COVID-19 (Coronavirus) - Guidance for risk screening and assessment for home visiting health services

Home visiting health services

A range of acute outreach and community-based services deliver services by visiting the people in their homes. Examples of health services that are delivered in the home include:

• hospital in the home
  
• community home nursing
• midwifery home visits
• child and family health screening
• palliative care
• allied health.

Health services that are provided in a clinic setting (such as hospital outpatients or community health centres) should follow Guidance for outpatient clinics.

Given the evolving situation, services should regularly monitor NSW Health - COVID-19 for updates and refer to the advice for Home Care Service providers from the Chief Health Officer.

Refer to Find your Local Government Area by suburb for a list of individual suburbs in relevant Local Government Areas.

Context

Management of patients prior to community-based appointments and home visits should be according to current public health guidance for testing and home isolation.

Home visiting services should review models of care and incorporate risk screening, assessment and mitigation processes that includes:

• Screening of patients for symptoms prior to attendance as part of routine clinical assessment. Anyone who is symptomatic or has a temperature should be advised to access testing at an appropriate location and seek medical advice for management of symptoms.
• Measures to encourage physical distancing to ensure 1.5 metres of space between people where appropriate and practical whilst providing a service. This will include minimising the number of household members who are present in the room in which the service is provided (it is recommended that babies and young children are accompanied by one parent/carer) and minimising close contact during the provision of service.
• Ensure all staff have completed infection prevention and control training, including practical personal protective equipment training where relevant.
• Measures to ensure standard infection prevention and control precautions are stringently followed at all times with transmission precautions applied in accordance with the risk assessment. The Clinical Excellence Commission COVID-19 Infection Prevention and Control - Guidance for Home Visits should be followed. Infection prevention and control resources for residential & in-home care are available.
• Ensure availability of personal protective equipment for all staff conducting home visits, including hand sanitizer, cleaning wipes for reusable equipment and waste disposal bags.
• Prioritise alternative models of care such as use of telehealth technology where appropriate, especially for people who are vulnerable to severe illness such as elderly or immunocompromised people. Guidance in relation to telehealth is available at ACI - Telehealth.

Guidance for home visiting

Before the home visit

In addition to usual work health and safety assessment, health care providers should conduct routine risk screening and assessment prior to home visiting. Services will need to develop a system to implement the steps below, including appointing an appropriate person to assess whether or not it is safe to defer the home visit appointment and communicating with relevant partner service organisations.

Risk screening and assessment should be undertaken for:

• the patient/client
• carers/residents in the home
• any person that will in the home at the time of the home-visit

Pre-screening patients prior to the home visit

Develop a system, prior to attendance (e.g. phone call, SMS), to pre-screen patients and others present in the household for risk criteria. Where there is a yes response to any of the risk criteria, home visiting health services should ensure systems are in place to manage patients appropriately, including appointing an appropriate person (e.g. a senior clinician) to assess whether or not it is safe to defer the appointment.

Patients and others present in the household should be asked:

• Have you ever been diagnosed with COVID-19?
• Have you had any symptoms​ in the last 14 days that are new:
• fever (37.5° or higher)
• cough
• sore throat
• shortness of breath (difficulty breathing)
• runny nose
• loss of taste
• loss of smell.

Advice on current areas of concern is at Latest COVID-19 case locations and alerts in NSW.

Reviewing the timing and mode of appointment based on risk criteria screening

If there is a 'Yes' response to any of the risk criteria:

• Consider alternate methods of conducting the home visit if appropriate (e.g. tele-health)
• If it is not possible to conduct the home visit in an alternate way and it is not clinically urgent, reschedule the appointment (refer to the relevant fact sheet to determine the timing of a re-scheduled appointment).
• If the appointment is rescheduled, consider follow up phone calls with the client prior to the time of release from self-isolation in order to determine the outcome of medical assessment, if there is a change in circumstances and to monitor their needs.
• If it is clinically necessary to conduct the home visit, providers must follow measures as outlined in the CEC COVID-19 Infection Prevention and Control - Guidance for Home Visits.
• If screening and appointment scheduling is performed by a non-clinical staff member and risk criteria are identified this should be escalated to the responsible clinician for further assessment as to whether it is clinically appropriate to defer the home visit and what other management may be required.

Home visiting for patients with Yes response to any of the screening criteria

• If clinically urgent, the appointment may proceed following the completion of a risk assessment and formulation of risk mitigation that includes infection prevention and control strategies.
• Conduct the appointment while following appropriate infection control procedures. This will include standard precautions, as well as transmission based precautions (contact, droplet or airborne precautions depending on required clinical management). For more detailed information, refer to:
  • COVID-19 Infection Prevention and Control - Guidance for Home Visits.
• Infection Prevention and Control - Decision algorithm for Recommended Personal Protective Equipment in Allied Health Procedures
• Ask the patient to gel their hands with sanitizer, wear a surgical mask and, where possible, maintain a physical distance of 1.5 metres from others.
• Support patients who have new symptoms to get tested, if they have not already done so and seek medical advice from their general practitioner or HealthDirect on 1800 022 222 to manage their health symptoms.
• Remind the client and anyone who will be with them that they must self-isolate at home for 14 days if they have had close contact with a person with confirmed COVID-19 while infectious or after they have returned from overseas or have been on cruise ship.

Home visiting for patients with no identified risk factors

For patients who are well and do not have a yes response to any of the COVID-19 risk criteria, the visit may proceed ensuring that service delivery is consistent with the most current infection control advice.