Shift change and visitation in ICU/stepdown - page 2

by opossum

6,116 Views | 31 Comments

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 0700-0730 and 1900-1930; my... Read More


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    I work in a combined ICU /step down. Our posted visiting hours are 11-2 and 5-8. Exceptions for patients going for surgery or an invasive procedure. Limit 2 and no one under the age of 12.
    Unfortunately, it seems the only ones to follow the rules are the pleasant family members.
    There are constant interruptions at change of shift and its very frustrating. Family members like to hang out at the desk and are appalled when we kindly shoo them away because we are discussing private information on other patients.
    Recently at a staff meeting, our nurse manager said we are going to have unlimited visiting hours due to JACHO policies. We will still be able to limit 2 visitors.

    And just to vent.. Seriously families- please tell me why anyone would think its appropriate to have 8 visitors in a room at once??? It's hard enough to maneuver around with 2 visitors. I'll be damned if they go downhill or code and you're in my way!! Ugh.
    hikernurse likes this.
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    We have an open-door policy on our unit. Sort of. Visitors are required to call the unit from the hallway before they enter. We generally restrict to 2 at the bedside and parents are not permitted to sleep on the unit except in the most extenuating of circumstances. (We simply don't have the space. We have 8 open beds, 7 single rooms and one double room.) Visitors are not asked to leave during shift change or during rounds, but we do close the unit for sternal closures, ECMO cannulation and decannulation and some other procedures. Opinions vary as to whether we should close the unit when a patient is actively dying, during codes and such. Recently a long-term patient of ours who was palliative arrested and died in one of our open beds - in the middle of the big evening crush of visitors. The patient was moved to a private room but the unit was not closed so the other families were witness to these parents' grief. Some felt this was inappropriate and that the unit should have been closed. Others didn't see the point. I'm on the fence.

    In terms of logistics, there is very little cause for concern over having families on the unit during shift change or rounds. They are typically respectful of others' privacy (with a few notable exceptions, and we pick up on them very quickly); most don't interrupt during report and are quite patient during assessments. The double room presents some potential issues, but my experience with families in that situation is that they understand the limitations of the space and mind their own business as much as possible. We only have rare complaints over shared space. As one of the PPs has said, education on expectations is key.
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    I'm so jealous of those of you with visitation restrictions! The other two ICUs in my hospital do not allow visitors between 6a-8a and 6p-8p. I work cardiovascular surgical ICU, and we have NO limitations on visitors. It nauseates me to see small children running around visiting immediate post-op open heart patients. Not to mention visitors roaming around during report. I usually ask visitors to leave the room while I do my assessments, and many of them perceive this as being rude. They don't realize that I'm trying to consider the privacy of my patients, plus it's much easier to do what I need to do without having to work around a number of people gathered around the patient. Sorry, went off on a bit of a tangent there. Lol.
    hikernurse likes this.
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    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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    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.
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    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.
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    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.
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    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.
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    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.
  10. 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.


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