Shift change and visitation in ICU/stepdown

  1. 0
    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 personal feeling is that we should extend it to 0800 so that each nurse has enough time to at the very least give the patient a once-over after receiving report.

    A coworker suggested doing away with visitor/call restrictions during shift change altogether, in the name of family centered care...I did a cursory web search for any studies focusing on visitation and shift change, but came up with nothing. (I plan to research more extensively on EBSCO or other scholarly database in the near future).

    There is, however, plenty of anecdotal evidence abound. My question to you all is: have you heard of open visitation during shift change? If so, do you know how well it has/has not worked for that unit?

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  2. 31 Comments...

  3. 1
    Your facility sounds similar to ours. We restrict visiting from 0630-0730 and 1830-1930. In Our ICU there are only 2 visitors per patient and no children under the age of 10.
    We are currently in the process of revising our policies and attempting to make it better. The problem in our unit is that there is a constant influx of patient family members and visitors with total disregard for the nurses. The previous admin tended to side the the "customer" and it seemed like our ICU visiting policy wasn't utilized. When we could ask visitors to leave or adhere to the 2 person limit, they would get upset and "report" the nurse. It was extremely frustrating.
    Now we have new admin and management. Apparently they are focused on family centered care and apparently studies have shown that patient morale (not to mention satisfaction scores) have improved with the initiation of the "support person" that is allowed to stay with the patient at all times. They are allowed to stay all night in the ICU as long as they aren't a creating a disturbance or preventing staff from properly caring for the patient. We are going to attempt to place visiting hours at certain times of the day/night. We are still in the early stages of planning. I'm hopeful that it will help.
    opossum likes this.
  4. 1
    In the icu I work in we have a no visitors policy from 6a-8a and 6p-8p. Outside of those hours the patient is allowed one 'support' person who may come and go as they please. The are asked to wear an armband that identifies then as the support person and we keep a picture of them in the patient's thin paper chart. Any other visitors are held to visiting hours. There are three times for open visitation on day shift and one at night. A lot of the nurses will let family back during non-visitation hours though if the family is not a problem and it doesn't interfere with care of the patient.
    opossum likes this.
  5. 4
    My only experience is as a NICU and PICU parent.

    In the NICU, they had a no vistors +/- 30 minutes from shift change. It was sometimes problematic for us as a family. I later did a preceptorship there and they had eliminated that policy, with no significant deleterious effects.

    PICU was 24x7 access, soft limit at 2 but were generally OK with 3 or 4.

    I'm an advocate of providing unrestricted and unlimited access to the family - but as a privilege, not a right... and privileges can be revoked.
    Halcyonn, poppycat, umcRN, and 1 other like this.
  6. 1
    Our PICU allows parents 24/7 access, others are cut off at 2030, limit three total at bedside and none except siblings under 18. One parent may sleep at bedside, but they can both stay if they are awake.
    We have had to restrict visitors to those who will comply with isolation and hygiene policies when that becomes an issue. We are a locked unit, and that helps a LOT.
    opossum likes this.
  7. 0
    Thanks for all your replies; it's good to get a sense of what policies other ICUs have. Ours is pretty generous, as we let basically anyone in, however many want to come in as long as it doesn't interfere with patient care. We have a locked unit with a camera so we can see who is buzzing in. If there is an entourage waiting to be let in, I'll usually go to the door myself and request 2 or 3 at a time.

    We also restrict children under 12. Interestingly, when reviewing the literature, I found that there is no evidence to support restricting children based on fear of infection to either the child or patient (Knutsson and Bergbom, 2007). They actually refer to previous studies that support this...Nurses' and physicians' viewpoints re... [Nurs Crit Care. 2007 Mar-Apr] - PubMed - NCBI

    My main issue at this point is whether or not we should pursue this idea of doing away with shift change restrictions altogether. I'm going to see if HIPAA requires it. I would feel it would be in both the patients' and nurses' interests to have adequate time to do report and assess the patient.
  8. 3
    We have no visitor restrictions during shift report and it is very challenging. We are a combined ICU/Step-down and we report off in the pods outside of our assigned rooms. There is no privacy. Visitors and sometimes patient's use this as an opportunity to request things, vent frustrations, try to lurk behind us and listen in, etc. etc. It is EXTREMELY frustrating. I find myself having to tell people constantly that they cannot listen in. Often times they become confrontational and I have to tell them I have two patient's and I must protect both patient's private information and that I am sure that you would not appreciate me letting a stranger listen in on report about YOUR loved one. It is frustrating and time consuming. I NEVER leave on time and neither do many of my coworkers.

    Based on just my experiences on one unit (so take that for what it is worth) I would say open visitation during report leads to incomplete report (do not want to chance anyone overhearing something like drug use, ETOH, STD's, Psych history etc.), frequent interuptions, and unexpected overtime costs due to nurses leaving later. I also think it contributes to low staff morale.

    If we had a designated private room for report like we did on the med-surg unit I worked on I would have no problem with open visitation.
  9. 0
    I work PEDs but we have open visitation for parents and others may come during visiting hours 10a-8 p. We rarely have issues. We only allow two visitors at the bedside and that includes the parents so they have to rotate out. Siblings are allowed as long as they do not have a fever or have had any cold symptoms...this I have a problem with as this past winter we had one of our cardiac kiddos come down with the flu bad (kids never been home in his life). Mom was in an uproar blaming every one of us, until their entire family was taken out by it.
  10. 0
    We have 24 hour visitation. The other day a patient's family member came out of the room and interrupted report with some information and questions. Luckily, the interruption was brief. I could see it being a major problem at times, but the RN does have control to ask people to leave as needed.
  11. 1
    We transitioned to a completely open unit and took the locks off the doors in the name of family and patient centered care. The literature presented clearly supports it, and family members love it. Nurses generally hate it, because they treasured the no-visitor shift change time to prep for the shift without any distractions.

    It is workable and even beneficial, IMO, if nurses are consistent with what they tell family members about what to expect about shift change and bedside report. After addressing any pertinent questions or needs right before shift change, request no interruption during report. Let them know that you will come into the room to do bedside report and medication and IV line reconciliation with the oncoming nurse, too.

    If family members grow to expect a routine, the majority of them will be respectful... in my opinion. There are always outliers.

    If it were my family member hospitalized, I would be offended if I were not allowed to be bedside at an hour of any day.. as long as I was not interfering with care.
    umcRN likes this.


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