Health & Safety

Family Practice Residency Program Policies & Guidelines:

Need a visual? Take a look at the Driving Safety Guidelines infographic.

Residents are often required to drive significant distances for rural rotations or house calls. Safety is of paramount importance, particularly in winter conditions.

Do not drive if you are tired. Have some rest prior to departing. If this means you will be delayed for your rotation, inform the preceptor as early as possible.

Inclement conditions may mean a trip needs to be delayed. Inform your preceptor and await reasonable road conditions.

Always take a charged phone.

In cold weather, take winter clothes and boots, a candle, and a match.

Refer to the BCAA Winter Driving guide for winter driving preparations.

Residents may wish to take the Winter Driving Safety course from the Justice Institute of BC

Never drink and drive.

In some BC regions, residents must be aware of mandatory winter tire requirements. It is preferable to have all-wheel drive for winter driving.

Resident must not respond to cell phone calls or text messages while driving. If on-call, be sure to stop the call prior to answering.

Approved by PGEC October 6, 2015

House Call Safety Guidelines

General Rules

Go with a faculty or allied health professional person for a 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 the 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

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.
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.
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

Review article: House Calls.
American Family Physician. 2011 April 15; 83(8): 925-93.
House Calls 101. Ontario Family Physicians
CMPA Spring 1995 – Revised February 2008 IL9520-4-E. House Calls: What the Courts Have Said.
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.
Home Visit Safety Tips
Vancouver Coastal Health Authority Employee Protection Guidelines for Safe Home Visits.

Approved by PGEC October 6, 2015