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Guideline For Carrying Out Home Visits At Discharge Prepared by:

Caitlin Edwards

Responsible Area: Approval Information:

Provider Services Date Approved: COMMITTEE:-

Lead Director:

Robert Flack

14th November 2007 PEC

Version No. Approved:

First Version

Review Date:

August 2008

Reference to Standards for Better Health Domain

First Domain-Safety Second Domain- Clincal and Cost Effectiveness Fourth Domain- Patient Focus

Core/Development standard

C1 C5(a&b) C6c C13(a&b)

Performance indicators

1. Audit of how many discharge homevisits have been carried out. 2. Audit of compliance to guideline

History of Document First Created March 2007

CONTENTS Section No. 1.

Page No’s 1

Introduction/Overview Aims and Objectives



In-Patient Home Visits- Purpose



Guideline for Carrying out Home Visits at Discharge





NICE Guidance Once NICE guidance is published, health professionals are expected to take it fully into account when exercising their clinical judgement. However, NICE Guidance does not override the individual responsibility of health professionals to make appropriate decisions according to the circumstances of the individual patient in consultation with the patient and/or their guardian or carer.



Introduction/Overview Aims and Objectives This guideline was created in order that the Acute Occupational Therapy Service could carry out home visits at Discharge. This will help to contribute to a seamless coordinated discharge. The guideline will be widely distributed so that the multidisciplinary team are aware of their responsibilities in this process. It will form part of a “Home Assessment Guidelines Pack” once ratified which will include our home visit guidelines for entering a patient’s house already approved. Aims and Objectives 1.1 Aims – to make discharges more timely and co-ordinated 1.2 Objectives – to establish a standard that the Acute Occupational Therapy Service and wider multi-disciplinary team can follow.


In Patient Home Assessment – Purpose – Overview Purpose of Home Assessments The purpose of a home assessment is to ascertain a patient’s functional abilities within their home environment and is an integral part of the OT’s intervention into their treatment package. There are three main types of home assessment:

1. Environmental Home Assessment This focuses on the suitability of accommodation, identification of potential difficulties and the need for equipment and/or adaptations required. This is usually carried out without the patient, but often with relatives/carer. If there is no relative/carer cover available, the patient’s written permission should be sought and two people should be present. 2. Home Assessment The need for this is identified by the Occupational Therapist in discussion with the patient and other multi-disciplinary team members. It is carried out when the patient is medically stable and has reached an appropriate level of function within the hospital. 3. Discharge Home Assessment This is carried out at the point of discharge when all perceived needs have been met. The Occupational Therapist will use/her clinical judgment in deciding when discharge can take place in consultation with the wider Multidisciplinary team. Refer to the “Home Assessment Carried Out at Discharge” guidelines (attached).


Guidelines for Carrying Out Home Visits at Discharge This must be agreed by the Multidisciplinary Team and will not be carried out without full agreement


Home assessments at the point of discharge from hospital are indicated if the following criteria can be fulfilled. ¾

the patient has been adequately assessed in the hospital environment by an occupational therapist


the therapist agrees that it is appropriate for a discharge home assessment


any foreseeable problems have been identified and can be dealt with on, or immediately after discharge


the previous care package is adequate and has been reinstated for discharge or an increased package has been agreed and is ready to commence immediately


joint care management or an intermediate care team/or enabling home care have accepted the patient immediately, where appropriate


there has been discussion with the rest of the team and the patient/carers/family and all are in agreement


an entry has been made in the medical notes/and Nursing Records to indicate when agreement has been reached by the team for the home assessment and discharge to be combined, and the patient is medically stable as ascertained from the medical staff.


bed must remain open until the therapist confirms with the ward clerk that the patient is discharged

The following guidelines should be adhered to by the therapist before and after the assessment. ¾

necessary liaison has taken place with the team and the patient. The patient and relatives have been made aware that if the visit is unsuccessful the patient will be returned to hospital


2 weeks medication, discharge letter and any equipment are ready to be taken on the assessment. If Leeds intermediate care are involved they must be informed of what equipment will be required in good time so they can bring it on the visit.


support services required have been informed of the discharge


the ward are informed of the outcome of the assessment as soon as possible


the outcome of the assessment to be recorded in the medical notes immediately on return to the hospital and the bed released if successful


full home assessment report to be written and included in both OT and medical notes Access into property must have been considered for all services going into the patient and where identified a key safe fitted prior to discharge home visit taking place. Key safes in Dewsbury ordered via the social workers, key safes for patients in Leeds O.T. to contact 0113 2382024 for key safe installation (with client/carer permission) cost is £35.00. -2-

In the case of an unsuccessful home assessment the therapist should ensure that the patient is fully aware of the reasons and what the next steps are. More junior staff should discuss these visits with their supervisor or Head Occupational Therapist and agree appropriateness of discharge home visit. If necessary more senior staff to accompany them on the visit. There is a possibility that a community intermediate care bed could be considered if the Discharge home visit was not going well (for Leeds patients only) rather than bringing the patient back to the hospital. The need for a community intermediate care bed could be flagged up with the Leeds team prior to the visit if it was felt it might be needed. Mostly for over 65 year olds although one home will take 60 upwards. Short term night sitters can be used (2 nights) to enable clients to adjust to being home again. As with other visits the patient may self discharge on the visit. The usual procedure will be followed (self discharge form, inform ward/medics/social workers) Immediate risks will be reduced where possible. These are guidelines only, and, as at all times, the therapist should exercise his/her professional judgment to the given situation.


References This guideline was developed using an existing policy from the Occupational Therapy Department at Leeds Teaching Hospitals NHS Trust.