Kicking out visitors during report

[delphine22]

Rumor at my facility is we will soon scale back our very liberal (meaning: 24-hour) visitation policy to removing visitors between the hours of 6 and 8 twice a day, with the exception of the health care surrogate/decision maker. It's becoming harder and harder to give report with all these family members milling around in the hallway and potentially listening in on other people's HIPAA, plus we like to turn and clean our pts together at this time, which is hard when the grandkids are all around.

If your unit does this, how do you get them out? Tell me your firm but gentle script that you say, please!

[icuRNmaggie, BSN, RN]

We seem to have a lot of visitors who make a beeline to the nurses station when we start report at 1845.

They interrupt report as though it's very important but what they want is to socialize. Then you find out they are not even related to the patient. It's weird.

[ChipNurse]

Yes, liberal visitation is beneficial for the patient and the family, but many family members feel it necessary to never leave the patient's side and take care of themselves. I have literally seen family members who don't go to the bathroom or eat for 10 hours straight. That is not healthy. Some family members need to be "forced" to leave in order for them to feel it is "ok" to leave the bedside. Of course exceptions are made for actively dying patients. I also call them back if there are unexpected changes in patient condition. Also, many times family rotates out 24 hours a day, each one requesting updates and have many questions. I am thankful to have an hour to get acquainted with the patient, get report, get my assessment done and review orders without interruption, then when they come back I can better update them on the plan of care.

[aei631]

I know that studies show open visitation is helpful to the patients but in the ICU I work in I don't find this to be very accurate. Our patients are very sick, and a lot of the times we end up with families anxiously hovering and agitating the patients. We also have a policy of no visitors between six and eight.

I politely tell my family members that hover that while their loved one is in the ICU they are on a 2:1 ratio with their nurse and they are receiving a great deal of attention in the ICU. This is a good time for them to rest and make sure they are as healthy as possible because the real time their loved one is going to depend on them for assistance is as the improve and move out to the floor and prepare for discharge. They are usually pretty receptive.

Anyway, I guess I got a little off topic there. I'm just polite and straightforward with them. It's explained at admission so we page overhead throughout the unit and let them know that quiet time is starting, to please exit the unit, and that they may re-enter at 8.

[canned_bread]

I say "Hi, *introduce myself if haven't done already*, visiting hours have finished until such-and-such-time. Would you like to go downstairs to our foyer and get yourself a cup of coffee? You can come back up at *such and such a time*"

[fitzfan82]

I think in general spouses should be an allowance. I was hospitalized with DKA last winter and the ER triage nurse made my husband wait and told him "because I might still be getting changed". Um, I think he's seen it . DKA is scary AF, I wanted my husband there. And Hipaa? Again, he knows, and should know, everything about my condition. I may need to write this into my living will.

Previously I worked hospice inpatient - thst could get out of hand but we tolerated it, to a point. I can see asking siblings, friends, cousins, to leave, but not spouses.

[weirdscience]

Having no audience for the initial assessment IS helpful. I want zero people asking me how I like working nights, asking for blankets/ice, or making other idle chit-chat while I'm checking gtts and listening to their loved one's heart tones and lungs for the first time. It makes all the difference in the world in starting the shift off organized and well-prepared.

Most families are respectful of it and appreciate the feeling of a short release from the bedside. We have signs, and we reinforce it at the beginning of each shift. We also make exceptions for comfort care.

[CodeNurseBrown]

The only unit I've seen it work well in was when it was announced overhead at 6pm that all visitors needed to leave at that time and could come back after 8. My unit encourages people to leave, but it isn't a requirement, so it never happens. I make them leave by telling them, "Hi, we're about to have shift change and I'll be asking you to leave for about an hour. This lets us thoroughly report off on your loved one and make sure that we don't overlook or leave out information that is pertinent to their care. It also lets us talk about our patients without risk of violating federal privacy laws. I appreciate your cooperation."

[CodeNurseBrown]

And Hipaa? Again, he knows, and should know, everything about my condition.

I don't think the concern is that he hears about you. The concern is that Nosy Ms Mable down visiting in room 2 hears about your condition.

[MunoRN, RN]

We actually request that family or members of the patient's support system be there during report since staff won't be doing the continuous monitoring we would usually be doing, which is why the highest likelihood of falls, self-extubations, etc occur during shift change. The more family that can be present and help prevent adverse events the better. I can't really imagine discouraging that help, that seems like you're just inviting adverse events.

[PacoUSA, BSN, RN]

I have fantasized about having large STOP signs posted at the nurses station at 7am and 7pm to alert visitors and patients that the nurses should not be interrupted during report. Nothing is more irritating that to have someone waving a plastic pitcher in between two nurses faces at 705am/pm asking for ice!! >

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[66h123]

The the two ICUs on my wing of the hospital have large STOP signs posted in front of the doors, yet visitors walk around the signs, move the signs and feel as though the instructions to give us an hour to deliver a safe and uninterrupted report don't apply to them. More frustrating is that the majority of the nurses (but worse yet management) in my unit don't enforce the 'no visitors during shift change'.

Yes, the 'no visitors' request can and is modified when the patient is actively dying, however most patients in the unit are not is that state. Visitors can be there 22 out of 24 hours. Please, give the nurses 2 hours with no requests for coffee, a phone, ice, etc. It's not an unreasonable request.

[VANurse2010]

We actually request that family or members of the patient's support system be there during report since staff won't be doing the continuous monitoring we would usually be doing, which is why the highest likelihood of falls, self-extubations, etc occur during shift change. The more family that can be present and help prevent adverse events the better. I can't really imagine discouraging that help, that seems like you're just inviting adverse events.

If you're relying on family to prevent self-extubation, the patient is not being managed well in other ways