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Total Posts: 37
Moderator
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Don Berwick's Challenge: Open Visiting Hours
10/13/2003 10:56:14 PM
“We implemented an open visitation policy for all our critical care units more than a year and a half ago. Our patient satisfaction got higher and complaints were less than before. The night shift has the hardest adjustment period but they have caught on. We do encourage visitors if able, NOT to visit during report time or end shift to decrease interruptions. 1 & 1/2 hour each change of shift within a 24hr. period. We printed this information in the brochure we give every pt/visitor.” -- Bon Secours Venice Hospital Venice, Florida, USA
“We have had open visiting hours 24/7 for the past 10-12 years. Both the staff and visitors feel good about our ability to embrace family/close friends into the care of their loved one. It helps us with open and continuous communication with family members and staff have come to realize that family members are an asset to us and our care. Family helps to calm patients and this helps them understand all that we're doing to help their loved one. The only time visiting hours are restricted is when it becomes detrimental for the patient. *patient needs to rest and isn't able to with family in the room (happens 1-2x/year); *procedures/treatments that require privacy (we ask them to step out for a few minutes); *too many unexpected things happening within the unit and we need all the staff to be working on saving the patients.” -- Cambridge Health Alliance, Cambridge, Massachusetts, USA
“The ICU redesign team at Charleston Area Medical Center has discussed this for some time. Just this past weekend, the wife of an elderly MICU patient asked if she could just stay with her husband and hold his hand from six until midnight. She, herself, was in a wheelchair. I discussed this with the nurse who took matters in hand and made this happen. The patient was more comfortable and the patient's wife was pleased. As for me, I had the distinct pleasure of witnessing these two people communicating through their hands and soft-spoken words as if in defiance of their harsh surroundings.”
-- Charleston Area Medical Center
Charleston, WV
“We will begin our test of open visiting. Signs will be posted for the visitors on the unit door and in the waiting room. We will be closely monitoring how this affects our ability to get our work done, and reviewing the test weekly. We are also creating a survey for the staff and visitors to objectively document the results of the test. Open visiting does not mean free for all, and we will still limit the number of visitors at the bedside and continue to ask visitors to leave when we need to work with the patients or when the patient needs to rest.” -- Geisinger Health System, Danville, Pennsylvania, USA
“I have read everyone's comments with great interest. We have had open visiting (closed at change of shift) for the past few years. Recently, we have had a resurgence of interest in enforcing stricter visiting guidelines. I am against this and now have quite a bit of info to share with the group looking at the policy! I do have a couple questions and they are this: Do you limit the number of visitors allowed in the room at one time? Do you enforce an age limit in regard to children visiting?
I'm glad to see that families are invited to attend rounds and also wondered how everyone deals with blue alerts. It depends on the staff at the code but we have let family attend. The most beautiful code I have ever seen was several years ago. It was a cardiac patient whose wife was at the head of his bed whispering to him during the entire code. What a wonderful thing… she was there when he died and her voice was what he was hearing.” -- OSF/St. Francis, Peoria, Illinois, USA
Edit by: Janice Gagnon on 9/15/2004 4:52:56 PM
Edit by: Janice Gagnon on 9/15/2004 4:53:45 PM
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James Henry
Total Posts: 1
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Re: Excerpts from the listserv discussion of organizations accepting Dr. Berwick's Challenge
10/27/2003 10:08:54 PM
The challenge given by Dr. Berwick was addressed to Critical Care Units, we are interested in instituting this challenge in our Labor & Delivery and Post Partum Units. If there are any institutions that have a modified or unrestrictive practice for these areas, could you please share your innovative visitation policies with us. Replys can be sent to henryja@umdnj.edu
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Total Posts: 1
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Re: Excerpts from the listserv discussion of organizations accepting Dr. Berwick's Challenge
12/30/2003 12:16:43 PM
In the UK context, it is more or less routine for patients to receive visitors 24/7. A large number of units also have overnight stay facilities for family members and carers. Numbers are limited and small children are allowed in exceptionally. There is also a move to restrict visiting so that patients have a "quiet period" during the day to allow a period of rest. It is also not unknown for relatives to be present during the performance of some clinical procedures.
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Marian Saffer
Total Posts: 1
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Re: Excerpts from the listserv discussion of organizations accepting Dr. Berwick's Challenge
1/13/2004 11:15:55 PM
Open visiting is beneficial to patient and family in terms of psychological and emotional effects, to be sure. But there are also significant benefits in quality of care (and thereby, outcomes) when family members are able to develop context and continuity. Even more important than reducing "complaints", this practice can reduce medical error. Open visiting can promote many things: quality assurance (e.g. family members monitoring medications), communication (family members have the "big picture" that the specialist clinicians often lack), patient education (family members are learning along with the patient) and resource allocation (family members can address patient needs rather than nursing staff). I can attest to all of the above from personal experiences in my family as well as professional experience in patient-centered disease management programs. I believe the reduction in medical error rates alone justifies the practice.
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Donald Berwick
Total Posts: 2
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Re: Excerpts from the listserv discussion of organizations accepting Dr. Berwick's Challenge
1/14/2004 3:49:22 PM
Thanks. Some examples of how it has reduced or prevented an error would be very helpful, if you can share one or two specific ones. we can always use good teaching cases.
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Cathy Miller
Total Posts: 1
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Re: Excerpts from the listserv discussion of organizations accepting Dr. Berwick's Challenge
1/14/2004 9:32:22 PM
We are in the process of getting ready to move into our new critical care building ( april 2004 ). ( New 32 bed ICU/ Step Down Unit combined in one big unit) All Step down nurses are currently being crosstrained to ICU getting ready for the change over. When this happens we will also switch our visitation policy to open visitation. Each of the rooms has a "family area" built into it on the side with a bed / desk w internet connection/ fridge so one family member can stay in the room at all times. Patients will stay in this room from admit to ICU until discharged (simply being downgraded from an ICU to to a Medical or Surgical patient ) I am told their are only about 10 similar units set up this way across the US. I am curious if anyone on this list has such a set up and how it works with the families the pros' and con's they have found? Any staffing issues they came upon with this type of set up? One issue that is consistently coming up is who is responsible to clean and straighten the family side of the room ie clean the fridge etc. . Their is no division such as a curtain / door between the patient area andfamily area.
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Total Posts: 2
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Re: Excerpts from the listserv discussion of organizations accepting Dr. Berwick's Challenge
5/12/2004 3:20:08 PM
We will be occupying a very similar unit in Aug. Are you into yours yet? How is it working? If anyone is willing to share their rules or guidelines for open visitation please send them to me at mmontgomery@st-joseph.org.
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Daniel Garros
Total Posts: 1
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accepting Dr. Berwick's Challenge
8/10/2004 5:02:41 PM
Hi
This is my first posting here.
I am quite surprise about this challenge. In the PEDIATRIC ICUs, the practice of allowing 24/7 visitation is wide spread, with the benefits already aluded to in the discussion.
We have in our unit (17 beds, mixed surgical and medical) not only OPEN VISITATION but we have OPEN DAILY ROUNDS, when parents sit at bedside during rounds and are even asked questions and are stimulated to participate.
The main complain form staff is confidentiallity, since not beds are isolated by phisical barriers. How do you manage that?
It is about time that the adult ICUs stop this SECRET WORLD that it is their ICUs!
Thanks,
DANIEL GARROS, MD
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Denise Thornby
Total Posts: 1
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Re: Excerpts from the listserv discussion of organizations accepting Dr. Berwick's Challenge
9/7/2004 5:27:12 PM
the American Association of Critical-Care Nurse has long advocated for open visitation and the support of families. They have a number of resources to promote changing to an open visitation model. Ther web site is aacn.org
The needs of families and how to support them is well researched and there are many resources. Critical Care Nurse (one of the authors was Cardin) - had an excellent article on how to implement and get buy in for open visitation. For specifics - you can call a Practice Specialist at AACN (1-800-394-5995).
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Keith Walker
Total Posts: 2
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Re: Excerpts from the listserv discussion of organizations accepting Dr. Berwick's Challenge
9/10/2004 5:44:41 AM
I have worked in a general ICU unit at another hospital, and it was AWFUL! having family members in the room overnight when the Pt is chronic and on a ventilator is sad. You end up spending more time tending to the family members than caring for the patient. one of the hospitals in our system has open visitation and the Rns do not like it. I believe in RELAXED visitation during the day, but not at night...having family members in the room also interferes with their sleep. there is a rreason it is called an INTENSIVE care unit...you should not have to trip over family members and their stuff to get to the pt. We have scheduled visitation times 5 times a day, and we get very few complaints. Spending time with your families during visitation and facilitating communication between families and MDs goes a long way too.
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