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Appendix 6: Sample Policies adapted from the Austin Hospital (NSW) Policies

Home Visit Risk Assessment Policy and Procedure

Overview

Outlines measures that will maximise the safety of all employees when conducting home visits and track the return of employees following completion of home visits.

Objectives

To eliminate or reduce as far as practicable the risk to employees who make home visits.

Scope

All staff will observe the Home Visit Risk Assessment Procedure prior to conducting a home visit. These procedures are to be applied within the organisation in so far as is practicable/ Covers all staff who may make home visits.

Reference

Developed by Occupational Health and Safety Unit in consultation with the Aggression Management Committee and Home Visit Working Party.

Policy

The employer has a commitment to provide health care services which are best practice, cost effective and safe for staff. This includes providing services in people's homes or other appropriate locations. The employer has a commitment to the safety of its staff in all work locations including people’s homes, other venues not on the hospital campus and safe travel to and from these venues.

The employer's services shall not be provided in people's homes or at other venues not on the hospital campus, unless a risk assessment has been carried out and which indicates that the service provision does not place any person in a position of unacceptable risk.

It is the responsibility of the employer, line managers and supervisors providing the service to ensure that this policy is observed.

It is the responsibility of employees to follow this policy and supporting procedures.

The Occupational Health and Safety Act (2001) states that the Employer must provide a workplace that is safe and without risks to health for employees. The Act also states that an Employee must take reasonable care of his or her own safety.

Procedure

Rationale

Home visits should only be conducted with consent, consistent with policies of CMDHB Health. When organising any home visit staff are expected to assess any potential risks prior to undertaking the home visit. If risks are identified this must be documented in the medical record and discussed with the manager/supervisor of the department.

The managers/supervisors responsible for providing these services will ensure that administrative procedures are in place which:

• Ensure risk assessments are carried out and acted upon
• Track and record the safe return of employees following completion of the home visit
• Ensure appropriate equipment is provided
• Provide an up to date record of the employee and recent photographs
• Establish police notification in the case where safe return of the employee can not be established.
• Ensure staff who provide home visit services are appropriately trained and conversant with these procedures.

Risk Assessment

The assessment of risk should be holistic and include points that may impact upon staff safety. This may include but not be limited to:

• Verification of location
• Access to premises
• Time of visit. This includes the consideration of circumstances after dark, taking into account the increased isolation and subsequent vulnerability that occurs when conducting visits after dark
• Persons present on the home visit
• Presence of potential dangerous animals and pets
• History of violence, aggressive behaviour or domestic violence
• Presence of fire arms
• History of mental illness, medical conditions or substance abuse
• Family conflict
• Cultural needs

The Risk Assessment is conducted by completing the risk assessment form (appendix 1) or by reviewing a previously completed risk assessment form and reassessing the current risks. Where this data is kept will be in keeping with Privacy Legislation.

Risk Management

The home visit will proceed when all identified risks have been addressed.

If the employee assesses a potential risk following completion of the risk assessment form, staff are required to document this in the medical history and discuss these concerns/risks with their immediate manager/supervisor. If their immediate manager/supervisor is unavailable, contact should be made with another senior staff member.

If any risk is identified, staff should not proceed with the visit. The manager/supervisor are to be advised of the risk assessment and will take appropriate action.

If safety risks/concerns are raised with the manager/supervisor that can not be managed (removed or mitigated) to an acceptable level, then the manager/supervisor will arrange one of the following:

1. a second support worker or security officer to accompany the primary worker
2. cancel the home visit and consider other ways of providing the service.

If the service provision is assessed as an unacceptable safety risk to the employee, this needs to be documented. If the service provision has been discussed with the client, the client should be advised why the service will not be provided. Where a letter has been sent to the client a copy of this letter should also be sent to the Director of the service.

Each department who has staff that conduct home visits should as part of staff orientation collect information that may be used in the event of an emergency. This information will need to be updated annually by managers/supervisors and during the year by employees if changes occur with respect to contact details or they make significant changes to their personal appearance. It includes:

• Employee contact details (including Next Of Kin)
• A clear photograph (both sitting and standing) of employee
• A physical description of the individual (completed by the employee)

Prior to the Home Visit

Managers/supervisors responsible for providing services involving home visits shall establish a record system. Employees involved in providing home visit services are responsible for recording data related to the home visit. This data must include the following:

• Name of visiting staff member(s)
• Name of patient/ client
• UR number
• Address and phone number of destination
• Departure time
• Expected time of return
• Car type and vehicle registration
• Mobile phone number
• Completed Risk Assessment

Only take essential items with you are on a home visit.

This includes (but is not limited to):

• Identification badge
• Licence
• Mobile phone number with pre-programmed 000 emergency phone numbers. Select the emergency number prior to entering an unknown situation, for example, a first visit to an unknown address. If contacting emergency services, always begin by giving the address first and then the complaint/report.
• Confirm that there is mobile phone coverage in the area (ask patient and refer to the risk assessment form). If not is a GSM phone required?
• Torch and batteries
• Personal alarm (“screecher”)

Managers are responsible for ensuring all staff undertaking home visits are orientated by taking them through the safety considerations incorporated in the Home Visit Staff Security Orientation Checklist (appendix 2) prior to undertaking any home visits.

Vehicle Guidelines

Prior to conducting any home visit all staff should refer to the “Guidelines whilst Driving” in the Home Visit Staff Security Orientation Checklist (appendix 2).

Prior to departure it is the responsibility of the staff member to ensure that all equipment is functioning and that:

• where mobile phone use is required for business purposes (staff are expected to answer or make calls whilst driving) the vehicle must be equipped for hands free operation
• the mobile phone is charged and turned on.
• that there is a recent Auckland Road Maps available (either country or metro depending on travel details)
• that there is adequate fuel in the car – minimum quarter tank
• petrol card
• the car contains a mobile phone charger, hands free car kit, fire blanket and any other necessary emergency equipment
• Do not leave equipment in full view in the vehicle.

Whilst Conducting the Home Visit

On arrival staff should park the vehicle in an appropriate and safe location. This should be considered in terms of loading/unloading equipment and /or patients, proximity of house to the street and how busy the street is including available parking.

In the evening park in a well lit area.

Upon arrival staff should assess the premises for potential risks. This may include but not be limited to:

• Listen for any conflict that may be occurring at the premises
• Observe the room that you will be located
• Identify potential exits
• Keep car keys on your person
• Staff are responsible for their personal property on a home visit

If at any time during the home visit there is an assessed risk to the staff member, remove yourself from the premises as quickly as possible. Secondarily ensure the safety of the patient if they are also at risk.

Leave and contact manager/supervisor immediately.

If it is not possible to leave immediately, attempt to diffuse the situation and leave at the first available opportunity. If staff are unable to leave the premises then they should attempt to use their mobile phone or landline to contact police.

Staff are not expected to provide a service if the environment is not safe. Staff are able to refuse service delivery in these circumstances.

Upon Return from the Home Visit

Record your return and/or inform appropriate accountable persons as per department procedure.

If any incidents occurred whilst on the home visit, these must be reported to the manager/ supervisor who will initiate the appropriate action required to assist the staff member following any incident/accident.

This includes:

• Access to first aid or medical assistance
• Access to critical incident/accident debriefing and counselling
• Advice regarding WorkCover
• Advice regarding appropriate reporting and direction on completing the incident forms and documenting the incident
• Review the patient risk assessment.

Failure to Return from Home Visit

In order to provide a safe service a management process needs to be in place to track the safe return of staff from home visits. If the staff member does not expect to return by the nominated time, it is the responsibility of the staff member to contact and leave a message with the manager/supervisor of a revised time.

If the staff member is returning after hours, arrangements should be in place to confirm safe return from the home visit. This can be either by contacting a direct manager/supervisor on return to the hospital or leaving a message with the on site manager that you have returned.

If the staff member has not returned and is ½ an hour later than their expected return time the Manager/supervisor or delegate should:

• Contact the staff member on their mobile phone
• If staff member does not answer the phone - Contact the clients listed for home visits to establish if the staff member arrived and/or left and at what time.
• In the event that the staff member is not contactable, notify the police and provide description and relevant details of the staff member. Also contact the Executive via the switchboard.
• Notify the Security Department
• Contact next of kin
• Complete incident form.

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