Visitation and family centered care

TiffyRN, BSN, PhD · Feb 13, 2007

1. There is virtually no restriction on the time that visitors may be in; only shut out during report (6:30-7:15 am and pm) or if a certain room is closed outright due to admissions; procedures (like line insertions, intubations). There are some restrictions on who may visit; such as no siblings

2. Time is not limited except when it runs into report time.

3. There is no restriction on grandparents at bedside during rounds (we are not a teaching facility with several docs going around discussing cases). The only restriction was as mentioned above; one "banded" individual must be at the bedside.

4. I guess we have an open concept; multiple bedsides within a big room, but we have several large rooms that accommodate between 5 and 16 infants.

Having the 2nd band implies that the individual is approved by mom to discuss the infant's condition. But we do have mom sign an authorization form naming with whom we may discuss the infant's condition. Technically we need this signed even to discuss with the infant's father unless he is legally married to the mom. Interestingly did you know that in many states the husband is legally the baby's father unless a court (with a DNA test) orders otherwise, or I guess if he, the mom and the bio dad come to some agreement?

matchstickxx · Feb 13, 2007

Question #1: Are grandparents and/or siblings limited to certain hours for visitation? (i.e. 0900-2100).

No set visiting hours except we close for report. We do limit the total number of visitors at the bedside to two visitors. One of these visitors must be a "banded" person.

Question #2: Do you limit the amount of time of these visits?

Siblings under 14 y.o. are limited to 15 minutes per day. We used to have a strict no visitors under 14 policy until recently. For most young children, 15 minutes is about as long as they can "behave" in the NICU. I know parents get upset about the time restriction, but there really isn't anything for them to do in the NICU. Bored children often either become noisy children or they try to find something to amuse themselves with and will start getting into things.

Question #3: Do you allow grandparents to remain at the bedside during physician rounds?

Generally, yes. Sometimes a neo will ask a visitor to step out for a few minutes, but for the most part the visitor gets to stay. Again, they must be with a "banded" person and the banded person is rarely asked to leave unless we are doing a sterile procedure with their baby or a nearby baby.

Question #4: Does your unit have individual rooms or an open concept (multiple bed spaces within an area)?

We have both. Most babies are in the "open area". The individual rooms are usually used for babies on isolation precautions and sometimes for stable multiples. Sometimes, when the decision has been made by the family to withdraw care for a critical baby, we will move the baby and family into one of these rooms to allow them to have some private time with the baby until the baby dies.

In the case of the dying baby, we do make reasonable exceptions to the visitation policy.

desilu92 · Feb 14, 2007

Question #1: Are grandparents and/or siblings limited to certain hours for visitation? (i.e. 0900-2100).

The only time family is not allowed is from 6:30-8:00 am and pm. We do not use wrist bands for identification, mostly due to infection control. Instead the parents are given a 4 digit code that they must give when they call in and when they are in the waiting room and call in to visit. The only other time we don't allow visitors is during a procedure, such a PICC placement or unexpected surgery at the bedside.

Question #2: Do you limit the amount of time of these visits?

No, they can sit at the beside all day if they want. And we have had some parents that we have essentially had to force out to go eat and go to the restroom.

Question #3: Do you allow grandparents to remain at the bedside during physician rounds?

As long as there is a parent at the bedside with the grandparent, they are not asked to leave. But our visiting policy states that there can only be 2 people at the bedside and one must be the parent or legal guardian. Children under 13 are not allowed to visit unless it is a child of the parents and they may only visit on Saturday and Sunday. During RSV season, we don't allow these children in at all, no exceptions!

Question #4: Does your unit have individual rooms or an open concept (multiple bed spaces within an area)?

We have 8 rooms and 2 open areas. 7 of the rooms have 4-6 spaces for patients and the other room is isolation, which has 2 rooms within a room. The open areas are called family care, feeder grower area, and they each have 12 spaces. 2 of the open spaces in family care are rooming-in rooms.

Mags4711, RN · Feb 14, 2007

In the interests of family centered care we are reviewing our policy on the visitation of grandparents and siblings. We are interested in how other units approach this.
Question #1: Are grandparents and/or siblings limited to certain hours for visitation? (i.e. 0900-2100).

If the parents choose our "Open Visitation" plan there are NO limitations for grandparents, siblings, or anyone in the whole wide world. They can come anytime they like and stay for however long they want to. (This is the plan most people choose.)

The parents can choose the "Parents Only" plan which means anyone visiting must be with either mom or dad.

Then there's the "Everyone except:_____" plan where the parents say who CANNOT come see the baby.

One caveat: Only parents are allowed to stay at the bedside during shift reports (0730-0800, 1530-1600, 1930-2000, 2330-0000), but we do not close. Yep folks, you heard that right, parents are allowed to stay in the room during report. which makes protecting HIPAA info a challenge and makes getting organized at the beginning of your shift a bit difficult sometimes.

Question #2: Do you limit the amount of time of these visits?

See the answer above, nope, no time limitations, but only two visitors per bedside allowed, except for little kids, we don't really count them. :uhoh3:

Question #3: Do you allow grandparents to remain at the bedside during physician rounds?

Yep, sure do... And that makes it really sticky if the docs discuss something on rounds and the grandparents find out about care before mom and dad do. If the docs are rounding, they try not to discuss plans in front of someone they know is not mom and dad, but that makes rounds tough.

But our manager is STAUNCHLY against closing for anything except a bedside OR or an emergency situation.

Question #4: Does your unit have individual rooms or an open concept (multiple bed spaces within an area)?

Four open rooms, one with 10 beds, two with 9 beds and one with 12 beds plus a negative pressure isolation room. We are a 40 bed (plus a triage bed and two treatment room spots) Level IIIc NICU in a teaching hospital.

Our manager will NOT allow closing of the rooms for report, either. She will not believe there are HIPAA violations that we can't control. If I were a mom who was a G6 P1 and was positive for THC and Cocaine on my tox screen or positive for HIV or Chlamydia I'd be pretty darned upset that someone is discussing that in front of others. But we're supposed to try to keep our voices low... :rolleyes:

She believes that no parent should ever be denied access to their baby at any time unless it is for OR in the room or an emergent situation. I understand her desire to provide family centered care, I truly do, but I have strong feelings of my own about giving report in front of parents and about not having time to do my inital assessment of my bedside without some peace and quiet.

grlgid · Feb 15, 2007

question #1: are grandparents and/or siblings limited to certain hours for visitation? (i.e. 0900-2100).

parents and grandparents can visit when ever we are "open" and stay as long as they choose, we "close" twice a day for shift report/rounds (0630-0930 then 1830-2000) and a chance to regain some sanity before going home.

siblings can visit either saturday or sunday afternoon, have to be at least 5 and go thru a short screening process. their visit is limited to 20 minutes per sibling.

parents can bring in 2 other visitors to visit between 1600-1800. it used to be 2 per day but now it is 2 at a time per family.

question #3: do you allow grandparents to remain at the bedside during physician rounds?we are closed during rounds in the morning, the docs or nnps will come out to talk to the parents individually but grandparents usually just get a generalized update

question #4: does your unit have individual rooms or an open concept (multiple bed spaces within an area)?

we are open concept, 3 rooms with approx 7 bedspaces per room (we utilize the "halfspace" concept when beyond capacity ) and then a 23 bed stepdown area

the only "individual" room we have is our negative pressure room

we are 44 bed community level iii nicu

Bugzi · May 3, 2008

Any suggestions on how to start an advisory council started in the NICU?

What kinds of things do these volunteers do?

Thanks

ScammRNC · May 3, 2008

We have private rooms. We are closed for report time from 0700-0730 and 1900-1930. Parents can be in the rooms basically 23 hours a day if they wish. All other visitors, including grandparents & siblings have visiting times of 0900-2100. There can be up to 4 visitors in a room at a time. Parents can designate up to 4 people to be independent visitors. These independent visitors can visit without the parents being present from 0900-2100. Allowance are often made for younger mothers with no FOB involved.

elizabells, BSN, RN · May 4, 2008

In the interests of family centered care we are reviewing our policy on the visitation of grandparents and siblings. We are interested in how other units approach this.
Question #1: Are grandparents and/or siblings limited to certain hours for visitation? (i.e. 0900-2100).
Question #2: Do you limit the amount of time of these visits?
Question #3: Do you allow grandparents to remain at the bedside during physician rounds?
Question #4: Does your unit have individual rooms or an open concept (multiple bed spaces within an area)?
I know visitation has been a previous topic but, I need to relate the information to units similar to mine. Thanks.

Open as all get-out. We can make them leave for report, but many nurses don't, which makes it hard to be one who does. Gparents are allowed 24h per day, parents present or no, and in theory parents/gparents only after 2100, but it's totally not enforced. Anyone who's there can stay for rounds. Kids year round, no matter the age. We have pods with 2-3 babies apiece. Our unit is a free-for-all, basically. Half the time we have to brawl with parents to get them out during sterile procedures! We have one mom who never, ever, EVER leaves, and gets the charge nurse to change assignments if, for example, her baby's nurse has a kid in an adjoining pod, because she thinks her baby won't get enough attention. It's madness. She's "fired" a good half of the nurses her baby has had.

RN4Little1s · May 5, 2008

In the interests of family centered care we are reviewing our policy on the visitation of grandparents and siblings. We are interested in how other units approach this.
Question #1: Are grandparents and/or siblings limited to certain hours for visitation? (i.e. 0900-2100).
During RSV season, no children allowed at all (unless we're handling a bereavement). Other than that, The parents are allowed to list the grandparents by name who they approve of to be able to visit on their own without them there. If they do not list them, then they may visit only with the parents present. The parents are given a 4 digit code to use when calling in to get information and coming in.
Question #2: Do you limit the amount of time of these visits?
Shift change lasts 1/2 hr and that is the only time time all parents are asked to leave the pods so that information is not overheard. We inforce this very well. During rounds, we asked parents to step out of the pod and only step in when we are rounding on their baby.
Question #3: Do you allow grandparents to remain at the bedside during physician rounds?
If the grandparents are with the parents, it is implied that they are allowed to be present during rounds. If the grandparents are alone, we must have permission from the parents that they may be there to have that information.
Question #4: Does your unit have individual rooms or an open concept (multiple bed spaces within an area)?
Each pod has multiple bed spaces in an open area. We also have some individual rooms for transition to home. Parents do sometimes wander over to other bed spaces, which is very strange to me! And it is awkward to tell them :nono:"No, you cannot look at their baby and ask questions about him/her!" I'm thinking, would you want someone coming over to your child to observe them??? Crazy!

NicuGal, MSN, RN · May 6, 2008

question #1: are grandparents and/or siblings limited to certain hours for visitation? (i.e. 0900-2100).grandparents can visit from 11am to 10pm with the parents, same for sibs over the age of 4, sibs are limited to 1/2 hour unless they are older like 10 and can sit for long periods of time. grandparents can only come with parents.

question #2: do you limit the amount of time of these visits?see above

question #3: do you allow grandparents to remain at the bedside during physician rounds?no, unless they are the parent of an under 18 nonemancipated minor

question #4: does your unit have individual rooms or an open concept (multiple bed spaces within an area)?we have 9 pods that have 6 beds each, each pod is like a room with open windows to the other pods

we don't take calls from anyone but parents and no info is given to anyone without the parents present. parents must have their band on, if the band is cut off they have to have a photo id, even if we know them, they are required to have it or they are not permitted into the unit (with 100 of us, we can't know everyone!) they can have unlimited visitors between 11am and 10pm, but only 3 people at a bedside at one time, one having to be a parent. we found that if we tried to limit it to only 2 per day, there were more hassles...most people bring in a gaggle for the first few days and then die down. if it does get to be a constant parade, we talk to them and then place limits. no one is allowed in the pods for rounds or report, parents can stay for rounds on their baby if they really want to, but then they have to leave until they are done with the whole room. we clear the unit for report for half an hour, no phone calls either.

wrighty · May 12, 2008

Hi our visiting policy got a hugh overhaul in 2006 Dec. when we had out breaks of ESBL in the unit. The visiting policy before was anyone can coming in to visit (mum or dad had to be present- can have 4 people at a time - the only restriction was children under 13 yrs (unless ther are siblings) were not allowed. Warde rounds were 9-10ish visiting was not encouraged unless mother were breastfeeding then.

Due to the rise of the evil bug ESBL (and further mutation )- our visiting policy is mum, dad, grandparents and siblings only - two visitors at a time. Every entrance to ward/ and bay has hand pump microbal solutions. Each baby has hand solutions. We found the ESBL in the sinks, but not in the water supply. Thus no sinks -only have two areas to srub for procedures/ changing Longline solutions etc. :bugeyes: :banghead: