Locked I.C.U

athomas91 · Jan 29, 2004

i agree w/ you completely...those doors should be locked and unlocked at the nurses discrimination...i imagine you could all write an unsigned letter to a HIPPA review board (or whatever) - i suppose administration would quickly change their minds then....

BarbPick · Jan 29, 2004

I would imagine you can use hipaa as an excuse , like codes are private. It can be a violation for the other ICU patients.

TraumaNurse · Jan 30, 2004

If you mention HIPPA violation to admin, they might actually do something. I'm all for allowing families to be in the unit most of the time, but around shift change/report time and when procedures are being done, visitors should be out! The unit I am currently in is locked and only allows visitors for 1 hour on each shift..good for pt's and nurses, not good for family.

LilRedRN1973 · Jan 30, 2004

I'm a Nurse Apprentice in the ICU at one of the bigger hospitals in town. We are a locked unit. Anyone wishing to come in must pick up a phone in the waiting room and call the main nursing desk. They are on camera and must wait for that patient's nurse to give the OK to come in. You can't even get the phone number for the ICU by calling the main hospital number. I tried to call the unit the other day and was told by the woman who answered the information line that they are not allowed to give out that number but she could transfer me. Our ER and Labor and Delivery are also locked units, with L & D having a security officer posted at the elevators.

kc ccurn · Jan 30, 2004

Our unit allows visiting for only 10-15 minutes per hour, 2 at a time. No visiting between 2:30-4:30 for shift change. We are flexible if needed-say if pt is dying, etc. If there is a cor we usher out all the family and close the doors. It does get crazy and there are plenty of families that abuse the visiting hours.

For Hippa, we only give out info over the phone if they "have the code" we use the last 4 digits of medical record number. This number is given to the pt's medical proxy only, they can give it to whoever they want to have information about the patient.

We've run into problems with this too because families will give the code out to anyone.....and they feel that they have the right to the pt's health information eventhough they may be a neighbors long lost cousin who is also the pastors wife.....YA KNOW WHAT I MEAN. So in the ICU we still only give info to immediate family who have the code.

K O'Malley · Feb 1, 2004

When I worked in MICU we had to end up putting a lock on the door. When open visiting became the rage it was a complete nightmare. There would be as many as 10 visitors at a bedside, hordes of people trooping in and out all day, visitors taking a "tour" of the unit and peaking in every room, visitors standing outside the pt's room and watching everything going on, not to mention standing at the desk at report time and listening to confidential information. And what we really loved was finally getting a vent pt settled down and sedated so he wasn't constantly fighting the vent and a visitor would come in and shake him and say "wake up George!" We were worn out from policing visitors and finally put a lock on the door. We did have fairly frequent visiting times. But it sure helped to make our jobs more manageable and the pts were able to get some rest.

gizelda196 · Feb 2, 2004

Thanks everybody!

We are having a meeting with the heads.I dont know why they are so against a lock. It is really out of control on our unit. We have the same issues as k omalley did. They are ongoing. People call all day ,come all day.walk thru our work space gather in the halls. It is out of control.We feel we are alone in this. Administration is really against locking it , but they really are sooooooooooo clueless as to what is happening every day on our unit. our job is so much more difficult, paper work,phone calls all day long,families, friends,nieghbors, the grocery bagger ,battling families,it is mental!. And I know all to well about settling down the very anxious copd bucking the vent,freaking out on propophol just getting settled after being admitted to us and 10 people comming in .I have had pts in Tberg and family has come in and reworked the bed and sat the pt up.!!!!!!. I mean can we talk about this!!!!!!geeezzzzzzzzzz

thanks again

Meressa · Feb 3, 2004

I agree totally with the HIPPA issues gang, among other things that poorly planned visitation times can cause.

I am an RN on a 20-bed ICU. A large majority of our patients are respiratory (pneumonia, COPD, ARDS, MO failure) and on the vent with sedation. Our unit is not actually physically locked. Our visiting hours are 10AM-2PM and 6PM-10PM every day.

I guess it could be much worse, but these times can be horrible for staff. In our hospital, 10AM is the time when ALL QD or BID meds are given. So, for us this means busting chops to get your 10AM full assessment and meds done completely for both of your patients well BEFORE the 10AM visiting time starts. If your patients are very care-intensive, this often means by the time you finish your initial am assessments, it is time to start the 10AM one (around 9:15AM). Otherwise, you are going to have to deal with working around visitors or even asking them to step out so you can do a 10AM treatment. THEN, in many cases, if you have to ask them to step out, they complain when visiting time is over saying they should be given some extra time cause they were forced to step out during the time they would have been visiting.

Then, we come to the 6PM visiting time. This is actually worse for staff than the am one. I mean, come on. We have no room we can go to for report, and even if we did, it is not conceivable on our ICU. I mean, who would monitor the patients while both shifts are in report? So, typical for an ICU, report is done just outside the patient's room (in the hallway where we have our desks/computer terminals-one for every 2 patients).

It never ceases to amaze me the families, esp if their loved one has been with us for awhile & they have gotten to know the staff pretty well, who will just come out into the hallway and plop right down in any empty chair, even during report. Of course, each of us has at least 2 patients, so joy joy! They also get to hear just how the patient next to their loved one is doing! And, what if that neighboring patient has AIDs or some other such terminal illness that is totally no one else's business? Amazing, huh?

One thing I have done at times, IF by chance I have a patient not on a vent or sedation or with arrhythmia issues, one that I do not have to eyeball constantly, is to move the family into the room with the patient and close the door during report. I mean, give me a break, isn't that why they are there in the first place?

We have a monitor in each hallway also, so I can still see if someone has a problem. But it is seldom safe to close the patient's door, so we still have the same problem with families overhearing the 7PM report, even if they are in the patient's room.

I used to be a traveling nurse (for 3 years) before I decided to move back to my hometown last year. I worked at a large downtown hospital in Atlanta,GA for about a year as a traveler and loved their visiting policy. 15 min visiting times four times a day. Unless we expected a death or some unusual circumstance was going on, there were no exceptions. In fact, the doors that accessed the entire ICU floor and all of the 5 ICU's were locked & staff accessed the Units with a magnetic card on the back of our name badges. So, four times a day we hit a button inside the unit that unlocked the doors. It was wonderful and staff never had a single complaint about it. Of course, this WAS in a 1500-bed inner city hospital in which security for staff & patients was also an issue. I have been an ICU RN for close to 15 years now, so I have seen every end of the gamet visitation-wise.

Anyway, I adore the ICU I am working on and the staff I work with. My Director is awesome. I can honestly say that this is the only complaint I have. So, I spose I am lucky huh? I have only been here about 6 months, but once I have some time under my belt, I do plan to bring up this issue and see if I can help to come to some kind of workable resolution. Like maybe shortening the visiting times to 2 hours twice a day rather than 4 hours. And, starting them at less care-intensive times, like 11AM-1PM. And, most of all, NOT starting the evening visitation till AFTER 7PM report is completed (maybe start at 8:30PM to give oncoming shift time to assess their patients before they are barraged). That being said, I am STILL all for flexing those times in cases such as when you are terminally weaning a patient from the vent and family should be with them in their last hours. But, somewhere there has to be a compromise for everyone, right?

And, sheesh! I could go on forever with my wonderment of how I can try to enforce visiting hours for my patients who really need it when the nurse next to me lets her patient's family come in and out all through the day as they desire. That is not nearly so bad on the ICU I work on now, but I have seen it become utterly impossible on other Units I have worked on.

Please don't misunderstand me. On the personal front, my own Dad suffers from CHF & COPD. He is in and out of the hospital at least 3-4 times a year. I can totally understand a family wanting to be with their loved one and I too have gotten aggravated at times with visiting hours, but I always make myself step back and remember that my Dad is there for the nurses to care for him and that comes second to my needs, no matter what.

Sorry for the tirade folks. Can you tell I am very passionate about this topic? It never ceases to amaze me the number of times, like someone else said, that you finally get the Ativan or Diprivan gtt titrated just right, get your patient turned, suctioned, no longer bucking the vent, all nice & comfy...and in walks the son who just HAS to yell "Wake up!".

Rant over..thanks for listening.

Meressa, ICU RN

kc ccurn · Feb 4, 2004

Many time with families that don't feel that the visiting rules are for them as well, we like to provide more education and make the family feel included in the care. What I mean is that we try to phrase it "It is very obvious that you love your dad a lot and want him to get better. We need your help with that. One way that patients get better is to have a quiet calming atmosphere so they can rest. Can you help us to take care of your dad by not waking him when he is sleeping. We'd appreciate it if you could pass it a long to the rest of the family."

Not every family will follow this but most do, if they can realize that it is in their loved one's best intests.....sometimes though it needs to go a step beyond. As a charge nurse many times I've been called in to negotiate with a family about visiting. If the family is still refusing, it goes to our director. She's good at negotiating with the family. Many times, it is difficult to negotiate with families but it is a part of the job. A little patient and family education can go a long way!

That and a valium salt-lick in the waiting room....:chuckle

gizelda196 · Feb 5, 2004

That and a valium salt-lick in the waiting room....:chuckle [/b]

:chuckle ::roll

Frenchy01666 · Feb 26, 2004

Many time with families that don't feel that the visiting rules are for them as well, we like to provide more education and make the family feel included in the care. What I mean is that we try to phrase it "It is very obvious that you love your dad a lot and want him to get better. We need your help with that. One way that patients get better is to have a quiet calming atmosphere so they can rest. Can you help us to take care of your dad by not waking him when he is sleeping. We'd appreciate it if you could pass it a long to the rest of the family."
Not every family will follow this but most do, if they can realize that it is in their loved one's best intests.....sometimes though it needs to go a step beyond. As a charge nurse many times I've been called in to negotiate with a family about visiting. If the family is still refusing, it goes to our director. She's good at negotiating with the family. Many times, it is difficult to negotiate with families but it is a part of the job. A little patient and family education can go a long way!
That and a valium salt-lick in the waiting room....:chuckle

When my daughter was in ICU I was unhappy with all the people visiting her. I was barley able to speak and would have loved for someone to get rid of these rude visitors. They only made it worse. They apparently didn't even think that she needed sleep and drove me crazy. Sitting around the ICU waiting room it was horrible. What I would have appreciated from the nurses is a written schedule with there names and who was taking care of my daughter. I am a RN but have not worked in ICU in years. I also would have liked a print out of the medication she was receiving with side effects and the way it should be given. I am upset with some of the nurses because I see they didn't take her temperature but would dope her up or sedated her. If they had asked me to help I would have gladly filled in. There was so much going on.