What must happen on a home healthcare visit

DHA says home healthcare is for people whose health or limitations call for in-home care, without needing regular visits to a facility. Services are offered to patients referred by a physician. The standard then lists criteria that include:

• Homebound or semi-homebound, unable to leave without help because of illness or injury
• Needing skilled nursing, such as IV therapy, tube care, wound management or tracheostomy care
• Needing rehabilitation such as physiotherapy, occupational, speech or respiratory therapy
• Functional limits on daily tasks such as bathing and dressing
• Safety risks at home, or a chronic or progressive disease needing monitoring
• Antenatal or postnatal, paediatric, palliative or mental health care that can be managed at home
• Medically stable, without needing immediate hospital care or constant attention
• The family agrees, and the home has adequate facilities for proper care

The standard does not spell out which criteria must all apply together. Agree your written patient acceptance criteria with your medical director, and check with DHA if your model relies on any one of them. This matters most for services aimed at people who could travel to a clinic.

DHA is clear that a qualified physician must assess the patient face to face before any home healthcare services can take place. That assessment covers medical history, physical examination, level of impairment, medication, drug allergies, and how the condition affects daily living.

The care plan is then developed with the treating physician and your interdisciplinary team. Patient identification, assessment and care planning each need a written policy.

Plan physician time for every new patient. If your model is nurse-led, you still need a route to this first assessment.

You must have signed general consent before services begin, from the patient, legal guardian or substitute consent giver. If the patient lacks full capacity, such as someone under 18 or not oriented, consent comes from a relative up to the fourth degree. Keep a copy in the record for DHA inspectors.

Informed consent must be written and cover the nature and purpose of the treatment, benefits and risks, alternatives including no treatment, the consequences of refusing, and patient rights and responsibilities. Specialised services, such as dialysis and IV therapy, need their own consent forms.

Records must be documented electronically within 24 hours of the visit and authenticated by an electronic signature. So your staff need a working way to record from the field, and a clear rule for visits where signal is poor. DHA expects an electronic record or NABIDH-connected system containing:

• Patient identification
• Vital signs and assessments at each visit
• Medical history and allergies
• Medication, dose, route and frequency
• Care plan, goals and changes
• Risk assessments, such as falls and pressure ulcers
• Signed physician orders
• Consent forms
• Communication with patient and family
• Referrals and specialist reports
• Discharge summary

You must also keep a list of all active and non-active patients in the facility office.

• Who: your facility must define who can prescribe, dispense and administer. Physicians and registered nurses prepare and give medication, while assistant nurses support under supervision.
• Labels: patient name, medication name, dose, instructions and expiry date.
• Checks: routinely check for expiry and integrity.
• Records: each dose goes in the record every time it is given.
• High-alert medicines: use an independent double verification. Plan how this works when one nurse is alone in a home.
• Incidents: report drug incidents and medication errors to DHA by form within 48 hours, and have the medical director review them.

Version 2 says home healthcare facilities shall not manage emergency or urgent cases. They must be promptly referred to the designated emergency department. You still need a full emergency plan, covering:

• Medical emergencies such as cardiac arrest, respiratory distress and severe allergic reactions
• Natural disasters, fires and other environmental emergencies
• Evacuation and communication with emergency services
• Regular staff training and drills
• An emergency kit, under DHA's emergency medication policy

The care team should also have an agreement with a hospital for emergency transfer, services such as admission or radiology, and referral.

Complete DHA's home care discharge plan when care goals are met, when the patient or family refuses or stops cooperating, when care goes beyond what you can provide, when the patient leaves your service area, when the referring physician will not continue orders, when the home no longer supports care, or when the patient needs hospital.

A detailed discharge summary goes in the record. Our guide to daily operations covers what sits behind all of this, and HealthcareSetup UAE has a guide on starting a home healthcare business.