Why domiciliary work needs hospital-grade rigor
The setting is quiet; the risk is not. VIP care outside the hospital adds logistics, privacy exposure and variable environments. Safety depends on three aligned pillars: licence, insurance (with domiciliary rider), and privileges that explicitly list home/hotel/yacht.
Gatekeeper checks (before accepting a visit)
Regulatory: active licence; competency fit for the planned care.
Insurance: schedule names home/hotel/yacht; limits adequate.
Privileges: domiciliary scope approved; advanced items (e.g., IV meds) clearly listed.
Roster: escalation backup named; contact tree printed (medical lead, receiving hospital).
Pre-visit pack (copy/paste)
Micro-kit: ABHR, PPE, wipes, sharps, basic airway, pulse oximeter, BP, thermometer, glucometer if relevant.
Med safety: high-risk meds separated; labels checked; no bedside compounding unless privileged and safe to do so.
Docs: care plan with numeric escalation thresholds (e.g., SpO₂ <92% for 5 min, MAP <65), allergies, consent note.
Logistics: access permissions, quiet room, table height, lighting, power, parking/dock details.
Transfer plan: named receiving hospital; route, ETA, and accepting service pre-agreed.
Privacy choreography (UHNWI/Royal households)
One clinical voice (medical lead) handles updates; household PA/security manage logistics only.
Neutral language in semi-public spaces; devices/screens angled away; doors closed.
Chaperone offered appropriately; attendance list recorded.
On-site sequence (calm, repeatable)
Room ready → clean field established; kit laid out.
Identity & consent → confirm identity discreetly; consent documented.
Vitals & assessment → baseline numbers captured.
Procedure/therapy → follow IFU; maintain clean field.
Medication custody → independent double-check for insulin, anticoagulants, electrolytes, opioids.
SBAR note with numbers → thresholds + owner of next action.
Briefing → family logistics clarified by medical lead; follow-up time agreed.
Yacht-specific notes
Confirm stability, power and lighting; secure sharps and waste per maritime rules.
Seasick risk → antiemetic plan; equipment secured; spill kit available.
Evacuation drill: marina/helipad options and receiving hospital aligned.
Red flags—and calm fixes
No domiciliary rider on insurance → add before visit; defer unless covered.
Advanced task not on privileges → re-scope or arrange clinic setting.
Crowded room → reduce to essential personnel; chaperone if needed.
Medication brought by household staff without provenance → do not administer; escalate to medical lead.
Mini-audits (5 items after each visit)
SBAR note includes numeric escalation lines.
Two-person check documented for high-risk meds.
Waste/sharps returned and logged.
Transfer plan remained valid (time/route/hospital unchanged).
Any near-miss? → ≤72-hour huddle with one change adopted.