Shift change and visitation in ICU/stepdown

[opossum]

Hi everyone,

I'm currently looking at various policies re: visitation in the ICU and it got me thinking about issues with shift change. At our 10-bed ICU/stepdown, we restrict visitors from 0700-0730 and 1900-1930; my personal feeling is that we should extend it to 0800 so that each nurse has enough time to at the very least give the patient a once-over after receiving report.

A coworker suggested doing away with visitor/call restrictions during shift change altogether, in the name of family centered care...I did a cursory web search for any studies focusing on visitation and shift change, but came up with nothing. (I plan to research more extensively on EBSCO or other scholarly database in the near future).

There is, however, plenty of anecdotal evidence abound. My question to you all is: have you heard of open visitation during shift change? If so, do you know how well it has/has not worked for that unit?

[andi.w]

I'm so jealous of those of you with visitation restrictions! The other two ICUs in my hospital do not allow visitors between 6a-8a and 6p-8p. I work cardiovascular surgical ICU, and we have NO limitations on visitors. It nauseates me to see small children running around visiting immediate post-op open heart patients. Not to mention visitors roaming around during report. I usually ask visitors to leave the room while I do my assessments, and many of them perceive this as being rude. They don't realize that I'm trying to consider the privacy of my patients, plus it's much easier to do what I need to do without having to work around a number of people gathered around the patient. Sorry, went off on a bit of a tangent there. Lol.

[hofamb]

I work in 2 different ICUs, neither of which restrict visiting hours or ages. I've never ran into an issue with it. Occasionally a family member will want to talk to you during report, but I just inform them that we are rounding and will be in shortly. We also explain upon admission that the nurses will be giving report between 0700-0730 & 1700-1730 but will be able to monitor the patient from outside the room. I think this helps reduce fears that they are forgotten about during shift change.

We also allow visitors in the room at all times. There are very few examples of asking family members to leave and they are usually given the option to stay or go to the waiting room.

[organichombre, ADN, BSN, MSN, LPN, RN]

In our small SICU (6 ICU and 3 TCU) we've had 24 h visitation for a little over a year now and it has worked out well. New staff are often unsure of themselves and don't like to get too nosey with family/friends around, however when asked most people often retire to the shadows to allow staff to finish up assessments.

[MomRN0913]

We restricted between 7 and 8 am and pm. Still with visitors trying to come or getting mad. People would sneak in so we finally got a buzzer on the door.

If there was an actively dying patient or a critical patient, we let them stay.

Too many times family emembers would stand over you while giving report to the oncoming nurse to ask for a blanket or water and there were too many interruptions causing things to get left out in report.

I think 22 hours out of 24 in the day is acceptable visitation.

[Yammar]

I have seen much made about how studies support open visiting in the ICU. However, I do not see where all considerations were taken into account in any of these studies. Where is the consideration of the stress when family members feel obligated to stay bedside each and every day? Sometimes sending a family member home allows them to recharge their batteries and protects their health. Also, are the families that hinder care of the ill. Anxiety and suspicious of everything or have the need to call the nurse to the bedside for every single issue.

The hospital where I work we have designated visiting hours and kick everyone out at change of shift. We do open reports and to comply with HIPPA and insure a proper handoff we have found that the families got to go.

Exceptions are made and often left to the nurse caring for that patient.

I would never work in a facility that had open visiting (if I were civilian) as sometimes we as caregivers need to focus on out patient and not the family.

[SwansonRN]

We're trying to implement visiting hours. Right now it's open. I will say I think it's very important that nurses are able to give report as uninterrupted as possible. For me this means two nurses, sitting at the computers/charts ALONE. Not getting up to answer call bells (unless a nurse is truly needed at that time) and not fetching things for the family or answering their questions. Sorry, I will deal with the family, but first things first I must know how to safely care for my patient. I also think it would be wonderful to have at least a half hour without visitors to go in and assess my patients before the troops come rolling in. I understand dealing with a child of the patient or the spouse, but I really don't want to be tiptoeing around second and third cousins and neighbors at shift change.

[boogalina, ADN, ASN, BSN, MSN, LPN]

30-bed MICU/SICU at a Level 2...unit locks down for 1 hour at each shift change, but visitors may stay in the patient's room w/door closed so nurses may report.

Current policy is to allow visitors back during report if they are very insistent and the patient's nurse allows it. While there is a general restriction of 2 visitors per patient and no one under 12 (unless the patient is on comfort care), the age restriction is the most strictly enforced.

For the most part, this works pretty well. Families seem satisfied. It only really sucks for the unit clerk who gets to play traffic cop. Lots of diplomacy and kissing up helps.

[tswim]

Our ICUs are closed 6-8am & 6-8pm. No children under 12. Flexible.

Pretty happy with this as it allows time to focus on learning about patients and getting good baseline assessments.

[LNRN11]

I work CVICU and our visiting hours were actually implemented by our CT surgeons. They are 9-11AM, 2-6 PM, and then 8-10 PM. Doors are locked otherwise. Nurses do have some discretion and we always let family members back for a few minutes whenever patients return from surgery. Honestly, I appreciate the restrictions. If I had a hemodynamically unstable patient, I would find it very difficult to concentrate with family members in and out of the room all of the time. For the most part, our family members are actually pretty cooperative. I think the primary reason is that the cardiac step-down the patients move to is 24/7 open access.

[mb55]

We used to restrict visitation from 6:30 to 8:30. Both shifts. This gave ample time for report and initial assessments, etc.

We are now Open. All visitors all the time. Family centered, supposedly only one significant other is allowed during shift change/report. However, everyone and their brother too (literally) come in and out at will. Of course administration implemented this new rule, NOT the actual bedside caregivers. Not a single one of us RN's like this situation. We need some time to, pardon me but, get our **** together. When visitation was restricted, it gave me time to thoroughly read charts/orders and truly assess my patient and plan my shift. Also, I was more able to answer families questions. Now, I get bombarded with questions when I literally haven't even spoken to or touched my patient. I feel like I can't/don't do as accurate of an assessment when someone is staring at me, watching every move, and asking questions the whole time.

[opossum]

Well, it looks like we've revised the policy to basically reflect what the AACN recommends: http://www.aacn.org/WD/practice/docs/practicealerts/family-visitation-adult-icu-practicealert.pdf

We agreed that it should be flexible enough to allow nurses who want to keep the doors locked to be able to do so, but I'm worried about the inconsistency. I don't know...we'll see how this works!

Thanks again for all your input!

[gaonsi]

Lucky you. We have open visitation, including during shift change. It can get very frustrating and chaotic trying to be mindful of pt privacy but being thorough.