CP 4.1: Home Visits

Updated:
Reviewed: 

Purpose

• To outline the standardized procedure for all home visits performed by the Community Paramedic (CP).
• To describe the difference between initial and repeat visits for the same diagnosis.
• To describe the difference between medical and non-medical/educational visits.
  
  

Policy Statements

The CP will provide home visits for patients in response to a Request for Service from a primary health care provider or a Health Authority.

The Request for Service form must be received from an appropriate referral source and contain requests for appropriate services to be provided by the CP based on the CP’s scope of practice and permitted services.

The referral will include the patient’s name, date of birth (DOB), contact information, diagnosis, reason for visit, the requested services to be provided by the CP, and the reporting expectations based on the results found.

Procedure

1. REVIEW the patient’s health history, care plan, lab results, list of current medications, and any other pertinent information as provided by the referring agency or health care provider.  NOTE: It is important that the CP become familiar with the patient’s condition and needs, as much as possible prior to the first visit.
2. SCHEDULE the CP visit with the patient within the first 24 hours.  Suggested verbiage for the encounter is, “Your physician has requested that I stop by your home and check in on you.  What time would be convenient?”
3. ARRIVE at the patient’s home in a marked vehicle.
4. ARRIVE at the home visit wearing an official BCEHS uniform and with official BCEHS identification.
5. Upon arrival, EXPLAIN the purpose of the visit and OBTAIN verbal consent.
6. PERFORM a home safety screen in conjunction with a falls risk screen on the initial visit.  Report any concerns to health care team.
7. COMPLETE the initial assessment screen as outlined on the Community Paramedicine Initial Assessment Screen form.  The screen and accompanying assessments may be conducted over a few visits based on patient’s tolerance, time, and condition.
8. PERFORM a head-to-toe assessment, OBTAIN a set of vital signs (HR, RR, BP, T, SpO₂), and note any additional assessments (e.g., weight, glucometer reading, capillary refill, pain score, etc.) as requested on Request for Service form/care plan.
9. PROVIDE treatment, care, and/or other assessments as outlined on the Request for Service form/care plan.
10. For initial Non-Medical/Educational Visits: FOLLOW the same procedures as medical visits, but without vital signs, physical assessments, or treatment services.  In consultation with the health care team, the CP may suggest adding more services if indicated after the initial assessment is completed.
11. COMPLETE services as requested.  If more services are indicated, CONTACT the primary health care provider to obtain additional direction.
12. SCHEDULE follow-up visit(s) as necessary, or as per primary care provider direction.
13. For subsequent visits under the same referral, PERFORM a focused assessment based on the findings from the previous visit(s) and COMPLETE the services as requested or as per the care plan.
    
    

Documentation

DOCUMENT on the appropriate records:

• Initial health assessment screen on the Community Paramedicine Initial Assessment Screen form.
• Head-to-toe assessment on the Physical Assessment form.
• Vital signs can be plotted on a vital sign graphic record if a trending of vital signs is desired.
• Arrival time, departure time, visit summary, care provided, any additional assessments or services provided, and who/when notified of any concerns on the Community Paramedicine Client Visit Progress Notes.
  
  

References

1. Eagle County Paramedic Services. Community Paramedic Protocols Manual. 2013. [Link]
2. Tri-County Health Care Emergency Medical Services. Community Paramedic Policy & Procedure Manual. 2016. [Link]
3. Vancouver Coastal Health. Vancouver Community AOA Practice Guidelines. Initial Assessment Tool – Guidelines for Use. March