Clinical Guidelines

Clinical guidelines have been developed for:

• Anaphylaxis
• Parenteral drug administration
• Staff safety

Anaphylaxis Guidelines
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The Anaphylaxis Guidelines have been developed following a review of existing Victorian Hospital in the Home Anaphylaxis protocols and consultation with Department of Allergy and Immunology, Monash University, The Inner and Eastern Health Care Network (now dissolved & restructured) HITH Co-ordinators, ACA Advisory Group and a number of Victorian hospital pharmacists.

They consist of an algorithm that informs the procedure to be undertaken in the event of an anaphylactic reaction, recommendations for the contents of an anaphylaxis kit to be carried by HITH staff and suggested protocols for nurses and patients and their carers.

Parenteral Drug Administration Guidelines
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All HITH programs should develop clear precise policies and procedures applicable for parenteral (intravenous, intramuscular and subcutaneous) drug administration in the home care setting.

Policies and procedures should also be developed for patients and their carers in programs where they participate in drug administration.

Guidelines that outline the written policies and procedures required to ensure safe practice in the administration of parental drugs in the home care setting have been developed to assist HITH programs. Some of the areas covered by the guidelines include:

• Drug orders
• Checking of medications
• Administration of medications by nursing staff
• Administration of medications by patient or carer where relevant

Staff members working in the community are exposed to many risks, which will vary between HITH programs dependent upon the demographics of the area. In an effort to minimize risks to staff, it has been recognised that HITH programs need to develop clear precise policies and procedures relating to staff safety whilst care is being provided beyond the hospital campus. Staff safety guidelines have been developed in consultation with Victorian HITH coordinators and ACA Advisory Committee.

The Safety Guidelines include references to the following areas:

• Staff recruitment, orientation & ongoing education
• Communication
• Assessment of the patient & environment
• Guidelines for home visits
• Travelling in cars
• Manual handling
• Isolation
• Critical incident management
• Bush fires (if applicable)

Patient Selection & Assessment Guidelines
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Hospital in the Home (HITH) has a clear brief of providing acute care in the home, which is a substitute for in hospital care for a range of medical conditions and patients. To ensure that HITH programs fulfil their brief it is necessary to have clearly defined admission criteria, which can be applied to evaluate the patient's suitability for HITH. The selection of patients for HITH can be informed by information provided through the referral process, but it is also necessary to ensure a comprehensive assessment of the patient, family and environment is undertaken. Comprehensive, ongoing assessment ensures that the patient is clinically appropriate for HITH, remains so throughout the episode of care, and that all of their health care needs are being met. Therefore, HITH programs should develop clear policies and procedures regarding the selection and assessment of patients for HITH. Guidelines for Patient Selection and Assessment have been written in collaboration with Victorian HITH Coordinators and address the following:

• Admission Criteria
• Referral Information
• Comprehensive Assessment
• Consent Documentation

Copies of these guidelines are available through ACA.

For futher information about ACA guidelines contact Dr. Lisa Demos on (03) 9076 3789 or via email at aca@alfred.org.au