As part of my services, I am on occasion required to visit clients or patients in their own homes. In the advent of COVID-19 this document outlines the requirements of myself, the patient or carehome facility as well as justification for home visits.
This policy has been developed and is under review in line with the CSP’s Framework of 7 Key Factors in Making Decisions about patient contact.
Legal, Regulatory and Professional Responsibilities
As a Chartered and HCPC-registered Physiotherapist, I am bound by these professional bodies to ensure I am working safely, legally and in the best interests of individual and public health.
All registered physiotherapists regardless of sector or setting owe a duty of care to their patients
In addition, I must also comply with the HCPC standards of proficiency for physiotherapists, specifically section 6 – Identify and Manage Risk
In the context of COVID-19, these responsibilities extend to physiotherapists ensuring that they:
- Comply with government social distancing and shielding directives and mitigate, as far as reasonably practicable, the risk of transmitting the disease to patients and the wider general public, particularly to those in the vulnerable and extremely vulnerable categories.
- Use appropriate personal protective equipment and manage any clinical areas in accordance with COVID-19 infection prevention and control regulations.
Infection prevention and control measures
For close contact or within 2m of coughing patients including those with or without COVID-19 diagnosis: Disposable glove, disposable apron and surgical mask type IIR to be worn. Goggles or visor to be worn if a patient is coughing.
For Non contact work only a type 1 or 2 mask is required to protect the potential spread from physio to others.
Hand Hygiene – I will be bare below the elbow. I will carry a minimum 70% alcohol gel. I will utilise handwashing facilities in patients own homes where they are available without further surface contact eg. opening other doors or entering other parts of the home. I will implement the WHO 5 moments for hand hygiene:
- Before patient contact
- Before aseptic procedures (not applicable)
- After body fluid exposure / risk
- After touching a patient
- After touching patient surroundings.
I will also carry cleaning wipes in order to sanitise any equipment used in the home.
Personal Protective Equipment
I will replace all PPE in-between patients except where the items are specified for multiple patient use. In these cases the items will be cleaned using a neutral detergent wipe, allowed to dry, disinfected with a 70% alcohol wipe and left to dry; or by using a single step detergent/disinfectant wipe, allowing the item to dry afterwards.
PPE will be donned and doffed either outside the patients home, or inside the hallway whichever is most practical and allows 2 m distancing to be maintained.
PPE will be disposed of into a normal black bin liner in the boot of my car, and double bagged. It will be disposed of in the usual household waste after 72 hours holding.
PPE supplies will be transported in a closed plastic box.
Virtual First Approach
Physiotherapy assessments must be carried out on a “virtual first” basis. This is ideally via video call. If video calling is not available, then a telephone consultation can also take place.
The initial call will also screen for COVID symptoms for any householder, or identify any shielding or high risk patients:
The higher-risk groups include those who:
- are older males
- have a high body mass index (BMI)
- have health conditions such as diabetes
- are from some black, Asian or minority ethnicity (BAME) backgrounds
Initial treatment such as advice and exercises can be provided by email. In the case of individuals who will require assistance with exercises, the individual must consent to the sharing of the treatment plan and exercise plan.
Patient Risk Assessment, Clinical Reasoning and Informed Consent
The decision to undertake a face to face physiotherapy appointment is taken between myself and the patient and/or carer. This will take into consideration a risk:benefit analysis, considering:
- If the patient / household is shielding
- If social distancing is possible in the home environment
- What degree of contact is required to fully assess and / or treat the patient.
- The duration of contact that is likely to be required
- Whether the patient / family will need to wear a facemask.
A discussion of the pro’s and con’s of both face to face and remote treatment can be had. The patient and/or carer can ask any questions.
Informed Consent will be documented in writing.
Attending a Patients Home
- On the day of the appointment I will telephone to review any potential COVID symptoms and ensure the face to face contact is still appropriate.
- On arrival I will don the PPE either outside the house or just inside providing there is ample space for the 2m distancing.
- I may take the temperature of householders.
- I will record the temperature and the names and times for Track and trace purposes only.
- I can provide you with a facemask should you require.
- I will maintain 2m distance until such a time that I am required to assess or treat at close contact.
- I will follow the procedures outlined above for hand hygiene and surface decontamination.
- Any exercise sheets or other information will be emailed to you later the same day.