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24 hour open visiting in the ICU

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rnmama3 rnmama3 (New) New

Specializes in cardiothoracic, trauma, SICU.

I am an RN in a 20 bed SICU that encompasses cardiothoracic as well as trauma, neuro and general surgery patients. Our unit, as many others have, adopted a 24 hour open visiting for family members approximately two years ago. Prior to the change in policy we had a specialized visiting policy which had been working well and appeared well received by family members. Our unit used to be locked with a visitor restriction in place from 2300-0700 as a safety precaution due to our trauma population (and past occurences). Once "the memo" came down the pipes this was no longer an issue and the lock was disabled.

We have over 60 nurses employed within our unit and many handle this visiting policy differently. While some tactfully teach and explain that "peeking in" at any time is acceptable, others pull up three chairs 1 hr. post-op. We are looking at developing unit guidelines regarding visiting in order to get our practice somewhat standardized.

I find that most families after teaching are willing to follow your recommendations on not moving into the room 24/7. Once a patient is awake and talking I welcome families to visit. However, many are not reasonable (due to the stress they are enduring?) and insist on staying 24/7 while a patient is ventilated, sedated on pressors, etc. Any feedback on what your ICU/hospital visiting policy is would be greatly appreciated!

Ruby Vee, BSN

Specializes in CCU, SICU, CVSICU, Precepting & Teaching. Has 40 years experience.

i am an rn in a 20 bed sicu that encompasses cardiothoracic as well as trauma, neuro and general surgery patients. our unit, as many others have, adopted a 24 hour open visiting for family members approximately two years ago. prior to the change in policy we had a specialized visiting policy which had been working well and appeared well received by family members. our unit used to be locked with a visitor restriction in place from 2300-0700 as a safety precaution due to our trauma population (and past occurences). once "the memo" came down the pipes this was no longer an issue and the lock was disabled.

we have over 60 nurses employed within our unit and many handle this visiting policy differently. while some tactfully teach and explain that "peeking in" at any time is acceptable, others pull up three chairs 1 hr. post-op. we are looking at developing unit guidelines regarding visiting in order to get our practice somewhat standardized.

i find that most families after teaching are willing to follow your recommendations on not moving into the room 24/7. once a patient is awake and talking i welcome families to visit. however, many are not reasonable (due to the stress they are enduring?) and insist on staying 24/7 while a patient is ventilated, sedated on pressors, etc. any feedback on what your icu/hospital visiting policy is would be greatly appreciated!

are you ever lucky that most of your families are reasonable! depending upon where you work, that is often not the case!

a standardized visiting policy would be helpful, but only if all nurses follow the policy. if you're going to be the one to say "no food or drinks in the room and only two visitors at a time" as outlined in your policy while the nurse who relieves you says "come on in and have a party", you're going to be "the bad nurse", the one the family didn't like regardless of how critical your thinking skills and skillful your care. personally, i thought the lock was a good idea and am constantly amazed at what can go on without our management team being able to get a lock in place. knives, guns and a gang confrontation didn't do it, so i'm not sure what would, short of a full scale terrorist attack!

your best option is to get all of your fellow nurses on board with the idea of guidelines, and then a small group of interested parties develop them together. if everyone is onboard from the start, there's more chance of everyone abiding by the guildelines once they're in place.

good luck!

tanjaccurn

Specializes in critical care. Has 7 years experience.

I work in the critical care unit of a small community hospital that has 24 hour open visitation.....keep in mind that the hospital now refers to patients as "customers"......the nurses are expected to perform all of their nursing duties/care for the patient while running back and forth to get coffee and sodas for family/friends of the patient....there is no security whatsoever and feel certain that one night a drug-crazed or drunk 'good 'ol boy' will come in with a gun and killl all of us.......maybe administration will then re-think this policy of 24 hour open visitation......:devil:

Ruby Vee, BSN

Specializes in CCU, SICU, CVSICU, Precepting & Teaching. Has 40 years experience.

i work in the critical care unit of a small community hospital that has 24 hour open visitation.....keep in mind that the hospital now refers to patients as "customers"......the nurses are expected to perform all of their nursing duties/care for the patient while running back and forth to get coffee and sodas for family/friends of the patient....there is no security whatsoever and feel certain that one night a drug-crazed or drunk 'good 'ol boy' will come in with a gun and killl all of us.......maybe administration will then re-think this policy of 24 hour open visitation......:devil:

i doubt it. we've had gang members with guns come in and although our manager is concerned with our safety and security is immediately called, we still don't rate a lock on the door!

tanjaccurn

Specializes in critical care. Has 7 years experience.

Why does it always take a major law-suit for hospital administration to 're-think' how they're running the place?

luvRNs, BSN, MSN, RN

Specializes in criticalcare, nursing administration. Has 41 years experience.

This question is a 'hot button' one. Having open visiting comes with associated problems, but ALSO comes with advantages. The advantages are that some families can (gasp) actually be helpful. :rolleyes:

Are there safety and security risks ? Absolutely. I feel the best approach is to have the capability of a 'lock down' if indicated, and clear policies for what that means ( i.e. gang members, domestic violence risk etc)

As far as open visiting, many units per the research has partially open. In tihs case, shift change and rounds may be restricted, with open visiting otherwise. Again, policies and consistent expectations are key.

Finally, staff education and SCRIPTING are critical:pntlft: If suctioning, you may want to say to family " This may make you uncomfortable, so feel free to leave and come back in 5-10 minutes" Many families ( again based on research) may need 'permission' to leave, and will happily do so if you ask them !

I guess the bottom line is safety first, and collaboration, and consistency second. It CAN work :specs:

caeRn

Specializes in ICU, Float RN , Quality & PI. Has 6 years experience.

This seems crazy to me. ICU i work in visiting hours are 8am-2pm and then 4pm-8pm No BODY under age 12 permitted. 24 hours omg i think i would go crazy.:uhoh3: