Why UHNWI home-care needs a different SOP
Private homes and hotels are non-clinical environments with clinical expectations. To protect patients and clinicians, you need clear scope, written protocols, documented handover, and a defined escalation route to private hospitals. Stability comes from repeatable routines—not heroics.
Define scope before day one (no grey zones)
Contract title ↔ regulator category ↔ privileges: what you are authorised to do, where, and with which devices/medications.
Setting: home, hotel suite, yacht; list what is in scope (e.g., wound care, IV therapy, post-op monitoring, rehab sessions) and what is out of scope.
Hours & on-call: standby vs call-back rules, maximum consecutive days, recovery time after night call.
Insurance alignment: malpractice policy confirms domiciliary cover and travel between sites (home–hotel–yacht).
Documentation that stands up in any review
Daily note (date/time, vitals, interventions, response, patient education).
Medication administration record (MAR) with batch/lot, dose, route, time, two-person check where indicated.
Device log (model, serial, calibration/maintenance dates).
Escalation log (time-stamped calls to medical lead/hospital with SBAR summary).
Supply chain record (delivery receipts, temperature control if required).
Store files as colour PDFs; name consistently:
Surname_Name_HomeCare_YYYYMMDD.pdf.
Medication safety in private settings
Chain of custody: who orders, receives, stores, transports.
Storage: locked, temperature-appropriate; separate high-risk meds (anticoagulants, insulin, opioids/electrolytes).
Checks: LASA read-back (drug, dose, route, time), expiry and integrity before use.
Sharps & waste: sealed containers; approved disposal schedule.
Controlled drugs: double-count at start/end of shift; log discrepancies immediately.
Privacy & discretion without clinical gaps
Consent boundary: identify who may hear clinical updates (PA/security ≠ clinical).
Room choreography: neutral lighting, quiet space, equipment out of public view.
Visitors: pause care, cover documentation, resume privately.
Transport & transfers: anonymise labels in public; coordinate secure routes to hospital.
Escalation and hospital interface (make it real)
One medical lead named with 24/7 contact.
SBAR script ready; practise two minutes max.
Receiving hospital pre-briefed; pack handover summary, MAR copy, last 24h vitals, allergy list.
Thresholds for immediate transfer (e.g., persistent SpO₂ < target, uncontrolled pain, acute neuro change).
Rehabilitation & physio in the home
Environment scan: trip hazards, lighting, space for gait training.
Programme design: goals agreed with the physician; session notes time-stamped; home exercise plan printed and taught.
Red flags: new neuro deficits, syncope, uncontrolled pain—stop and escalate.
Yacht & travel nuance (when applicable)
Stowage & stability: secure all equipment/meds; spill kits available.
Communication: satellite/ship-to-shore tested; hospital rendezvous plan along the route.
Sea sickness & dehydration protocols; IV administration only if in scope and pre-approved.
Daily micro-routines that create reliability
Start-of-shift: device checks, meds counts, emergency bag inventory, verify allergies.
Mid-shift: review vitals trend, pending results, supply levels; update medical lead as scheduled.
End-of-shift: handover note, meds reconciliation, waste disposal, equipment wipe-down.
Family/household interface
One logistics contact (PA/house manager) for schedules and access.
Boundaries: no informal clinical advice outside scope; no photos/messages with clinical content in personal apps.
Education: teach simple warning signs and how to trigger the escalation plan.
Common pitfalls—and calm fixes
Scope drift → restate limits; request written endorsement before expanding tasks.
Oral instructions only → summarise in writing; file to the record.
Medication storage lapses → move to locked, temperature-controlled storage; re-log inventory.
No backup clinician → maintain a short list of cleared relief staff to prevent fatigue errors.
Copy-paste checklists
Pre-assignment pack
Contract title = regulator category; privileges list issued
Malpractice policy lists home/hotel/yacht settings
Escalation pathway (medical lead + receiving hospital) documented
Supply list (meds/devices) approved; storage plan confirmed
Start-of-shift
Devices tested; batteries/consumables stocked
MAR updated; high-risk meds counted and checked
Emergency bag verified (airway kit, fluids if in scope)
Patient ID, allergies, consent boundary reconfirmed
End-of-shift
Notes completed and saved to PDF
Meds reconciled; waste disposed; sharps sealed
Handover sent (SBAR) with next review time
Environment reset; equipment cleaned/stowed