Introduction
Some staff may be required to work by themselves either within the premises or out on home visits. The purpose of this policy document is to establish basic principles to ensure that any personal risks are properly assessed and controlled. Employers are responsible for health and safety of their workers whether in the surgery or on location, and, where necessary, should undertake a risk assessment sufficient to adequately assess the individual circumstances applicable to each member of staff.
Working within the Surgery
Ensure that:
- All external doors and accessible windows are locked where patient/public access is to be prevented.
- Lone workers should not admit anyone into the premises who is unknown to them.
- Ensure that you are familiar with the locations of telephones with direct access to outside lines, and that you know how to access these.
- Keep your keys secure and not accessible to visitors.
- Use the most secure door for access and exit, preferably one that has a security camera or a door-viewer available. Where the building has CCTV available to monitor the external area, use the system to check visible areas before exiting.
- Do not undertake high-risk physical activity such as lifting / carrying, working on ladders, or undertake manual work whilst alone in the building.
- Lock all doors and windows behind you when you leave an area.
- When moving around the building, ensure access to other areas is prevented or controlled to ensure that intruders cannot access another part of the building without your knowledge.
- Keep a mobile telephone on your person.
- Be aware of the number of the local police station and key organisation contacts or keyholders who live locally.
- Be aware of the intruder alarm system, the procedure for calling the security control centre (where used) and the method by which a duress call may be activated.
- Ensure that a colleague or family member is aware of the time that you are expected home. Ring that person if you are delayed. Ring them to tell them that you are leaving the building and what time you expect to be home. Ensure that the person knows what to do should you fail to arrive in a reasonable time, and that they have the means to contact you both in person (mobile phone) and in the surgery after hours.
Home Visits
Patients who are unwell or suffering from stress may be unpredictable or act in an unusual way. The organisation will take all necessary steps to remove the risks associated with visits that have the potential to cause the staff member alarm. Home visits will not be made to patients who are known to be generally aggressive, or where other members of their household pose a similar threat.
Where a staff member perceives that a home visit may be inappropriate for personal safety reasons, an alert will be placed on the clinical system and an alternative means of delivery of the health service will be investigated.
Where a repeat home visit is a normal part of a particular patient’s care then the risk associated with this may be minimal. Where a home visit is requested for the first time, it may be considered appropriate for two staff members to attend initially to assess any potential risk.
Staff may:
- Decline a visit where they feel uncomfortable.
- Decline a visit where the house or the area causes concern.
- Decline a visit where other aspects of the visit may cause concern, e.g. aggressive animals not fully controlled, aggressive or intimidating family members, threats to person or property.
In addition, where the house is occupied by persons smoking, or where the atmosphere in the house is affected by recent smoking or is otherwise smoke affected, the staff member may decline to enter or remain on the premises. In these circumstances the staff member may return to the organisation and make a report. The clinical system will normally be endorsed with an alert message to the effect that a visit has been declined due to smoking, and the patients will be written to with an explanation, which will include the future requirement to ensure a healthy atmosphere prior to a visit request.
Each Home Visit must be recorded in a recognised format and / or location, including the estimated time of arrival and departure. Where the Home Visit is one of a series of visits the records must have a clear indication of the order / sequence and the duration of each. The record should include:
- Who you will see
- Their contact telephone number
- Time of Appointment
- Duration of visit
- Reason for visit
- Time of return to the surgery or arrival at next visit
- Time of arrival at home if not returning to the surgery
Where the visit is a first to a particular patient or house, then the visit record will be endorsed prominently to that effect in order to emphasise a greater risk element.
- Each visitor should be provided with, or have access to, a mobile phone and / or a personal attack alarm.
- Each visitor should be trained in dealing with aggressive patients and in self-defence / avoidance techniques.
- Each person visiting and using a car should be a member of one of the driving recovery organisations.
- Arrange a distress code or phrase with the organisation – its use via a mobile will alert the organisation staff to a situation where the police may be called without alarming the patient / householder.
- The visitor should park as close as possible to the house, ensuring the area is well-lit.
- If the visitor is unhappy in visiting a particular home or a particular area then do not go. Alternative arrangements will be made, including, if appropriate, the need for two people to attend. This may include visits to high-crime areas or isolated rural locations.
- Visits during “unsocial” hours or finishing after dark should be avoided.
- Establish a procedure whereby the visitor contacts the organisation before and after each visit to confirm that each one has been safely completed. Where this confirmatory call is not received within a defined time after the estimated duration, the organisation should contact the visitor on the mobile phone provided.
- Call base upon entering a patient’s house inform them of your location.
- Base will call back at 15 minutes.
- During consultation leave at any time if there are concerns and call base to inform.
- Call Base at the end of the consultation.
- If there are any concerns at the time of the call please ask to speak to ‘Dr Smith’.
- At this point Base will ask you questions that require yes/no answers to assess your concerns.
- When returning directly home after visits you should establish a system whereby you phone the surgery to confirm that you have safely completed your visits and arrived home. In the event that this call is not received, a system should be established within the organisation to initiate follow-up action including contacting the visitor or relatives as appropriate.
- Reception staff are to ensure the effective management of the above procedures and ensure there is an effective “handover” when organisation staff change during the day.
- When undertaking a home visit there may be times when, on arrival, you feel uncomfortable about either entering or remaining in the house. In these circumstances, do not enter, make a suitable excuse, and leave immediately. If necessary, make a mobile phone call to the surgery and pretend that an urgent call has arisen.
- It is the responsibility of Dr.Vijay Sivapalan to ensure that systems are in place whereby the whereabouts of the visitor(s) are known at all times, and to start enquiries where there is cause for concern.