Home visits are part and parcel of being a locum; whether it is GP or nurse certain locum shifts require a locum home visit. AppLocum have put together this article as a rough guide for all locums to follow if they have concerns over potential home visits they may need to undergo.
Here at AppLocum we understand that home visits are particularly difficult compared to standard consultations in a practice. This is why we want to create guides like these to help out any locums who needs them.
There are many reasons to why home visits are more complicated and come with more risk. This can be due to the limited access to patient records, the home may not be up to scratch for a consultation and of course the locum will most likely not have any previous contact, knowledge or relationship with the patient.
The main key to home visits is preparation, always make sure you are well prepared for your home visit before you set off.
Get an idea and feel for the local area
Some practices have locum packs available, you should always check to see if the practice you are working at has one as it will always include useful information. It can include advice and knowledge on in regards to local services and relevant documents that you may need such as DNACPR forms, local prescribing formularies and even community DVT pathways.
We all know that home visits can be very time consuming, the travelling alone takes up a considerable amount of the time of a locum home visit. Firstly, it is important to know how many home visits you are expected to do for each session. You will need to allow one hour for each home visit, checking your route and taking traffic into consideration (rush hour, peak times etc.)
It is also a good idea to ensure that you have any key codes to any areas that require them. This will ease the pressure and avoid feeling stressed over the time constraints of the visit.
Know who you will be visiting and why
Information is key when it comes to performing a locum home visit! You need to obtain as many factors as possible before you travel:
– Who requested the visit?
– The reasons given for the visit
– Does the patient lack capacity?
– Is a chaperone required?
– Are third parties likely to be present?
These are all questions that you should have the answers to minimise risk. If the visit was requested by a third party, it is important that you identify their concerns to ensure that you address these fully. If in doubt, it can be helpful to call and speak to them before visiting and, if possible, try to attend when they can also be present.
Know what equipment you will need
Referring back to the previous point, again knowledge is key in this situation. The last thing you want on a home visit is to be arrive and realise you need equipment that you don’t have. You should check a full set of observations for most patients requiring home visits. As well as providing objective data, it can also help to identify if their condition is more serious than you had initially appreciated. This is an important step – which can be done in just one or two minutes – that can help to avoid adverse events.
You should therefore ensure that you are well prepared with all necessary equipment. In addition to your stethoscope and sphygmomanometer, you may like to take a tympanic thermometer, blood glucose meter, PFR meter and a pulse oximeter.
Keep good records
With the increased risk factors surrounding a locum home visit it is important to keep very good medical records. They play a key role in delivering quality care, and will protect you if any issues arise after a consultation.
You should always make comprehensive notes of your consultation with a clear follow up plan. These notes should be uploaded onto the practice system as soon as possible.
You are not alone, you have support
Home visits often involve multiple factors and complex issues, if you are in any doubt about what you should do in a certain situation then you should not hesitate to seek appropriate advice. This may include contacting an experienced partner at the practice, a secondary care colleague or your medical defence organisation if necessary.
If you feel that a consultation is not going as well as you would have liked, take a moment to check with the patient and others present to ensure that everyone agrees with the management plan you have discussed. If not, then you still have an opportunity to rectify this while showing control over the situation.
In conclusion, working as a locum home visit can be challenging and potentially high-risk. However, as long as you are prepared for this, familiarise yourself with local guidelines, inform your MDO of the work you will be undertaking and know what support you have available, it can be a satisfying change from surgery-based consultations in general practice.