HUNTINGDONSHIRE PRIMARY CARE TRUST REHABILITATION SERVICES by zaaaaa4

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									      HUNTINGDONSHIRE PRIMARY CARE TRUST

              REHABILITATION SERVICES

       OCCUPATIONAL THERAPY DEPARTMENT




Policy and Procedural document for Occupational Therapists
      carrying out Home Visits with Hospital In-patients
                      CONTENTS                                 PAGE

1         Conditions to be met before a home visit is carried out   3

2         Transport                                                 4

3         Security                                                  5

4         Personal Liability                                        6

5         Emergencies                                               6

6         Conduct                                                   6

7         Product Liability                                         7

8         Pest Infestation                                          7

9         Home visit procedural checklist                           8

10        Home visit assessment and report guidelines               9

11        Typing of reports                                         10




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Review March 05
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                      OCCUPATIONAL THERAPY SERVICE

INTRODUCTION

It is essential to follow the advice/procedures contained within this document,
which should be read in conjunction with the BAOT Service Standards
Documents, and local discharge policies.

1      CONDITIONS TO BE MET BEFORE A HOME VISIT IS CARRIED OUT

1.1       For in-patients requiring a home visit, an initial assessment must have
          been carried out by the Occupational Therapist (OT) or Occupational
          Therapy Technical Instructor (OTTI)

1.2       The patient MUST give their consent to a home visit. (See Clinical
          issues, Policies and Procedures)

1.3       The resuscitation status of each patient will be identified prior to the
          visit. If the patient has expressed a wish not to be resuscitated (see
          Ethical resuscitation policy) the OT will request advice from the
          Consultant in charge of the patient’s care and document the reply in the
          OT notes prior to the home visit.

1.4       For in-patients requiring home visits from hospital, one other member
          of the treatment team must accompany the OT or OTTI. If there are
          specific mobility needs, this needs to be the appropriate physiotherapist
          for that patient. Equally, the OT Assistant may accompany the
          OT/OTTI, Social Services etc. as appropriate.

1.5       If the member of staff treating the patient is off sick at the designated
          time of the visit, another member of staff will undertake the visit
          whenever possible. This staff member will be of an appropriate level of
          seniority. If no appropriate member of staff is available the visit will be
          cancelled. Other agencies/relatives involved will be contacted
          immediately with an apology for the cancellation.

1.6       The patient should be present when carrying out the home visit unless
          there are circumstances where it is more appropriate for an access visit
          (without the patient) to be carried out instead. Relevant carers/relatives
          and other agencies should be present at the visit, as required.

1.7       Discharge home visits are not advised.

1.8       There must be clear and documented aims for the visit which may fall
          into all or one of the following categories:




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          1.8.1 To establish the patient’s ability to function at home, as part of
                the assessment process and to assure safe discharge from in-
                patient care.

          1.8.2 To establish/confirm the need for home rehabilitation e.g.
                Intermediate Care and/or long term Social services Care
                Packages

          1.8.3 To reassure a patient of their ability to cope at home, where a
                patient or carer may be excessively anxious.

          1.8.4 To establish/confirm the need for a patient to be considered for
                alternative     accommodation      i.e.   sheltered     housing,
                residential/nursing home care.



2         TRANSPORT

2.1       Own Transport

          2.1.1 It is no t advised that members of staff use their own vehicle to
                transport a patient.

          2.1.2 When using own vehicle the OT must be comprehensively
                insured for business use.

          2.1.3 The car must also be suitable for the transportation of equipment
                if necessary.

          2.1.4 Own car may be used for access visits or post-discharge visits
                WHEN no department fleet car is available and the staff member
                has business use insurance cover.

2.2       Department Fleet Car

          2.2.1 One of the department fleet cars must be booked in advance of
                the visit using the department diary system.

          2.2.2 The department must be informed if the car is no longer required
                so that the booking may be cancelled.

          2.2.3 When OT department fleet cars are unavailable every effort
                should be made to find an alternative fleet car e.g. ICT car
                before visit is cancelled.

          2.2.4 The member of staff undertaking the arrangements for the visit
                will book the fleet car as part of those arrangements.



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          2.2.5 Priority is given to transport needs for home visit over other uses
                of the department fleet cars.


                     For a home visit each fleet car will contain a ‘home visit kit’. This
                    kit includes items for prevention of cross infection e.g. rubber
                    gloves, apron, pads, vomit bowls, as well as self discharge
                    forms, tape measure and maps.


3         SECURITY

3.1       Identity badges must be worn at all times

3.2       A member of the OT staff, visiting a patient’s home may be under
          pressure to provide equipment or services which are not judged to be
          essential or which have cost implications beyond the authority of that
          staff member. Care must be taken to avoid any promises or
          agreements in such cases.

3.3       In the event of threatening behaviour being displayed towards a
          member of staff he/she should try to deal with the situation calmly,
          concluding the visit early if necessary. Such incidents should be
          reported to the line manager on return to base and an incident form
          completed.

3.4       In the event of a member of staff actually being attacked, he/she is
          entitled to reasonable, defensive action and should leave as soon as
          possible, summon assistance, and report the incident to his/her line
          manager.

3.5       If, during the visit, the patient expresses a wish to take items of value
          back to the hospital, the next of kin and the ward staff should be
          informed on return to the hospital.

3.6       It is advised that patient’s notes are not taken on the home visit. A
          notebook containing relevant points is appropriate.

3.7       In the case of a patient refusing to return to hospital despite attempted
          persuasion, a ‘self discharge’ form should be completed and the ward
          informed.

3.8       On leaving the patient at home, the staff member should ensure that
          they are in as safe an environment as possible. This should include
          informing the next of kin and relevant persons involved.

3.9       If, between the home visit being arranged and carried out, the patient is
          moved to another ward, the senior staff of each team involved will
          discuss the patients needs and decide upon appropriate action; e.g.


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          cancel visit, original staff member continue, or new staff complete
          assessment. An incident form will be completed




4         PERSONAL LIABILITY

4.1       There may be occasions when a patient is discharged before a home
          visit can be organised, or a patient is discharged, following a home
          visit, against OT advice. This should be documented in medical and OT
          notes. Where necessary, every effort should be made to refer such
          patients to external agencies for follow up.


4.2       The employer is responsible for ensuring safe systems of work apply,
          that staff of an adequate level of expertise and experience are
          allocated to such duties and making arrangements, which conform to
          the necessary standards. As such, the employer is vicariously liable for
          problems off-site where the member of staff is on PCT business.

4.3       It is strongly advised that all staff have personal indemnity insurance
          provided by membership of BAOT/UNISON


4.4       In the event of breakage to patient’s property due to negligence on the
          part of the staff member, an incident form must be filled in on return to
          base and discussed with the Lead Practitioner.


5         EMERGENCIES

5.1       In the case of accident/emergency, e.g. patient becomes acutely ill
          during the visit, the member of staff should carry out appropriate
          emergency action (e.g. call for help, basic first aid, telephone
          emergency services, reassure relatives)

5.2       On leaving an empty property the staff member must check it is safe
          and secure, if the patient is deemed unable to do so.

5.3       On return to the hospital, any incident should be reported verbally and
          in writing using the correct form to both the ward manager and Lead
          Practitioner.


6         CONDUCT

6.1       It should be remembered that during a home visit, any member of staff
          is a guest in a patient’s home. The patient has the right to refuse entry
          to whole or part of their home.

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6.2       If the patient or relative wishes to complain about staff conduct or any
          aspect of the visit they should be referred to the Lead Practitioner. The
          Lead Practitioner will discuss the matter with them and inform the
          relevant personnel in line with Hunts PCT Complaints Procedure.


7         PRODUCT LIABILITY

7.1       If equipment is loaned or issued from the OT department store it is the
          responsibility of the OT staff to ensure it is clean and safely installed, or
          that relatives and the patient have been given clear instructions as to
          the fitting and maintenance.


8         PEST INFESTATION

8.1       If, on arrival at the property, it is found to be infested, the visit should be
          curtailed. Personnel should return to the hospital and report to the
          ward.

8.2       Further advice should then be sought from the Environmental Health
          Department of the District Council.

8.3       Members of staff involved should also seek advice from Occupational
          Health.




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OCCUPATIONAL THERAPY DEPARTMENT

HOME VISIT PROCEDURAL CHECKLIST


Task                                                            Date/initial
Initial assessment carried out
Need for home visit identified
Patient’s consent obtained
‘DNR’ status discussed and recorded
Patient fit for visit (liaised with ward)
Need for visit discussed with N.O.K. /Carers
Visit booked
2nd staff member able to attend
Relative aware of visit arrangements
Carer (formal or informal) aware of visit arrangement
District nurse aware
District nurse able to be present
Patient has suitable outdoor clothes
Key is available/access arranged
Patient’s address is correct
Transport arranged
All necessary equipment present (including dept. home
visit kit)
Medication needs for patient checked for visit
Contact details left in diary/ fireboard before leaving dept.
including anticipated time of return.




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HOME VISIT REPORT GUIDELINES

Patient details
Name                     G.P.
Address                         Consultant
Date of Birth            Diagnosis – if appropriate

Date of Visit




Persons present


Reason for visit/background to admission


Home and Social Situation
House/flat/other         owned/rented/HHP
Heating
Lives alone/family/friend/lodger
Support from carers/family and frequency of support


Other support services
E.g. District nurse/community social worker/Choices, meals /Care provider.



Access to property
Gates, paths, steps, door key, lifts, general thresholds
Orientation around the house



Stairs
Up/down, covering, lighting, existing rails, height and length of any required rails


Corridors/halls
Space, floor covering, doors, lighting


Living room
On/off chair, height of chair, floor covering, space heating, lighting


Dining area
Table, chairs, transfer of food, space, floor covering, heating, lighting



Kitchen
Cupboards, sinks/taps, appliances, floor covering, shopping – preparation of drinks and
meals, removal of waste, safety aspects, laundry.




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Bedroom
In/out bed, including lying: sitting, height of bed clothes, storage, heating and lighting.
Location in respect of toilet facilities. Note if nocturia



Bathroom
In/out bath or shower, rails or other equipment already in situ or required. Basin, towel rails,
space, heating, lighting.

Toilet
On/off toilet, access to toilet, equipment in situ or required.



Patient’s mental state during visit
E.g. orientation, motivation, memory. Attitude to discharge.


Summary
To include general detail and state of dwelling, patient’s and relatives’ attitude to visit and
discharge. Brief description of services required.


Recommendations and actions
DETAILS of equipment and services required and WHO IS RESPOSIBLE FOR ACTIONING
EACH RECOMMENDATION


11             HOME VISIT REPORTS

     11.1           It is recommended that the home visit report be typed using a
                    Home Visit report form proforma. However, if this facility is not
                    available the report may be handwritten. It is important that the
                    report is completed and distributed as soon as possible after the
                    visit ideally within 2 working days.

     11.2           When writing reports staff should be mindful of the fact that
                    patients may access their own records and therefore the report
                    must be written objectively, stating facts and observations, all of
                    which should have been discussed with the patient during their
                    visit.


     11.3           Reports should be copied to:
                    Medical notes
                    Nursing care plan
                    Physiotherapy
                    Social worker
                    District nurse
                    GP
                    Other e.g. ICT.




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