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!

[VANurse2010]

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.

See, I've worked in hospitals with open visitation, but I've never worked in one where drink orders and blankets were considered acceptable requests. If family asks me for sodas etc., I politely direct to the cafeteria and/or vending area.

[MunoRN, RN]

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

Many years ago that was true, that would mean they weren't getting enough sedation, although that level of sedation isn't really considered appropriate anymore.

[VANurse2010]

Many years ago that was true, that would mean they weren't getting enough sedation, although that level of sedation isn't really considered appropriate anymore.

Despite the move against heavy sedation and restraint, if the patient is so unsedated and not restrained as to pose an extubation risk without constant supervision - that is mismanagement of their care.

[MunoRN, RN]

Despite the move against heavy sedation and restraint, if the patient is so unsedated and not restrained as to pose an extubation risk without constant supervision - that is mismanagement of their care.

If they are sufficiently sedated to ensure they can never rouse then that's generally considered excessive sedation by today's standards. In order to reliably assume a patient won't wake up at all you'd have to have RASS of -3 to -4, which isn't recommended in most patients.

[VANurse2010]

If they are sufficiently sedated to ensure they can never rouse then that's generally considered excessive sedation by today's standards. In order to reliably assume a patient won't wake up at all you'd have to have RASS of -3 to -4, which isn't recommended in most patients.

Again, I am not disagreeing that a RASS -3 - -4 isn't desirable; I'm saying that relying on family to constantly supervise an agitated patient or expecting nursing to be in the room 24/7 is inappropriate unless sitter staff is specifically employed for that purpose or other measures are deployed. That is not appropriate use of resources, and thus is a mismanagement of care.