Open Visitation: New ICU Visiting Hours Policy Puts Patients First
ICU Nurses Find Creative Solutions While Lifting Visitor Restrictions
The patient-centered, open visitation policy implemented at the Intermountain Medical Center in Murray, Utah, puts families first, said Lorie Mitchell, RN, MSN, nurse manager at the hospital’s 24-bed Shock/Trauma ICU. The policy is designed to provide unlimited visitor access while maintaining good patient-centered care, she explained. “As a result, patient and family satisfaction has improved, family involvement has grown, and nursing support of policy implementation has increased.”
The evolution of the open visitation policy began during the latter part of 2011 when the chief nursing officer (CNO) asked ICU managers to review the current visiting hours policy to decide whether or not they supported it, or if they wanted to look at other options. “I jumped at this idea because I felt badly when I had to ask family members to stay in our small waiting room twice a day when our unit was closed,” Mitchell said. “I’d often hear complaints about our visiting hour restrictions.”
Visitor Policy Evolution
Presented with the challenge of developing a workable visitation policy, Mitchell approached her nursing staff through idea-sharing sessions. The ICU nurses were generally comfortable that the 24-bed ICU was closed to visitors for shift report and patient assessment discussions. They expressed concerns about patient confidentially and HIPAA regulations; they also predicted shift handoffs would take longer due to interruptions from visitors and errors might occur due to missing shared information.
“However, some staff members expressed optimism about the possible elimination of visitor restrictions,” Mitchell pointed out. Aware of staff concerns, Mitchell suggested initiating a research study that would provide unbiased information about family visitation issues. “I brought the study idea to our CNO who supported it,” she said. The study began during January 2012 and was concluded during 2013; it included surveys from 103 visitors and 128 nurses. The results showed that expanding the visiting hours could have multiple benefits.
Open Visitation and Family Access
“We try to center our unlimited visitor access on what the patient or family would like, but we may have to limit this practice due to the size of our rooms,” Mitchell said. “In some rooms, one or two people can visit while in others more visitors can be accommodated. Children under the age of 12 are not recommended unless prior approval from the care delivery team has been obtained. At times patients let staff know they aren’t feeling well enough for visitors, or they may want the number of visitors limited.”
“When requested, we restrict visitors to meet patient wishes; when they want a limited number of visitors we ask who they want to visit; when they can’t communicate with us we ask family spokespersons for suggestions,” she explained.
“The implementation of the open, unrestricted visitation policy is ongoing in our five ICUS and has led to more family involvement in patient care that includes their presence during our daily rounds and during patient procedures,” Mitchell said. She has heard feedback that all of the hospitals within Intermountain Healthcare have implemented the open visitation policy with positive results.
A Response From AACN’s Chief Clinical Officer
“Unrestricted visitation means establishing policies and rules that allow unrestricted contact between patients and welcome members of their support systems,” said Connie Barden, RN, MSN, CCRN-E, CCNS, chief clinical officer of the American Association of Critical-Care Nurses (AACN). “It is not meant to be chaotic or unruly however, and policies must ensure protection of the privacy of other patients as well as the safety of patients and staff. In addition, policies should include restrictions for those who demonstrate abusive or disruptive behaviors.”
“The continued evolution of visitation policies indicates nurses and other healthcare professionals focus on patient- and family-centered care.” Barden continued. “It is also a reflection of healthcare teams’ attention to evidence which suggests that more flexible visitation can decrease anxiety and agitation, reduce certain complications, and contribute to improved quality and safety. Patient preferences and clinical condition should be the ultimate determinants for decisions made about visitation and are key to the evolution of these policies.”