Shift change and visitation in ICU/stepdown - page 2

Hi everyone, I'm currently looking at various policies re: visitation in the ICU and it got me thinking about issues with shift change. At our 10-bed ICU/stepdown, we restrict visitors from... Read More

  1. Visit  hofamb profile page
    0
    I work in 2 different ICUs, neither of which restrict visiting hours or ages. I've never ran into an issue with it. Occasionally a family member will want to talk to you during report, but I just inform them that we are rounding and will be in shortly. We also explain upon admission that the nurses will be giving report between 0700-0730 & 1700-1730 but will be able to monitor the patient from outside the room. I think this helps reduce fears that they are forgotten about during shift change.

    We also allow visitors in the room at all times. There are very few examples of asking family members to leave and they are usually given the option to stay or go to the waiting room.
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  3. Visit  organichombre profile page
    0
    In our small SICU (6 ICU and 3 TCU) we've had 24 h visitation for a little over a year now and it has worked out well. New staff are often unsure of themselves and don't like to get too nosey with family/friends around, however when asked most people often retire to the shadows to allow staff to finish up assessments.
  4. Visit  MomRN0913 profile page
    5
    We restricted between 7 and 8 am and pm. Still with visitors trying to come or getting mad. People would sneak in so we finally got a buzzer on the door.

    If there was an actively dying patient or a critical patient, we let them stay.

    Too many times family emembers would stand over you while giving report to the oncoming nurse to ask for a blanket or water and there were too many interruptions causing things to get left out in report.

    I think 22 hours out of 24 in the day is acceptable visitation.
    Melodies of Legend, Sugarcoma, KT17, and 2 others like this.
  5. Visit  Yammar profile page
    4
    I have seen much made about how studies support open visiting in the ICU. However, I do not see where all considerations were taken into account in any of these studies. Where is the consideration of the stress when family members feel obligated to stay bedside each and every day? Sometimes sending a family member home allows them to recharge their batteries and protects their health. Also, are the families that hinder care of the ill. Anxiety and suspicious of everything or have the need to call the nurse to the bedside for every single issue.

    The hospital where I work we have designated visiting hours and kick everyone out at change of shift. We do open reports and to comply with HIPPA and insure a proper handoff we have found that the families got to go.

    Exceptions are made and often left to the nurse caring for that patient.

    I would never work in a facility that had open visiting (if I were civilian) as sometimes we as caregivers need to focus on out patient and not the family.
    Sugarcoma, opossum, SummitRN, and 1 other like this.
  6. Visit  SwansonRN profile page
    2
    We're trying to implement visiting hours. Right now it's open. I will say I think it's very important that nurses are able to give report as uninterrupted as possible. For me this means two nurses, sitting at the computers/charts ALONE. Not getting up to answer call bells (unless a nurse is truly needed at that time) and not fetching things for the family or answering their questions. Sorry, I will deal with the family, but first things first I must know how to safely care for my patient. I also think it would be wonderful to have at least a half hour without visitors to go in and assess my patients before the troops come rolling in. I understand dealing with a child of the patient or the spouse, but I really don't want to be tiptoeing around second and third cousins and neighbors at shift change.
    tswim and opossum like this.
  7. Visit  boogalina profile page
    0
    30-bed MICU/SICU at a Level 2...unit locks down for 1 hour at each shift change, but visitors may stay in the patient's room w/door closed so nurses may report.

    Current policy is to allow visitors back during report if they are very insistent and the patient's nurse allows it. While there is a general restriction of 2 visitors per patient and no one under 12 (unless the patient is on comfort care), the age restriction is the most strictly enforced.

    For the most part, this works pretty well. Families seem satisfied. It only really sucks for the unit clerk who gets to play traffic cop. Lots of diplomacy and kissing up helps.
  8. Visit  tswim profile page
    1
    Our ICUs are closed 6-8am & 6-8pm. No children under 12. Flexible.

    Pretty happy with this as it allows time to focus on learning about patients and getting good baseline assessments.
    hikernurse likes this.
  9. Visit  LNRN11 profile page
    2
    I work CVICU and our visiting hours were actually implemented by our CT surgeons. They are 9-11AM, 2-6 PM, and then 8-10 PM. Doors are locked otherwise. Nurses do have some discretion and we always let family members back for a few minutes whenever patients return from surgery. Honestly, I appreciate the restrictions. If I had a hemodynamically unstable patient, I would find it very difficult to concentrate with family members in and out of the room all of the time. For the most part, our family members are actually pretty cooperative. I think the primary reason is that the cardiac step-down the patients move to is 24/7 open access.
    hikernurse and Sugarcoma like this.
  10. Visit  mb55 profile page
    5
    We used to restrict visitation from 6:30 to 8:30. Both shifts. This gave ample time for report and initial assessments, etc.
    We are now Open. All visitors all the time. Family centered, supposedly only one significant other is allowed during shift change/report. However, everyone and their brother too (literally) come in and out at will. Of course administration implemented this new rule, NOT the actual bedside caregivers. Not a single one of us RN's like this situation. We need some time to, pardon me but, get our **** together. When visitation was restricted, it gave me time to thoroughly read charts/orders and truly assess my patient and plan my shift. Also, I was more able to answer families questions. Now, I get bombarded with questions when I literally haven't even spoken to or touched my patient. I feel like I can't/don't do as accurate of an assessment when someone is staring at me, watching every move, and asking questions the whole time.
  11. Visit  opossum profile page
    0
    Well, it looks like we've revised the policy to basically reflect what the AACN recommends: http://www.aacn.org/WD/practice/docs/practicealerts/family-visitation-adult-icu-practicealert.pdf

    We agreed that it should be flexible enough to allow nurses who want to keep the doors locked to be able to do so, but I'm worried about the inconsistency. I don't know...we'll see how this works!

    Thanks again for all your input!
  12. Visit  gaonsi profile page
    2
    Lucky you. We have open visitation, including during shift change. It can get very frustrating and chaotic trying to be mindful of pt privacy but being thorough.
    hikernurse and opossum like this.
  13. Visit  umcRN profile page
    0
    Quote from mb55
    We used to restrict visitation from 6:30 to 8:30. Both shifts. This gave ample time for report and initial assessments, etc.
    We are now Open. All visitors all the time. Family centered, supposedly only one significant other is allowed during shift change/report. However, everyone and their brother too (literally) come in and out at will. Of course administration implemented this new rule, NOT the actual bedside caregivers. Not a single one of us RN's like this situation. We need some time to, pardon me but, get our **** together. When visitation was restricted, it gave me time to thoroughly read charts/orders and truly assess my patient and plan my shift. Also, I was more able to answer families questions. Now, I get bombarded with questions when I literally haven't even spoken to or touched my patient. I feel like I can't/don't do as accurate of an assessment when someone is staring at me, watching every move, and asking questions the whole time.
    Interesting. Must be different in the adult world. I work peds and we have 24/7 visitation for the parents (anyone else from 10-8 and two people at the bedside only and that includes parents). I still manage to have time to check drips with the off going nurse, check my chart, orders, meds, organize my day and get my assessment done. Yes the parents sometimes hover while doing the assessment, but hey it's their newborn/toddler/child and they have that right. Visitors don't typically interfere with the rest of my day though. Yes there is always that one​ family that sucks the life out of you but there always will be.
  14. Visit  SNB1014 profile page
    2
    in my pcu our patients are allowed to have visitors 24/7. i politely instruct them to leave when it comes to changing/cleaning the pt's bottoms, etc.

    in icu, at 0600-0800 and 1800-2000 there are no visitors, no exceptions. they make a loudspeaker announcement at 0545 and 1845 that all visitors must leave for change of shift and that security will "assist them", if need be. they say the icu waiting room is open and that the cafeteria is open if they'd like.

    they also do not allow visitors to stay the night, however i am not sure when visiting hours are, exactly.

    if the family member has been in the icu a few days or more, the family usually knows and starts heading out the door around 1740. it is also in the ICU "welcome pamphlet" that says this is so our RNs and RTs can more safely and effectively ready patients for the end of shift, clean them, prepare orders, give report and the oncoming nurse can familiarize herself, something like that.

    the nurses seem to really appreciate it.


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