Open visitation in the ICU

Night__Owl, BSN, RN · Jul 16, 2018

We have 7.5 total hours of visiting time per day. No kids under 12 (heavily enforced), and no food or drink (rarely enforced unless there's a problem.)

We do make exceptions (on both the kids part and the strict hours part) *occasionally* in end of life situations. And we will sometimes give spouses a little extra visiting time if they can't come during normal visiting hours due to work or something.

I would be against open visiting hours. Too many people don't understand what is appropriate, and would do things either detrimental to themselves or the patient. Like staying all night and bothering them further from getting sleep.

MGMR · Jul 16, 2018

I work in peds cardiac ICU, so the environment is obviously different than with adults. But we have open visitation 24/7. Technically only two family members are allowed into the room at a given time, no children under 7(?) are allowed without showing their vaccination records, and they're allowed food and drink (even though nurses can drink water at the computers lol). People usually come in for short bursts of time and then leave anyway, so it usually isn't a problem - especially for night shift.

Since it's a pediatric floor, we have security at the front allowing people in and keeping tabs on how many family members are at the bedside. If family members are not cooperating with the bedside or charge nurse, we can ask security to escort them out. Although this has never been needed in the years I've worked there.

smf0903 · Jul 16, 2018

We technically have visiting hours from

07:00-20:30. Two person max, strictly enforced. No one under 12. Flu season generally sees a period of time when no one under 18. We make exceptions for end-of-life as far as visitor policies. We let visitors stay the night conditionally...they are not to interact with a sedated or sleeping patient, no touching machines (yeah we've had people trying get to adjust settings on vents and bipaps...they get shown the door)...basically let us do our job and let the patient rest/heal. Anyone messing with that is asked to leave, no matter what time of day. We encourage family that are involved with care and decision-making to be there during A.M. rounds. No food/drink if patient is NPO.

Editorial Team / Admin · Jul 16, 2018

Almost 24/7 open visitation. Only exception is 0700-0800 and 1800-2000 for bedside report and patient quiet time. No children under 12. Exceptions to both rules made for end of life situations and the occasional ICU wedding.

PeakRN · Jul 17, 2018

What are your hospitals visitation policies?

Depends on the unit. Generally speaking we do not limit visiting times. We try to limit visitors to two at a time excluding end of life or other special circumstances. If visitors are disrupting patient care or the unit we will ask them to leave.

Do they allow children and what age is the cut off?

We limit kids under 14 during respiratory season for most units and situations.

Food and drink from outside allowed in?

Yes. Like anything else if it disrupts the environment of care we will address it.

Charge200J, BSN · Jul 17, 2018

Adult CVICU...2 visitors at a time. 24hr visiting. Only 1 family member can stay the night at the bedside. We make exceptions during end of life/withdrawal of care - then we allow larger groups/whole families to come back at a time but they cannot be blocking the halls/exits or disrupting other patients/families. No kids under 14. No animals, food/drink, or flowers. No sick visitors. I really wish that we'd enforce a "siesta time/quiet time" in the late afternoon - would help the overall stress level of the patients/visitors/and staff.

Kooky Korky, BSN, RN · Jul 18, 2018

When the patient needs to be turned, cleaned, nude how do you handle this?

I have never been comfortable with patients being nude in front of just anyone and everyone.

I don't think it's right for kids of any age to see their parents nude or vice versa (with grown kids), for instance, although I know that many people do not feel squeamish about this. Maybe they've even been doing bodily care of their loved one at home.

I just announce that it's time for the patient to get his dressing changed, his bath, be turned to prevent bedsores, etc. and there will be nudity, so that anyone who should not see Joe or Mary nude should go ahead and step out for about 20 minutes. It's amazing how much rancor this can engender. People don't realize that you just can't always do things on their preferred schedule. If they tell me they only have so much time to visit and that I should do my work later, I promise to try but do not promise to be able to because of the possibility of something more urgent arising. That seems to further piss them off, some call the Sup, some adamantly, defiantly stand in the way between staff and the patient, some understand and step out.

Life is fun, huh?

Ddestiny, BSN, RN · Jul 18, 2018

It sounds like I'm in the minority but, honestly, I really like having more open visiting hours. Granted I've only been in Critical Care for a year so I haven't known it any other way, but I do know that when people aren't able to be present for other reasons (time/distance/money issues) they are so much more anxious, and some will even be more suspicious. I am someone that wants everything out in the open and I tend to give more information than is asked just because I feel like it sets people at ease and it helps them to trust us more. I think when people are gone, especially when they feel we're not *allowing* them to be present, it can be taken as us wanting to hide something and they can start imaging the worst.

Our facility allows 3 family members between 8a-7p and 1 between 7p and 8a. Family is allowed to stay if appropriate. We have a graduated plan for allowing minors into the unit that does include younger kids at the nurse's discretion, to be made before the child arrives. Most of us are fine with allowing more family members during end-of-life situations.

No flowers. Outside food okay if the patient is not in an isolation room.

I've had a lot of family members that can help keep the patient calmer or help with translating some questions. If someone is particularly active then I try to find ways to "put them to work" in safe, appropriate ways (mostly help with ordering meals, feeding). I know a nurse that allows the family help with some basic cares in end-of-life situations as a way of allowing them to take part in taking care of their loved one (applying lotion to extremities, brushing hair, basic oral care).

That being said, if someone is disrupting the patient in any way (i.e. gotta love those family members that want to do their "own" set of Neuro checks in between those Q15/30/60 minute neuros on the new stroke instead of letting them get the very little rest we actually allow) then there is leeway for the nurse to make stricter boundaries. If family members start arguing then I send them out. It's rare and I think that the good that we do with having an open unit outweighs the annoyance we can get from the occasional frustrating family member. We have the right to say "she really needs some rest, please come back later."

But honestly I rarely see family presence as a problem. Some of our night shift crew is pretty old school and they don't want families around. Visitors ask a lot of questions, and that's okay. I would rather they get information from me than 3rd hand from someone else who misheard or has no understanding of medical issues. We do occasionally have families where they designate updates to only go through one specific person and they disseminate the info so as to avoid the "telephone game". I've never had anyone try to mess with our equipment or do something egregiously wrong. In situations where the patient is withdrawing or has a hx of substance abuse I tend to watch visitors more closely, but beyond that and the occasional family disagreement I really can't think of many issues. I guess certain cultures tend to want to bring in their whole families including their young children without permission and they have to be educated about what's appropriate. Have even had a few sick kids brought in to visit Grandma (eyebrow roll) but I've never had pushback when I tell people they need to go.

In this vein, I've also read about how it's appropriate to let family members see us coding their loved one and that the research shows it helps with the grieving process, while also allowing them to see that we really are doing everything. Our facility does this as well when able.

Ruby Vee, BSN · Jul 18, 2018

24 hour visitation is the thing in my hospital, only two visitors at a time and no food, drink or cell phones in the patient rooms. The rules are pretty much ignored until there's a real problem . . .

What might be a real problem, you ask?

There was the 19 year old lung transplant patient whose mother and her friends hung out in the room 24/7. They had all kinds of food and drink in the room, and couldn't seem to understand that since the patient was intubated, he couldn't eat or drink. One of our newer nurses told the mother that it was OK to wet the kid's mouth with a toothette sponge, even showed her how. I happened to be the nurse that followed her. The mother came up to me before we even finished report and told us that she had given the kid three bottles of Snapple via the toothette, and she was all out now. Could we order more Snapple so she could give it to her kid? I started to explain why that wasn't a good idea when Mom and three friends encircled me, calling me a *itch because "that other nurse -- the nice one -- said it was OK." The kid vomited, aspirated and coded while the mother and her friends carried on about the Snapple. Sadly, he died. I often wonder whether that mother realizes that she killed her kid.

There was the visitor who insisted on staying the night "to comfort Mommy." Mommy was constantly calling for the nurse to hold her hand while the visitor snored. Finally, I turned all the lights on and made enough noise to wake the visitor. I explained that I just had to check Mommy over, and that she was free to move her chair closer to the bed so she could hold Mommy's hand and comfort her. The visitor replied "That's YOUR job. I need to get my sleep."

There was the physician whose father had heart surgery. He brought his mother up to visit on Saturday morning. And drove back home, 200 miles away, leaving her there. The mother had Alzheimer's, and she was very, very confused. She wandered off looking for the cafeteria and didn't come back. Security found her eventually, on another nursing unit sleeping in the bed of a patient who had been off the unit for tests. This went on for two days until I came to work and was informed that my assignment was the two patients in her husband's room and keeping track of her. I called the son and told him his mother needed food, sleep and clean clothes and asking him when he was coming to get her. "Next Saturday" was the response. My manager (bless her!) called him back and told him if he wasn't there in two hours, she was reporting him for elder abuse. He was there in three hours.

There was the visitor who couldn't find the bathroom and was spotted on the security cameras taking a dump in the hallway in front of the nurse's station. I think she had Alzheimer's, too. She was also spotted streaking a few times.

There was the husband of a patient who would strip to his tighty whities every night and stretch out in bed next to her. The other patient in that room had a problem with it -- especially after he offered to "give HER some lovin'". Interestingly, the night nurse who had the assignment the previous three nights didn't think it was a problem.

There was the family that took over our break room, locked it and refused to admit anyone who didn't use the "special knock." When the charge nurse managed to follow one of them into the room, she found a sound asleep six year old and three toddlers playing with partially full bottles of booze and "Mommy's purse" which contained both a handgun and a knife.

These are just a few of the special situations which have not resulted in a substantial change in our visiting policies.

Mini2544, ASN, RN · Jul 20, 2018

Thank you everyone for your candor! From the research I have done, about 90% of all ICU's have some kind of visitation policy. Some are more restrictive obviously but at least a little structure. I work in a unit that reminds me of the wild wild west. Before I started working there, I didn't even know there were ICUs that didn't have locked doors. I didn't know it was appropriate for a baby to be on the unit, or for parents to bring other small children and let them run our halls barefoot. I also didn't know it was ok for families to bring outside food and trash up the room with it. Last but not least, I was quite surprised to learn that this had gone on for quite some time because either the staff didn't speak up (which I understand because usually the hospital doesn't care what we think) or they were shut down by upper leadership. Critical care is critical care. Patients are very ill. They have tight BP parameters and a ton of lines and open wounds in many cases. A good ICU has control of what goes in and what comes out. As annoyed as family gets, I think most understand our goal is care for patients the best we can. In end of life...I think its more appropriate to relax all these rules. I have had about 20 family members outside in the hallway before and that is quite taxing. Thanks again for all the sharing and I hope to be able to use this as a reference of sorts to start convincing the powers at hand..that we need a change.

AceOfHearts<3 · Jul 20, 2018

Total open door in my icu and it can be very frustrating. I had a patient who apparently had a family member come visit after the bars closed. We've had kids crawling on the floor (gag). A spouse walked around the patient's room in their underwear. Significant other has inappropriately climbed into bed with a patient (end of life I could see wanting to be close, but that was not the case). I've had family cop an attitude when they asked for a cup while I was getting report (wasn't even my room) and we said we'd get them one in 5-10 minutes.