HLT41812 Certificate IV in Pathology

HLTRAH302C
Undertake Home Visits

Topic 1. Prepare for home visit

Performance criteria - by the end of this topic you will be able to:

Check that client is expecting and prepared for a home visit at the agreed time

Clarify purpose of home visit and history of client in relation to unexpected issues
and needs

Prepare equipment, resources and/or documents required address purpose of

home visit and contingencies

Allow time in schedule for contingencies

Check that entry to the home is ensured

Ensure co-worker(s) are aware of intended time and place of home visit and
mobile contact details

Home visits
Health care is delivered in a variety of settings including the patients home. There are huge
demands placed on our healthcare systems, particularly financial demands which have
meant patients are discharged from hospital as soon as possible. Patients are now seen by
Nurses in the home and home care for daily living activities eg. showering. Pathology is no
different; the demand for blood testing to be performed in the home is increasing. The home
also extends to nursing homes and hostels. Home visiting in all forms of heath care is the
fastest growing aspect of community health.
Health care workers must be able to make preparations for the visit, work safely in
unpredictable environments and work within the limitations of training.

Occupational Health and Safety

Working in the community, such as visiting people in their homes and dealing with driving
hazards can be a difficult responsibility to understand and manage for the employer of a
health care worker.
Employers have a duty of care to their employees and the client. Under the OH&S& welfare
act 1986 employers are responsible for providing:

A safe working environment

Plant and substances in a safe condition ( safe electrical equipment )

Adequate facilities

Adequate OH&S information, instruction and training

Monitor working conditions safety assessments)

Identify hazards, conduct risk assessments and control the risks

Adequate human and financial resources to implement OHS&W strategies

safe and timely return to work programs for injured workers

obtain police security check of all employees

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Community Services OHS Information Pack

http://www.worksafe.vic.gov.au/__data/assets/pdf_file/0006/9528/Working_Safely_in_Community_Services.pdf

National OHS Strategy 2002-2012Australian Work Health and Safety Strategy

2012-2022 states the employer must provide a safe work place for employees. This is very
difficult to do in the home visit situation as the organisation have little or no control over the
environment in which their employees are walking in to.
http://www.safeworkaustralia.gov.au/
It is therefore your responsibility and you have a duty of care that you must do the following:

Take reasonable care to protect own safety and care

not affect the health and safety of others

use all equipment that is provided for your health and safety

Follow procedure regarding hazards, injuries and accidents

not be under the influence of drugs or alcohol

Clients homes will be your workplace and they must also provide as much as possible a
clean and safe working area. You may ask them to:

secure any pets

provide a clean work space

treat you with respect and be courtesy ( non-threatening or abusive)

not smoke while you are there

Provide safe and appropriate equipment eg. table, towel

It is your responsibility to report any concerns following organisational procedure. Take
responsibility for your own safety as no-one is else is there to do it for you.

Infection control
If you enter a home where it is very unclean try and find a place to
set up your equipment as best you can ask the patient to provide a
table or a clean towel to perform your collection. This is not always
easy to do and you must try and say it in a professional way that
will not offend patient about the state of
their home.
Follow organisational procedures regarding infection control,
protect yourself. Wear gloves wash hands or use hand sanitiser
before and after collection dispose of waste and sharps in correct
containers. You may be required to wear a gown if patient is
infectious.

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Equipment
You will have a case with all the appropriate collection equipment supplied by your
organisation. This should be checked prior to going out for your visits.
The equipment you will need for home visiting may be as follows:

Home visit case

Sharps disposal unit

Biohazard bags

barcode numbers

all collection tubes

vacutainer barrels

variety of gauge needles

variety of syringe sizes

rubbish bin

relevant paperwork

cotton balls

alcohol swabs

Pens, pencils etc.

map of area

day sheet

pager

esky ( to store specimens) with ice

ECG machine

Mobile phone or a phone may be installed in your company car.

spill kits should be in each car (blood spill kit or formalin spill kit]
Your home visit equipment should be kept clean and all equipment in date.
Also you will need to store stock in a secure area of the car as a backup if you need more
equipment. All stock stored in vehicle must be regularly checked to ensure condition and
that it is in date. In this stock you may carry other less used items such as swabs fungal
collection equipment, specimen containers, blood gas syringes.
You may look at home visit equipment as a mobile collection centre therefore you must have
all required equipment.

Clarify purpose of home visit

read maps

priorities visits

prepare equipment, resources and documentation required

Nursing home and hospital patient

deal with challenging behaviour

cultural diversity in the home

Language barriers and how to deal with them.

The home visits may be booked by a central office or designated branches, and a day sheet
should be provided for you with all patient details, tests and any special instructions e.g.
fasting.

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Paperwork for the patient may be located in the branch you start from for that area. Rule 3
patients will have a patient card with all details and the referral. Other patients may have the
referral with them at home. Checking your visits against your map is important so patients
are not missed. All company vehicles should have an up to date Melways.
There should also be a Melways located in the collection centre.
It is important to priorities your patient visits, such as fasting or urgent visits should be
carried out first. Organisation is very important when performing home visits as it can be
unpredictable how long each visit will take.

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Topic 2. Undertake home visit

Performance criteria - by the end of this topic you will be able to:

Obtain entry to the home, check for hazards to own and others' health and safety
and take action to control risk

Take standard precautions to control infection and, where required, take

additional precautions

Demonstrate respect for the home and contents and sensitivity as a guest in the
environment

Follow appropriate risk management practices when delivering services in an

unfamiliar and potentially unsafe environment

Security and Safety

Safety is for you and the patient as is security.
Tips for safety:

ensure car is locked when unattended

Obtain entry while being careful of any hazards (Pets, unsafe building)

Should you find yourself in a threatening situation distance yourself from the
threat as quickly as possible? phone 000, If possible leave the home as quickly
as possible,

Once in a safe place contact co-ordinator and advise them of the situation.

If feeling threatened before entering a home. DONT GO IN.

Report any threats via organisational policy.

Ensure someone has a copy of your days visits.

You may face challenging behaviour from patients at times and home visit staff are more
commonly faced with this than colleagues working in a collection centre. Challenging
behaviour may come in the form of physical, emotional or psychological. All organisations
should provide training on safety and have policies in place to assist staff to document these
correctly.

Equipment and cars

Company cars
Most organisations will provide a vehicle for you to carry out home visits and most will have
automatic transmissions. The car will usually have the company logo on it so it is easily
identified as part of the organisation. If required to use you own vehicle ensure you
document the kms undertaking to be reimbursed in your pay. In most cases there is no
smoking, drinking or eating in the company car. Only other members of the organization
should travel as a passenger in the car unless arrangements have been made.

Vehicle records
You may be asked to keep log book or day sheet providing records of you start and finish
odometer reading, with drivers name and date on it and any vehicle issues.

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Offences and fines

Most organisations will not pay for fines you receive while driving company car.

Accidents
Report any accidents to your supervisor immediately, they will provide assistance and
information to you. A replacement car should be provided to you. As in any other accident
full details must be exchanged if unsure of company insurer or other details contact your
supervisor.

Petrol and maintenance

Petrol will usually come from a fuel card at a specified petrol company. It is the responsibility
of the collector driving to ensure the car has at least tank of fuel at all times. The driver is
expected to keep the car clean on the interior and the exterior on a regular basis. You may
have a designated car wash or you may need petty cash for washing and vacuuming car.

Security
Car must be locked at all times when unattended and parked in a safe manner.

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Topic 3. Establish client relationship in the home

Performance criteria - by the end of this topic you will be able to:

Communicate with client or resident to clarify purpose of visit and confirm client
acceptance

Provide opportunity for client to identify and express any issues or concerns in
relation to the home visit and/or associated matters

Provide appropriate support and information within scope of own work role and
record and report relevant health issues or concerns promptly to appropriate
person

Deal with behaviours of concern promptly, firmly and diplomatically in accordance

with relevant policies and procedures
Remember you are a guest in the patients home and should ask permission before you do
or touch anything. At any time the patient has the right to refuse to have the blood test or to
even let you into their residence. You may be required to move things to make room for you
equipment and to find a clear space, ensure you ask permission before moving anything.
Always put things back to where they were. The patients first impression is very important
and the attitude of the collector may impact on future visits.
It is important to establish a relationship with the patient, carers and nursing staff. Promote
good communication by:

Introducing yourself, the company you represent and state why you are there.

Explain to patient what is required.

Establish yourself in an appropriate space; if patient takes you to unsuitable place

suggest somewhere that looks safer.

Give the patient the opportunity to ask questions and give clear explanations.

Check patient details according to organisation procedure.

Homes
Once entering a home there are factors to take into consideration eg. Does the patient speak
English? You also may be the only person they see for the day and may just want to talk
nonstop. Be polite but get all the information you require and try to do you work while they
chat remembering you may have a lot of other patients to attend to so your time is important.
If you feel threatened or in any way concerned for you safety leave the premises as calmly
and promptly as possible, notify your supervisor as soon as possible. Your safety is very
important.
Cultural Diversity in homes will be evident in many situations and you need to be respectful
of this and accept the situation, unless it puts you at risk or does not meet OH&S
requirements. If the patient does not speak English try to communicate verbally and nonverbally this may help with explaining what you require from the patient. If there is an
English speaking relative available ask them to translate for you. In some cases you may
need the services of an interpreter service. Be patient when trying to communicate, fast
actions and words will most likely confuse the patient more.

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Nursing Homes
When entering a facility introduce yourself to staff, the referral will most likely be at the
nurses station, ensure all details are on the referral. If not it is the staff responsibility to
obtain those details for you. Ask the staff to show you the correct patient and identify them.
When visiting a nursing home often the patient cannot identify themselves and may have
memory or behavioural issues. Ensure for your safety and that of the patient that a staff
member accompanies you to the patient and assist you during the collection e.g. staff may
need to hold patient arm for you. Although the patient is in a nursing home they still have
the right to refuse. You may encourage them but do not force them as it can put you in a
potentially dangerous situation. Even if a patient cannot communicate with you explain what
you are doing and dont assume the patient is aware of what is about to take place

Hospital visits
When visiting a hospital identify the patient as per organisation procedure. All hospital visits
should be marked with urgent as results may determine treatment. Check all id bands to
check details of patient. DO NOT attempt venepuncture on limb where an intravenous line in
situated.

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Topic 4. Follow up home visit

Performance criteria - by the end of this topic you will be able to:

Document all aspects of the home visit in line with organisation policies and
procedures

Promptly report and refer any areas of concern to an appropriate authority

Ensure any arrangements for follow up visits are recorded and implemented

Specimen transportation
All specimens must be carried in back of vehicle. Usually in an esky with an ice brick.
Specimens should be transported to a collection centre and processed on a regular basis no
longer than 4 hours. All urgent specimens should be processed in that manner.

Useful websites
http://www.safeworkaustralia.gov.au/
http://www.worksafe.vic.gov.au/__data/assets/pdf_file/0006/9528/Working_Safely_in_Comm
unity_Services.pdf

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