Managing Visitor Flow to Enhance Security

ThatBigGuy · Jun 10, 2015

I was curious how your ICU's control the flow of visitors on your unit. Do you have them register at a desk? Do you use nametags or access cards to limit visitors in a room? Do you use a security code and primary sponsor to disseminate information about a patient to the rest of the family? Do you limit visitation at night?

We have a locked unit. Visitors must call from the waiting room via the wall mounted phone, and then be buzzed in. Our unit policy is two visitors at a time, but the unwritten rule is that the RN ultimately decides. We don't use name tags or access cards, as a unit we're pretty good at checking with the assigned nurse before letting visitors in. As far as information goes, we are generally pretty stingy with that unless we are face to face with the appropriate family/caregivers. When the need arises to limit access to a pt or to information, then we set up a password or a specific guest list agreed upon by the appropriate family members.

At night, this works seamlessly. During the day, it becomes a bit more cumbersome as you tend to spend a bit more time and effort answering the waiting room calls and checking in with the RN.

AnthonyD · Jun 10, 2015

We have a locked unit, with a doorbell/camera. Visitors have to be buzzed in by the secretary. When a visitor is buzzed in, they have to stop at the desk, and they get a wristband that has their name and the room number they are visiting.

We limit it to 2 visitors at a time per patient, but this is also at the discretion of the nurse (We generally allow more visitors in end-of-life type scenarios, or if docs want to update the whole family at once, etc.).

This is the policy 24hrs.

We also assign each patient a 4 digit PIN code which is given to two designated spokespeople for the patient. These are the only two people that are supposed to receive detailed information, and other family members should be updated by them. Over the phone we won't give any information without the PIN and verifying the spokesperson's name. In the room, we will give general information to visitors, particularly anything that is within their view anyway, but we try not to get into specifics unless the spokesperson is present.

FurBabyMom, MSN, RN · Jun 14, 2015

I work in the OR so I don't have this problem anymore. We are the definition of a locked unit and we don't have visitors. The exception is sometime we have a peds patient and we've determined the peds patient would tolerate anesthesia induction better with a parent present (also that their parent would handle it well too, anesthesia induction is not "normal").

In our facility - all of our ICUs (NSICU, STICU, CTICU, CICU, MICU, PICU and NICU) are locked units (as are all peds inpatient units, L&D, and mother-baby). Most hospital staff don't have badge access to the units unless they work or have patients on those units. The anesthesia (residents/CRNAs/attendings) and OR staff do have badge access to all of the ICUs. We often help transport patients and we also do some procedures at the bedside so we have to have access.

All of our units have a phone system families can utilize to be "buzzed" in. There can be 1 person present 24/7, but the units do have more formal visiting hours for up to two visitors at a time (exceptions made per the ICU nursing staff / nurse manager). PICU and NICU close from 0700-0800 and 1900-2000. We also offer families a pass code that people must know to be given any information about the patient - and generally ask that they designate a point person (usually the patient's spouse, a child/parent, HCPOA, etc).

Greenclip · Jun 15, 2015

We have a very relaxed approach to visitors. The adult ICUs are not locked. Policy is two visitors at a time. When people see how cramped the rooms are they are always very understanding. It is at RN discretion though. End of life is probably the most common reason for us to admit more than 2 people. Visiting is 24/7 but we ask people not to "spend the night"...there is literally no place for them to sleep. We have a couple of large waiting rooms external to the ICUs and people crash there if they really want to stay.

I also explain to the visitors that privacy is important for the patients. In ICU most of the time the curtains are open so that anyone can observe the patient. For that reason it's important to limit the number of people walking past. (They get that very quickly.) For the same reason, we don't allow people to hang out outside the room. They have to be in the patient's room or in the waiting room.

There is no nametag/wristband requirement and no desk to help screen visitors. I would love it if we had that. We have multiple ICUs and visitors often go into the wrong unit. I think a desk and a dedicated secretary would help a lot with that. Although we encourage families to delegate a spokesperson, we only enforce that when we start getting a lot of calls. (We have a password system for people who request total privacy. That is hospital policy, not ICU specific. For password patients, whoever calls has to say, "I am calling about patient X and the password is --." We can't ask for the password, they have to offer it.)

The big thing we do crunch down on is no kids under 14, although at end of life, a short visit is OK. I explain to parents in a matter of fact way that it's not about their kids getting sick or about the kids bringing illness in. It's about the total environment...things that are scary to the adult visitors are much worse for kids. If a code is called, even if it's not in their loved one's room, it's frightening. The psych or withdrawal patients can display behavior that a casual visitor would find unsettling, even if they are just walking past a room. I think it's scary for kids just to see someone who is very sick...let alone walk past ten beds of very sick people with all the equipment that we have.

Here.I.Stand, BSN, RN · Jun 24, 2015

All visitors check in w/ security, and our unit is locked. Limitations on visitors are at the discretion of the RN; officially there isn't a limit, but if crowd control is an issue the RN may say we're going to limit to two at a time. If extra security is needed, e.g. for gang related shootings, we will limit to immediate family only, and tell security that they must check IDs on all visitors. Security and the nurses' stations have lists of people allowed. When the tightest of tight security is needed, we get sheriff's deputies at our unit door and outside the pt room. :ninja: