House Call Safety Guidelines

House

General Rules

  • Go with a faculty or allied health professional person for first home visit to establish safety issues
  • Carry a cell phone.
  • Lock your car.
  • Make sure patient and/or caregiver knows when you will arrive.
  • Tell supervisor about pet allergies (or other allergies).
  • Keep alert for safety issues at all times.
  • Don’t do a house call in the evening or night unless you know the patient/family/community and have been there before and know the environment.

Before the House Call

  • Look at previous notes regarding any previous alerts for aggression, pets, pests and unsafe conditions in the home.
  • Check the address to understand the surroundings (poverty, busy roads, isolation).
  • Know who else is in the house.
  • Be aware of support personnel going into the home.
  • Let the secretarial staff know when you are going and where you are.

During the House Call

  • Carry cell telephone and be aware of emergency contacts.
  • Park your car so you won’t be blocked in and can get away easily and lock your car.
  • Carry a safety alarm (if you have any concerns).
  • Dress professionally and have shoes with covered toes.
  • Pause at the entrance to introduce yourself and look around for possible hazards.
  • It is best not to remove your shoes and therefore carry surgical booties in case the family asks you to remove your shoes.
  • Ask the patient and family not to smoke in your presence.
  • If you become concerned about bed bugs, sit on a hard chair, stamp your feet, and carry little with you (wear protective clothing if you know they are in the home).
  • Sit in the living or dining room with clear access out. (It’s best not to sit in the kitchen where there may be weapons like knives
  • Eating or drinking in a house call needs your own discretion.
  • Take a hearing enhancement device in case the patient can’t hear well.

If Threats Occur

  • Use verbal de-escalation techniques.
  • Adopt a defensive posture.
  • Leave the home if you feel unsafe.
  • If the patient is certifiable and possibly aggressive, leave the home, call Mental Health Emergency Services, or police as needed. (Mental Health personnel should carry committal certificates with them.)
  • Report any incidents into records so future health care professionals will be alerted.

Physical Exam

  1. Do not do partial exams when a full exam is required. Instead have the patient go to an office or Emergency. “In a house call, although the setting in which the doctor/patient relationship takes place is informal, the duty of care imposed on the physician is as stringent as in the formal environment of the physician’s office or the hospital.” Reference: CMPA document.
  2. Tell the patient what you are about to do in a physical exam and ask permission to do the physical just as you would in the office.
  3. Consider using a chair or sofa whenever possible for an exam, and preferably in a public space in the home. Only use a private bedroom when it is not feasible to examine the patient in a more public area of the home.

References

  1. Review article: House Calls.
    American Family Physician. 2011 April 15; 83(8): 925-93.
  2. House Calls 101. Ontario Family Physicians
  3. CMPA Spring 1995 – Revised February 2008 IL9520-4-E. House Calls: What the Courts Have Said.
  4. Public Services Health and Safety Association. A Health and Safety Ontario Partner.
    Tips for Guarding Your Personal Safety on Home Visits. This is a free download.
  5. Home Visit Safety Tips
  6. Vancouver Coastal Health Authority Employee Protection Guidelines for Safe Home Visits.

Approved by PGEC October 6, 2015