Home Visits

Policy

Category: Control of Infectious Diseases
Subject: Home Visits
Division: N/A
Policy Number: CA.82.01.132
Effective Date: June 30, 2014

POLICY STATEMENT

It is the policy of Wellington-Dufferin-Guelph Public Health (WDGPH) to ensure that all employees are safe, and feel safe, during the delivery of Public Health services which require visits to clients in their homes. Home visits may be scheduled during normal business hours and/or evenings, weekends, and statutory holidays.

SCOPE

This policy applies to all Control of Infectious Diseases (CID) Public Health Inspectors (PHIs) and Public Health Nurses (PHNs) who deliver services to clients outside of the office and clinic settings.

RESPONSIBILITIES

Management will:
  • Ensure employees are provided with the training, information and equipment to work safely off site and specifically at a home visit;
  • Ensure that the policy and procedures of the program and organization are read, understood, and followed by all employees;
  • Implement systems for ongoing review of safety procedures and staff compliance with policies and procedures; and
  • Consult with staff to identify and manage new or emerging hazards associated with home visits. This may be done at team meetings or as part of staff appraisals.
Employees will:
  • Participate in training as provided;
  • Follow the procedures for visiting clients outside of the health unit to reduce risk;
  • Contact the on-call manager on weekends/statutory holidays to advise them of the home visit and the expected times that the visit will start and be concluded;
  • Check in with the on-call manager once they have safely completed and left the home visit;
  • Leave a home visit anytime they feel unsafe, threatened, or harassed;
  • Report hazards, threats (tangible or perceived), and incidents immediately to their Manager/ Supervisor or the manager on call; and
  • Complete a CA.30.01.102 Accident/Near Miss Form.

DEFINITIONS

Risk - A description of the likelihood and consequence of a hazard causing physical or emotional injury or illness.

Risk Assessment - The process of determining the likelihood and consequence of injury, disease, illness or damage arising from an exposure to the “hazard” or risk.

Risk Control - Measures that eliminate or reduce the risks associated with hazards using a hierarchy of controls approach (e.g. visit at neutral community site – Tim Horton’s)

Home Visit - Describes any work undertaken for the delivery of Public Health services which is undertaken at a client’s home or residence.

REFERENCES AND RELATED FORMS, POLICIES AND PROCEDURES

Corresponding Procedure: CA.82.02.132 Home Visits
CA.52.01.100 Harassment and Discrimination
CA.56.01.119 Violence Prevention
CA.56.01.122 Safety Around Animals, Particularly Dogs
CA.91.02.100 Safety on Home Visits

APPROVED BY

Rob Thompson  

 


Procedure

Category: Control of Infectious Diseases
Subject: Home Visits
Division: N/A
Procedure Number: CA.82.02.132
Effective Date: June 30, 2014

PROCEDURE

A Control of Infectious Diseases (CID) Public Health Nurse (PHN) or Public Health Inspector (PHI) may be required to meet with a client outside of an office or clinic set to ensure service delivery. Directly observed therapy (DOT) for tuberculosis management, provision of a High Efficiency Particulate Absorption (HEPA) filter for the home, meeting with a house-bound client, or other situations may arise that require employees to attend a client’s home.

On the initial client referral and/or contact, the employee must perform a risk assessment for potentially dangerous situations. These situations may include, but are not limited to, the following:

  • Client has a history of aggressive behaviour, violence, or crime;
  • Client has a history of or suspicion of aggressive behaviour or violence in the home;
  • Client  lives in a potentially dangerous neighbourhood, building,  or isolated area;
  • Client has a known history of alcohol or drug use or use is evident or implied based on assessments made during the visit (drug paraphernalia, smell of alcohol etc.);
  • Animals may be present and are not contained or controlled by owner making an animal bite possible;
  • The employee has knowledge of a criminal activity with the client or in the client’s home;
  • A weapon is produced or same is threatened by the client or in the client’s home; and
  • Verbal threats of violence are made or implied during the visit or over the phone.

Identified dangerous situations must be documented in the client’s progress notes and electronic chart. A flag/alert must be placed on the case’s file. Employees must also discuss the situation with the CID Manager/Supervisor and receive direction for future client contacts or provision of Public Health services.

Prior to visiting the client, staff must perform the following assessments:
  • An employee can decide to not conduct a home visit for safety reasons. Arrangements can be made, if possible, to meet the client in a neutral setting.
  • If the decision is made to conduct a home visit, the initial visit must be performed with another colleague or employee of Public Health.
  • If the decision has been made to conduct a home visit, and the situation has been identified as high-risk in terms of safety concerns, then it is the responsibility of the employee to do the following:
    • Ask for a second person to do the visit with him/her;
    • Advise the Manager/Supervisor of any new developments in the case where the assessment of safety has changed; and/or
    • Refuse to do the visit.
General rules for decreasing risk during a home visit include:
  • Gather as much information as possible about the client before visiting the home.
  • Advise colleagues/manager/supervisor when visit is scheduled and when you should be returning to the office.
  • Wear Agency identification badge at all times.
  • Carry a cell phone.
  • When arriving at the home, assess the situation and plan an exit strategy.
  • Observe the environment for signs of used syringes, odours, clutter and other persons or animals present, etc.
  • If possible, home visits should be conducted during normal working hours. When visits need to be conducted outside of normal working hours, the employee must inform someone of the scheduled meeting and the employee must make contact with that person upon completion of the visit. If the contact does not hear from the person visiting the home within 15 minutes of the appropriate time, a call will be made to the Manager and/or on-call, or the police.
  • If you must enter the home, sit where you have a good view of the bedrooms or the hall to the bedrooms. Keep yourself between the client and the door to exit at all times. Listen for others entering of leaving the area. Choose a hard-backed chair if possible. On occasion, DOT may be performed at the entrance to the home and fully entering the home may not be necessary.
  • Leave your shoes on in the event that a confrontation arises and you need to leave immediately. If your client asks you to remove your shoes, state you must wear them due to your employer’s health and safety policy.
  • Do not carry a purse. Leave it secured in the car or in the office.
  • Lock your vehicle when traveling and when you return to it after a visit. Check inside and under your vehicle before entering it. Carry vehicle keys in your hand for accessibility as well as a means of protecting yourself.
Managing a threatening or potentially dangerous situation:

If an employee is in a home where a threatening or potentially threatening situation occurs:

  • Stand up.
  • Stay calm, try to keep the client calm.
  • Leave the home immediately. Back up towards the exit. Never take your eyes off the client.
  • Report the threatening situation to the CID Manager/Supervisor immediately.
  • If an employee has concerns regarding the safety of others in the home, there is a duty to report to the police or other agencies, depending on the situation.
  • Following a threatening or potentially threatening situation, the employee must inform the CID Manager/Supervisor and discuss future service delivery.
  • After experiencing a threatening or dangerous situation, the employee is required to complete a CA.30.01.102 Accident Near Miss Form.  

REFERENCES AND RELATED FORMS, POLICIES AND PROCEDURES

Corresponding Policy CA.82.01.132 Home Visits
CA.30.01.102 Accident Near Miss Form
CA.50.02.102 Documentation Practices
CA.52.02.100 Harassment and Discrimination
CA.56.02.119 Violence Prevention
CA.56.02.122 Safety Around Animals, Particularly Dogs
CA.86.02.105 Documentation
CA.91.02.100 Safety on Home Visits

APPROVED BY

Rob Thompson