24 Hour Visitation

Recently we went to almost 24hr visitation, with only change of shift closed (and we have been fuzzing the boundaries there too.) It is great. Great for the families.

It does require the nurses to be more . . . assertive. When you have a family that wont stop stimulating a little premie, for example, you cant just think "oh, dr rounds are in 10 minutes, then they will have to leave, so I won't say anything." Same with sibling visitation - we now let in young siblings for "as long as is beneficial to baby and the sibling." Now the nurses have to learn how to politely say "Your crazy 3 year old with the poopy diaper and the wandering fingers is driving us all nuts so get him out of here!" Politely. :-) Personally I don't have a problem with it and think that when said with a smile, most corrections go over well with reasonable people. The unreasonable ones . . . well, they were going to create trouble no matter what I say or how lenient/strict the rules are.

The NICU I am working in will soon be transitioning to 24 hour visitation for parents. That means they will be able to be present for shift change as well as procedures that you would usually ask parents to leave for. For those of you who work in a NICU that has 24 hour visitation for parents... How has it been working out?

We have 24-hour visitation, but we do not permit parents into the unit during shift change.

In fact, I have never heard of a NICU that did.

Tell your manager that this is a MASSIVE HIPAA concern when giving off report, if report is currently done at bedside.

Our NICU is closed to parents between the hours of 6 and 7...am and pm.

They are told this on Day 1 and the hours are posted on the front door.

The only exception is if an infant is expected to die...the parents, obviously, do not have to leave.

Children under the age of 12 are not permitted...sibling or not. It's an infection control issue.

We don't permit more than 2 people at the bedside at a time and have to do the 3-minute scrub at the door plus hand sanitizer at bedside.

We have 24 visiting anytime for parents. No restrictions. We would only ask them to leave for things like bedside surgery or cath procedures. Report is given at the bedside, but will step away as necessary if parents are nearby and are careful to talk softly and away from families. Yes, report is a HIPAA concern, but it's not really as if no patient information is revealed any other time of the day. Anytime you give a parent a phone update, other parents in the room here you. Etc. It takes our attendings 8-10 hours to round on all our kids, so we couldn't possible restrict visiting for that whole time. We have not had a problem or complaints with this current arrangement.

We have 24 visiting anytime for parents. No restrictions. We would only ask them to leave for things like bedside surgery or cath procedures. Report is given at the bedside, but will step away as necessary if parents are nearby and are careful to talk softly and away from families. Yes, report is a HIPAA concern, but it's not really as if no patient information is revealed any other time of the day. Anytime you give a parent a phone update, other parents in the room here you. Etc. It takes our attendings 8-10 hours to round on all our kids, so we couldn't possible restrict visiting for that whole time. We have not had a problem or complaints with this current arrangement.

It's a HIPAA violation if you are talking about the treatment of the patient, right in front of the patient bed.

No ID is necessary...doesn't take a rocket scientist to figure out which patient you are reporting on.

I think more needs to be done to protect the privacy of parents...that is "assuming" that parents don't mind just because they don't complain.

They shouldn't have to file a formal complaint to get their privacy protected.

Well, that's why we step away if there are parents nearby. Depending on the size of the room, we may step across the room or even out of the room as needed to protect privacy. Of all our day, I feel our report is least a HIPAA violation as compared to....talking with a family at their own bedside about their baby, filling in people who come to the bedside in an urgent situation, taking phonecalls about the baby at the bedside. We have shift changes at 7 am, 11 am, 3 pm, 7 pm, and 11 pm, so restricting visitation during all those times would not be at all family friendly or family centered. Instead, we choose to alter our own routines as needed to protect the privacy of the patient rather than making these restrictions on families. I agree that is essential to protect patient privacy, I just don't agree to restricting visiting is necessarily necessary to do so, depending on the size and design of your unit.

We have 24 hour visitation. We have "pods" that have 2 babies each; each pod has a nurse's desk in the hall with windows that look into each pod. During report parents are expected to be off the unit or in their baby's room while we give report at the nurse's desk. No HIPPAA violation there. Siblings 7 years or older are allowed if they haven't been exposed to illness in the last couple of weeks; parents are given a questionnaire to fill out and sign on this. Most parents/family members are very cooperative with our rules; as mentioned before, any who aren't would be uncooperative in any situation. I was at this NICU before the new visitation rules, and our satisfaction scores have increased since this new policy has been implemented without detriment to our neonates well-being.