Dealing with ICU visitors

[leesespieces]

I need to know if others out there have the same difficulties with patients family members/visitors in the ICU.

In my facility visiting hours are more strict than they are on the floors. Visiting is supposed to be from 12-8 and we close the unit to all visitors during change of shift (for HIPPA reasons). There are only supposed to be 2 visitors at a time and no children under 12 allowed. We even give pamphlets on the ICU to the family at the time of admission to the ICU that outlines all of the above in addtion to things to expect when your loved on is in the ICU.

However, more often than not 3-4 or more people will show up and go into a patients room at a time. (Part of this is the fault of security and/or visitor control). When they are reminded of the rules or when the overhead announcement is made when visiting is over for the night or during shift change, visitors simply ignore us. In a few instances they refuse to leave. And once recently we've had to call security and the police dept.!!

I am not heartless and I do understand and am willing to make exceptions when I know the pt's spouse or child works until late and wants to come by after hours for a little while or if the pt is actively dying etc. But many times these are patients who are completely stable whose families give us the hardest time. Also, there are times there are 4 visitors in this rm with the patient, a vent, monitors, mult IV poles, IABP etc and they are crowded around the patient and when I come in to do my job to care for THIER family member they don't even back off so I have to do acrobatics to hang a new drip or check a BP! And they act like its such a nuisance to let me do what I need to do when I ask them to please move. We explain to them that ICU pts need more rest than they think with all the tests, procedures, etc they go through. But it doesn't stop them from yelling into their loved one's face (who is vented and on a propofol gtt) "WAKE UP MOM!!!! I KNOW YOU CAN HEAR ME!!! WAKE UP AND LOOK AT ME!!"

They use their cell phones in the room after being told it interferes with the monitors connected to their loved ones. They don't wear the appropriate PPE when going into an iso room. If they do wear it, they leave the room and go in the hallway to talk on their cell phones still wearing the gown and gloves. And the nastiest thing of all is when the use the bathrooms that are shared by 2 rms to dump bedpans and urinals!!!!

Not sure if I've just lost my patience along the way or if anyones meets this much resistance, and often outright rudeness from family members. I love it when they finally do leave saying so intentionally loud "Sorry I have to leave, the nurse is kicking us out" or "they won't let me stay with you."

Just wondering what your visiting restrictions are in your ICU's, if you meet the same resistance, and what you all do in these situations.

[SummerCCRN]

I bet we work in the same ICU and just haven't crossed paths...

[blueheaven]

I have worked in several hospitals and none of them had locked ICUs. We had a phone in the waiting room that dialed directly to the nurse's station and visitors could ask if they could visit. This works only if the person is literate. It was and still is amazing to me that you can post a large 3x4 sign on the doors of the unit to call before entering and how many people are suddenly illiterate and blind .

Have any of you noticed that usually when you get one PITA family-it spreads?! We had about a months worth of really "challenging" families. Seems like it comes in spurts.

Ms. X (patient) who had done everything to absolutely kill herself (without actually suiciding) with ETOH, drugs, etc. was dying of a complication of her lifestyle. Talk about problems! Her family said that we were just letting her lay there and die, (uh, excuse me folks...we weren't the one that came in with + everything on the drug screen, + other miscellaneous lifestyle diseases, and a liver shot to hell) complained about every little thing, went to the patient advocate over every other thing, threatened to sue us all etc...Anyway this bunch got many of the other patient's visitors in an uproar and it made life for all of us very difficult for a while.

We utilize security if we need to. Really and truly, all the nurses I work with follow policy pretty well. We also will bend rules where appropriate. A lot of the time, a simple explanation for the reasons behind why we ask them to call is enough. Guess we will always have a few that will make our lives "interesting" Sigh.

[dissle]

2 til 8pm, visiting, that is it. 2 visitors at a time, and next of kin only. Any other visitors are allowed if the nOK gives permission, again, this is restricted.

This is a given and is not questioned in my dept.

Relatives are told of this rule and why we have this rule.

There are of course exceptions to this as already stated.

It works well, it has done for years. We have never had to call security, we have never had an issue..may be somethig to do with the polite English, but we all know what we are doing and we all do it.

[dissle]

To be fair, it gives them "permission" to not be there exhausting themselves 24 hours a day.

Also, we get quite close to our families, and build up a trusting relationship, they see their relative is bieng cared for with respect and with dignity, then very often feel comfortable leaving thier loved one in our care. We are quite proud of this reputation.

Having spent time talking with families, we can kinda work out with them what level of visiting they feel comfortable with.

We are a small unit (13 beds) and as long as they are kept well informed and we communicate effectively with them, they dont usually make an issue of visiting.

When we have a child in, the parents stay, no questions asked....but then we transfer them ASAP to a specialist centre.

[Mommy_of_3_in_AL..RN]

We have oopen visits, with certain "rules", that are never followed. Supposed to be open from 0830 to 1800, but we ALWAYS have familys rolling in at all hours, while were are trying to give/get report, and trying to hoard the docs while they are trying to take care of the patients. However, that doesnt usually bother me as much as those that, never fail, call everyday at 0700, right in the middle of shift change, and insisnt on talking to the nurse from the night shift, the day shift, and any docs that may be there. And, kid you not, want us to take the phone into the (comatose, vented) patients room so that they can "talk" to them...iwant to scream sometimes!! dont usually mind having family there, as long as my room isnt crowded, i can get to what i need to do,and you arent agitating my patient that is already in 4 point leather restraints (yes, i am dealing with this now..meth OD plus a little of everything else)..And do not,and i repeat DO NOT come track me down in the other patients room down the hall to ask me if i took your loved ones temp last hour or if i will take it NOW..i am about to code this other patient. Your afebrile daughter can wait one darn minute...oh yeah, and not to mention said mother UNLOCKED her daughters LOCKED restraints, cause she wanted to move around in bed...WHAT??? yeah...and with all that kicking and fighting she almost knocked ALL of us nurses and a few security guards out! (yes, the previous nurse was an idiot for leaving the key in the room and letting mom know where it was..that is being handled) Seriously people...seriously (yes, i work in MICU, but lately it seems like the catch all unit for all the psych/OD patients.....)

[Ruby Vee, BSN]

we have oopen visits, with certain "rules", that are never followed. supposed to be open from 0830 to 1800, but we always have familys rolling in at all hours, while were are trying to give/get report, and trying to hoard the docs while they are trying to take care of the patients. however, that doesnt usually bother me as much as those that, never fail, call everyday at 0700, right in the middle of shift change, and insisnt on talking to the nurse from the night shift, the day shift, and any docs that may be there. and, kid you not, want us to take the phone into the (comatose, vented) patients room so that they can "talk" to them...iwant to scream sometimes!! dont usually mind having family there, as long as my room isnt crowded, i can get to what i need to do,and you arent agitating my patient that is already in 4 point leather restraints (yes, i am dealing with this now..meth od plus a little of everything else)..and do not,and i repeat do not come track me down in the other patients room down the hall to ask me if i took your loved ones temp last hour or if i will take it now..i am about to code this other patient. your afebrile daughter can wait one darn minute...oh yeah, and not to mention said mother unlocked her daughters locked restraints, cause she wanted to move around in bed...what??? yeah...and with all that kicking and fighting she almost knocked all of us nurses and a few security guards out! (yes, the previous nurse was an idiot for leaving the key in the room and letting mom know where it was..that is being handled) seriously people...seriously (yes, i work in micu, but lately it seems like the catch all unit for all the psych/od patients.....)

we have family that insist upon calling at change of shift. i don't even come to the phone; i just ask the secretary to ask them to call back in an hour or two. if they don't get any information at 0700, they'll stop calling at 0700.

[Mommy_of_3_in_AL..RN]

we usually do the same..but usually they call back in about 10 minutes...something about an "hour or s" just isnt comprehendable to some people!!

[morte, LPN, LVN]

we usually do the same..but usually they call back in about 10 minutes...something about an "hour or s" just isnt comprehendable to some people!!

then it keeps being an hour, from the LAST time that they called.....this comes under the heading "we teach persons how to treat us"

[I_LOVE_TRAUMA, RN]

We set up appt. with our family members. It is our policy to tell them that we will call them every morning at 0600 and every evening at 1800, and we do, not matter what, we let the family pick one person to be the call person. When we explain this to them we remind them how if people are calling all of the time, then it takes away from our time with the patient ( an the second patient if we have one), we also let them know that we will call them when there is any kind of condition change right away. Since implementing this policy we rarely ever get a call from family, except for the occassional frantic mom who had a bad feeling, and this is okay with us. When we call them we make sure to note any changes and the plan for the day, this helps to alleviate a lot of fears.

[colddeadpeople]

10 minutes every hour only invites trouble. Every hour, you're asking for it. Every 4 hours makes it more manageable. But even then, and you are correct, it must be backed up by management with some "help" to enforce it.

We all lose credibility when we aren't backed up.

[organichombre, ADN, BSN, MSN, LPN, RN]

Our visiting hours were 1030a till 9pm and we let people come and go pretty easy and tried to keep only 2 or 3 in at a time. We didn't let little ones in because of both the trauma of seeing all the stuff and the risk for catching something. It seemed to work pretty well but now the institution has went to 24/7 visitation with no age limitations. Of course they still say it's up to the "nurse's discretion" but we all know what that means...no back up when someone reports that they could not visit! We'll see how it goes and since we just moved into a new unit we can put up with some rules!

[IheartICUnursing]

My ICU has totally open visitation, 24/7. We do not really have any set rules as far as how many can be in the room at a time or who can visit. But it is still at our discretion to limit visitors if we feel that they are keeping us from providing adequate/ safe care or we see that the patient is becoming distressed.

I have not yet incountered a situation where I have had to ask family to leave or limit visitation (except once in a code situation when a family member refused to leave the bedside!)... but from what I have hear, management almost always backs up the nurse on these issues.

Even the design of our unit is very family friendly, with all private rooms with lots of space, usually room for several people to sit comfortably in the room at a time.

Most of the time we don't encounter many issues and our patient and family satisfaction scores are extremely high, but we do occasionally get those difficult families as well- seeming upset that they need to move out of the way so that you can get access to the pumps, the foley, the pt... or they think seem to think the bedside table is for them, and don't think its fair if we need to use the table for a procedure or something because they are too busy eating on it!! ughh, I could go on and on lol.

I feel like with these families it is so important to set limits with them as soon as they arrive on the unit. If one nurse lets them do whatever they want, then that is what they will expect for the rest of their time there!