It was the middle of the night and I was visiting a hospice patient who was in severe terminal agitation. Shouting and climbing out of bed, he was frightened and suffering. With orders to give a calming sedative, I administered the tablets rectally, as prescribed, since he was unable to swallow as most patients are in the last hours to days.
His son and I then began “that difficult wait” for the sedative to take effect. I sat and talked with his son, giving him emotional support, but an hour later the patient’s symptoms were even worse. This was challenging, since both the patient and family wished he could die peacefully and at home. After calling the doctor for a second dose, and preparing to administer the tablet, I realized the first dose was still un-dissolved in the patient’s rectum.
How could I help to ease this dying man’s severe symptoms and create a state of comfort within the home setting? Motivated to improvise, I crushed the tablets of the second dose, added water and administered the suspension into his rectum with a urinary catheter. The patient calmed down quickly and was sound asleep within minutes. This easy solution controlled symptoms with minimal subsequent discomfort or disruption, and the patient died peacefully at home a few days later.
Inspired by this success, I created an optimized catheter specifically designed for easy, discreet and comfortable rectal administration of medicine and liquids. I also co-founded Hospi Corporation, knowing that a commercially available catheter would be able to provide comfort and relief for thousands more patients. Now, the patented Macy Catheter has 510(k) clearance from the U.S. FDA and will soon be available for use.
As every hospice nurse is aware, rapid and effective symptom relief is critically important. The Macy Catheter is designed to leverage the speed and established benefits of rectal administration, while maintaining patient comfort and dignity. Not only does it facilitate immediate relief, but it also avoids the repeated discomforts of suppository use, and is convenient for both the clinician and the caregiver.
Another highly relevant contribution of the Macy Catheter is its ability to improve quality of care, while reducing cost. Rectal administration limits the need for more costly and complex administration routes, such as intravenous delivery. And providing relief to patients and their families, especially once they are home, can decrease hospitalizations and need for higher levels of care.
Over the years, I’ve seen thousands of difficult symptom management cases. The most challenging often involved the patient being unable to swallow due to decline in physical and cognitive status with impending death. The Macy Catheter can help reduce case management time by decreasing the acuity of care, especially for complex management cases.
I look forward to working with the hospice community to incorporate the Macy Catheter into standard practice. Finally, I encourage all nurses to consider how they can translate their significant bedside knowledge and experience into innovations that will help patients and improve our healthcare system.
Brad Macy, inventor of the Macy Catheter and a veteran hospice nurse, received the 2013 National Hospice and Palliative Care Nurse of the Year Award. To learn more, visit http://hospicorp.com.
