Sibling Visits in the PICU

[Devinthebrave]

Hello! I am working on developing a guideline for sibling visits in the PICU where I am the nurse educator.

When I first began working in my unit, about 12 years ago, we did not allow any children under the age of 13 years at the bedside unless a patient was dying. Since I then, we have become very inconsistent for when and how we allow young siblings to visit. Often, depending on which intensivist and/or charge nurse was on duty. We recently rolled out a new visitation policy and I am working with child life to figure out the best plan for sibling visits that would be consistent, safe and supportive of both the patient and their family.

I'm interested to hear the practice in your institution. For reference, we are a 14 bed unit, 9 of those are private or double occupancy. The others are in an open bay, separated by curtains. We run CRRT and ECMO occasionally.

[canoehead, BSN, RN]

I'd still go for the restricted visits for anyone under 12. Just entering the unit and seeing kids that have life threatening illness is hard for an adult, let alone a child. Even if their sibling is kind of awake, they see what COULD happen, and it would be terrifying. How about the policy stating that if the ICU stay lasts more than a week, there would be sibling visits by appointment arranged with the nurse? You'll want to make it as nontraumatic an environment as possible.

[ruby_jane, BSN, RN]

I am curious how this progressed now that we're wandering into flu season?

[chare]

Why would you want to restrict visitation? Aside from RSV/flu restrictions (no children <12 years of age, although we do make exceptions in the case of dying children) we have open visitation, although we do limit visitation to two visitors at a time.

Family's can visit around the clock, and they determine whether children are to visit. When children visit, if the family makes us aware prior to the child showing up we involve child life, either to discuss strategies with the parents or help prepare the child for what they are going to see.

[Devinthebrave]

Sorry to be away for so long. Chare, we restricted visitation in years past to absolutely no children under the age of 13, which was standard for most hospital units at the time we opened (circa Late 1970's). That rule was never modified but many nurses and physicians basically did what they thought was right in any situation and ignored the rule. Some doctors would tell families they could bring young siblings anytime while others said never. Same inconsistency occurred between charge nurses. I don't think I need to tell anyone that the inconsistencies brought about a lot of confusion and frustration for all involved parties.

Our unit has been, historically, physician driven. I just took this role as educator and the manager just assumed her position as well. We are slowly trying to change our unit to nurse-driven policies and this was the first one we tackled, as it had been a pet project of mine that was going nowhere with the management we previously had. So, while we boast being family centered, getting our physicians to comply and agree with open visitation for young siblings isn't happening. Also, our unit has only undergone minimal upgrades since it was built. We still have multiple open bay bed spaces which leads to clutter, traffic and a lot of noise. This would all be a different story if the unit were more modernized and everyone had private rooms. We have 14 rooms in our unit. 4 of those "rooms" are actually double occupancy patient rooms and 5 are open bays separated by curtains. We run ECMO and CRRT and cannot afford to have small children in the unit at any and all times because of the fragility of the circuits and equipment.

So, all that said, here is what we did. We researched other children's hospitals and came up with a working model. I must say that the main reason we got senior physician sign off was that our physician champion was able to site multiple other hospitals which were far more liberal in their policies.

We established a period of one hour daily for young sibling visits between 5-6pm. This is a good time for us because physicians are in hand off in a private office and most tasks should be done for the day. This time is only offered to siblings. No cousins or friends unless it is a death situation. It must be scheduled with the charge nurse at least 24h in advance to allow us to coordinate with child life, who MUST be involved if it is the sibling's first visit, and to have a sort of "cooling off" period for the parent to ensure the visit is needed and beneficial to both the patient and the sibling. No children under three are allowed to visit at all.

We haven't had any complaints from staff since the roll out. The only parent complaints I have received are from chronic families who have been here in the past and were allowed to do as they pleased at any time. And some inconsistency between staff when we first rolled out caused frustration for parents. It's a work in progress but it seems it will work for us for now.