AGENCY NAME

POLICY: Visit Safety

Date Initiated:

Date Reviewed:

Revised:

PURPOSE:

To offer visit staff training and guidance on maximizing safety while in the community and in patients’ homes.

POLICY:

  1. The Agency shall train visit staff in ways to maximize their safety and minimize risk while in the community and/or in the patients’ homes.
  1. Visit staff shall report unsafe situations or potential safety risks to supervisor and other visit staff. A plan to mitigate risk/unsafe situations shall be implemented to minimize problems.
  1. Should an unsafe incident occur, report to supervisor and complete incident report per agency policy.

KEY POINTS:

  • Your agency admission and visit policies along with your patient information booklets should contain rights and responsibilities of both the patient/family as well as the visit staff regarding the provision of a safe environment for care.
  • If environment is not safe, care should not be provided per agency policies.
  • Red Flags:
  • Area unsafe due to gangs, drug-trafficking, street crimes.
  • Household members with history of violent behaviors or threatening
  • Behaviors that make visit staff uncomfortable—alcohol/drug abuse or presence of weapons.
  • Threatening pets

PROCEDURE:

  • Patients, homes and communities are assessed for risk of violence.
  • Scan neighborhood and home for potential risks.
  • Note and document any red flags.
  • Ask about past medical and psychosocial history.
  • Pay attention to “gut” feelings
  • Do NOT admit patient if concerns identified and unable to mitigate.
  • When risk is identified, document all findings in the clinical record along with measures to be taken to protect the visit staff safety including:
  • Not accepting patient for care (ensure your admission policy outlines protocols)
  • Visiting only when deemed safe (during daylight only or when weapons/pets are secured and away from visit location).
  • Consider sending two staff members or ask for police escort.
  • Discharge patient per discharge policy and within regulatory compliance.

TIPS FOR VISIT STAFF SAFETY:

  • Be aware of environment and patients/household members moods and actions.
  • Take threats or threatening behaviors seriously..
  • First, secure your own safety
  • Then, determine best way to secure patient’s care needs/safety.
  • Carry your cell phone with you at all times.
  • Consider (per agency policy), flashlight, noisemaker or pepper spray.
  • For risk cases, position self between door and patient/household member.
  • Shorten visit.
  • Consider using excuse of “I forgot something in the car.”
  • Personal possessions/safety
  • Don’t wear expensive jewelry.
  • Lock purse in trunk before arriving at home, not once you arrive.
  • Park and walk in well-lit areas.
  • Lock car doors.
  • Use panic bottom on key chain if needed.
  • Avoid stairwells.

If you believe that your safety in the home may be at risk, consider these tips:

  • Leave the home
  • Consider calling 911
  • Call and consult with your supervisor

TIPS FOR DE-ESCALATING BEHAVIOR

DO:

  • It is generally helpful to meet with a disruptive person in private. Reduce stimulation. This provides an opportunity for the staff to address issues directly without interruption or shaming the person.
  • Use low, deeper tones, and avoid raising your voice or talking too fast.
  • Use gentle, soft voice, speaking slowly and confidently.
  • Allow the person to tell you what is upsetting them.
  • Acknowledge the person’s strengths/positives
  • Stay calm and paraphrase your understanding of the person’s experiences. Set aside your own thoughts and responses and focus on what you are hearing.
  • Validate the person’s possible emotions and what is upsetting them.
  • Be specific and gentle, but firmly directive about the behavior that you will accept. For example, “Please sit down.” Or, “Please lower your voice and do not scream at me.” Or, “Please do not thrash your arms like that. Please keep them lowered.”
  • Explain your intent before making any moves (e.g., “I’d like to get some water. Would you like some?” Or, I’m going to move behind you to close that window.)
  • Take deep breaths, slowing down your breathing so that you remain calm.
  • If the tension in the room is not dissipating, consider taking a quick break. (Apologize in a calm tone for needing to step out just for a couple of minutes, stating for example that you would like to consult with a supervisor; that you would like to get a glass of water, and offer one to the person; etc.)
  • Ask the person what would be helpful from you. Ask for permission to problem-solve the issue. The person may just be venting and may not want you to problem-solve with them.
  • Summarize what the person has said, and summarize any agreed upon resolutions.

DO NOT:

  • Do not argue. When a person is already agitated or angry, he/she may escalate if they do not feel heard. Even if you are correct, arguing at this point will likely increase aggression. It is more helpful to show that you heard them and to de-escalate than to be correct.
  • Do not focus on the person, and do not use adjectives or labels to describe the person. Instead, do focus on the specific behavior.
  • Do not restrict the person’s movement. If he/she wants to stand, allow them. Do not corner them.
  • Do not meet alone or behind closed door if you foresee possible danger.
  • Do not touch the person or make sudden moves.
  • Do not threaten the person. Threatening could increase someone’s fear, which could prompt defense or aggression.
  • Do not press for explanation about their behavior. Avoid “why” questions; these tend to increase a person’s defenses.
  • Do not take the person’s behavior or remarks personally. Disruptive or aggressive behavior generally results from other life problems.

TIPS FOR ANIMAL SAFETY

  • Even “friendly” pets can become unfriendly if they sense a threat to their owner.
  • Visit staff can be perceived as a threat.
  • Request that all pets be put “in a secured area” away from visit location before and during the visit.
  • Sources of injury from animals, especially pets, may include bites, tripping, and allergic reactions.

Bites

  • Unless absolutely necessary or you know the animal well, avoid contact with pets. An animal bite is painful and can cause an infection.
  • Cats often let you know when they have had enough attention by biting or scratching.
  • Dogs may appear friendly but can also be very protective of their territory and owners.

How to avoid a dog bite:

  • Never approach an unfamiliar dog.
  • Never run from a dog and scream.
  • Stay still when an unfamiliar dog comes up to you.
  • If knocked over by a dog, lie still.
  • Do not look a dog in the eye.
  • Do not disturb a dog that is sleeping, eating, or caring for puppies.
  • Do not pet a dog without letting it see and sniff you first.

Tripping hazard

Pets can present a tripping hazard so be aware of the location of animals and their toys at all times. Placing a bell on an animal’s collar can help alert you to their location.

Visit Safety Policy_CAHCH_02-2016