no longer funded in our area. Patients can only be on max twice daily IVs and have to be able to come in to the hospital day unit with their own transport. Anything more frequent and they have to be admitted.

maybe it’s time for you and your dad to have a really hard but frank conversation about what he wants. If he does actually want treatment, it’s just where it’s delivered that is the problem then absolutely exhaust all options in trying to get him treated at home. If not as incredibly hard as it is try and find a way to support him in his decision.

The hospitals I have worked in have had ‘hospital at home’ teams, specifically to give elderly people treatments, including IV antibiotics, with the aim of keeping them out of hospital. It is run by doctors, nurses and nurse practitioners and operates a 7 day service. The criteria to be accepted aren’t usually particularly strict. If your dad has capacity then he would have to be accepting of people coming into his home to give the treatments. They also discuss things like whether the patient would like to go into hospital should they get too ill to be treated at home and, again, the choice is with the patient if they have capacity. The oral antibiotics might treat his pneumonia sufficiently but if not, you could enquire with GP (OOH if still the weekend) as to whether this service exists with your local hospital. A&E should also be able to refer if this service exists- if you attend again and they cite ‘complicated criteria’ I would ask them what they mean by that, and maybe ask them to speak to the medical/ medicine of the elderly team to confirm that your dad is not suitable for this service.

thanks all for the ongoing advice, I've at least managed to persuade him (I hope), to attend a clinic tomorrow where they will check his bloods again, and I expect they will tell him he needs to be admitted - hoping the doctor this time is more persuasive than the A&E one who I sensed was in a hurry.

Curiously, when my dad expressed his initial reluctance to be admitted and asked if they couldn't just send him home with a box of amoxcil, the doctor very bluntly said no "if you refuse medical advice, we don't give you anything", but then as the conversation continued and it became clear my dad was not budging, they said "in your special case we will give you some oral antibiotics". Was that first blunt statement just a "shock" tactic to try and make him accept being admitted? Or is it NHS policy to only give the recommended treatments and not give lesser ones? I would have hoped the NHS were prepared to offer less effective treatments if that's the patients preference, especially if it leaves a bed free for other patients who do need and want to be admitted?

The refusal to give any treatment if patients self discharge is quite old fashioned. Patients are allowed to refuse consent to parts of their treatment without refusing to be treated at all. So no, a doctor can’t just say if you don’t accept my recommended treatment I’m not giving you anything at all.

It’s a balance of risk - recommended treatment vs compromise treatment vs no treatment at all. Unless there is significant risk of treatment at home then that will obviously be better than no treatment at all.

I imagine the doc was trying to get him to stay in and then realised he wasn’t budging. Im not a huge fan of this approach because it kind of infantilises patients rather than treating them like rationale adults. It’s be better to work out why he doesn’t want to stay and see if there are compromises to that aspect (not admitting to a named ward where they’ve had difficulties in the past, allowing them leave to go for walks/canteen for a break during the day etc).

Thankfully the oral antibiotics are working (confirmed by blood test), and my dad is on the mend.

I am glad your Dad is on the mend.