PENROSE-ST. FRANCIS HEALTH SERVICES

INTERDISCIPLINARY PRACTICES

SUBJECT: Visitation Guideline/Family Involvement with Care

PREVIOUS DATE: 1/80, 8/85, 3/92, 10/92, 12/95, 7/99, 1/02, 1/05Effective Date 7/11

RECOMMENDED BY:

ADMINISTRATION APPROVAL Jeff Oram Smith, MD, CMO Katherine D McCord, RN, CNO

Guideline for Care: Patients have the right to impartial access to visitors, subject to the hospital’s Justified Clinical Restrictions. Patients have the right to choose visitors including, but not limited to, a spouse, a domestic partner (including a same-sex domestic partner), another family member, or a friend. Patients have the right to withdraw or deny such choice at any time. Patients also have the right to an identified “support person” who can make visitation decisions should the patient become incapacitated.

DEFINITIONS

Justified Clinical Restrictions—any clinically necessary or reasonable restriction which may limit visitation to the patient.

PRACTICES

  1. Penrose St. Francis Health Services (PSFHS) will inform each patient upon admission of his/her right, subject to his/her consent, to receive visitors whom he/she designates, including but not limited to, a spouse, a domestic partner (including a same-sex domestic partner), another family member, or a friend
  2. The patient will be informed of his or her right to withdraw or deny consent at any time for any visitor.
  3. PSFHS will not restrict, limit, or otherwise deny visitation privileges on the basis of race, color, national origin, religion, sex, gender identity, sexual orientation or disability.
  4. PSFHS will ensure that all visitors enjoy full and equal visitation privileges consistent with patient preferences.
  5. The patient will upon admission designate a “support person” who can make the visitation decisions for the patient if the patient becomes incapacitated. It is understood that this “support person” is not a legal representative and is only serving to make decisions regarding visitors if the patient is incapacitated. (This does not supersede a Medical Durable Power of Attorney or other legal representative.)
  6. Patient Access will collect information at registration for the patient’s designated “support person” including primary and secondary phone numbers. This information will be printed and scanned into the Electronic Medical Record (EMR). When Patient Access is unable to collect the information as when the patient bypasses Patient Access due to emergent conditions, the nurse will ascertain the patient’s choice of designated visitor as soon as possible. Once that name is determined, the nurse will notify Patient Access so the name can be entered into the Clinical Information System (CIS)
  7. PSFHS will only require proof of a relationship between a patient and a visitor only when the patient is incapacitated and there is a clear dispute between two or more people over whether a particular person should be allowed to visit. The following may be forms of proof: an advance directive naming the individual support person; approved visitor or designated decision maker; shared residence; shared ownership of a property or business; financial interdependence; marital/relationship status; existence of a legal relationship recognized in any jurisdiction; and acknowledgement of a committed relationship (i.e., an affidavit). This list of proof and documentation is not intended to be exhaustive of all potential sources of information regarding proof of a relationship to allow patient visitation or support person preferences.
  8. PSFHS may develop clinically appropriate restriction (Justified Clinical Restrictions) on visitation privileges. Examples of reasonable reasons where PSFHS may impose restrictions include, but are not limited to the following:
  • There may be infection control issues either with the patient or roommate
  • Visitation may interfere with the care of other patients
  • The patient is undergoing care interventions
  • The patient needs rest or privacy
  • A court order limiting or restraining contact
  • Inpatient substance abuse treatment programs that have clinical necessary protocols limiting visitation
  • Extraordinary protections because of a pandemic or infections disease outbreak
  • Disruptive, threatening or violent behavior of any kind
  • Need for privacy or rest by another individual in the patient’s shared room
  • Reasonable limitations on the number of visitors at any one time
  1. The Emergency Department, BirthCenter, Critical Care Units and Neonatal Intensive Care Unit have specific visitation criteria (Justified Clinical Restrictions)
  2. Promote short visits, as these are better tolerated by the patient.
  3. Visitors are required to perform hand hygiene prior to entering and exiting the patient’s room. All patients are to be educated on this guideline by the nurse caring for the patient.
  4. Allow visits by children who have no symptoms of illness, provided their behavior is controlled and not disruptive to others. Overnight stays by a child without a non-patient adult available is not allowed.
  5. Discourage visits of people with colds, sore throats, or other contagious illnesses. Offer protective equipment (mask, gloves, etc.) and teach about correct use as appropriate.
  6. Visitors may be asked to leave if they interfere with care, are disruptive, or if the patient requests. The Security Department may be notified to assist with uncooperative visitors.
  7. Pet Visitation is per physician order only. (Refer to IDP P-17-a Pet Visitation)
  8. Encourage all visitors to leave at 8:30 PM to promote rest for the patient.
  9. One patient designated visitor may spend the night. If the patient is confused, one visitor will be encouraged to sit with the patient, provide care, and re-orient the patient as needed. To facilitate visitor spending the night at the bedside, move the patient to a private room as soon as possible. Encourage the patient designated visitor to rest on a lounge/sleeper chair, if available.
  10. ISOLATION PROCEDURES: Limit visitors for patients in an isolation room. Discourage visits in an isolation room by children under 12 years of age unless extenuating circumstances (long length of stay, terminal illness, etc.) Provide visitors instruction sheet about precautions to be used when patient is in isolation room. Stress the importance of good hand hygiene and appropriate use of personal protective equipment (PPE).
  11. Refer family/visitors who request local lodging to Care Management Department associates for a list of discounted providers and/or lodging at the John Zay Guest House.
  12. All visitors chosen by the patient will have “full and equal” visitation privileges consistent with the patient’s wishes.

FAMILY/PATIENT DESIGNATED VISITOR INVOLVEMENT WITH CARE

  1. Invite the family/patient designated visitor to help in the care of the patient. This may include bathing, back care, turning, repositioning, ambulating, hair care, oral care, treatments to be performed at home, and other care that may be identified.
  2. Involve the family/patient designated visitor in teaching whenever possible. Document teaching in Clinical Information System (CIS).
  3. Evaluate through interview & observation, the effectiveness of family/patient designated visitor’s involvement & adjust plan for participation accordingly.

References:

Maxwell, K.E.; Stuendkel, D.; & Saylor, C. (2007) Needs of family members of critically ill

patients: a comparison of nurse and family perceptions. Heart and Lung. 36 (5), 367-376.

Federal Register. (2010) Department of Health & Human Services Centers for

Medicare and Medicaid. Medicare and Medicaid Programs: changes to the hospital and

critical access hospital conditions of participation to ensure visitation rights for all patients.

Vol 75 No 223 42 CFR Parts 482 & 485. CMS—3228-F

(2011) Revisions to patient visitation standard in hospitals and critical access hospitals. Journal

Communication Perspective. 31 (3). 4-5.