Reports From the Field

Changing Hospital Visiting Policies: From Families as “Visitors” to Families as Partners

Journal of Clinical Outcomes Management. 2015 January;22(1)

References

1. American Association of Critical-Care Nurses. Practice alert: Family presence: Visitation in the adult ICU. Accessed at www.aacn.org/WD/practice/docs/practicealerts/family-visitation-adult-icu-practicealert.pdf.

2. New Yorkers for Patient & Family Empowerment and the New York Public Interest Research Group. Sick, scared and separated from loved ones: A report on NYS hospital visiting policies and how patient-centered approaches can promote wellness and safer healthcare. August 2012. Accessed at www.patientandfamily/default.html.

3. Liu V, Read JL, Scruth E, Cheng E. Visitation policies and practices in US ICUs. Crit Care 2013;17:R71.

4. Institute for Patient- and Family-Centered Care. Facts and figures about family presence and participation. Accessed at www.ipfcc.org/advance/topics/Better-Together-Facts-and-Figures.pdf.

5. Better together: partnering with families. Changing the concept of families as visitors bibliography. Accessed at www.ipfcc.org/advance/topics/Changing-the-Concept-of-Families-as-Visitors-Bibliography.pdf.

6. Institute for Patient- and Family-Centered Care. Accessed at www.ipfcc.org/about/index.html.

7. Institute for Patient- and Family-Centered Care. Better together: Partnering with families. Accessed at www.ipfcc.org/advance/topics/better-together.html.

8. Leape L, Berwick D, Clancy C, et al; Lucian Leape Institute at the National Patient Safety Foundation. Transforming healthcare: a safety imperative. Qual Saf Health Care 2009;18:424–8.

9. The National Patient Safety Foundation’s Lucien Leape Institute. Safety is personal: Partnering with patients and families for the safest care. Report of the Roundtable on Consumer Engagement in Patient Safety. Boston: National Patient Safety Foundation; 2014.

The Better Together campaign currently recognizes 12 hospitals in the United States and Canada that exemplify success in changing their “visiting” policies. The hospitals vary in size, structure, and geographic location, as well as in the processes they used to change. These “exemplar” hospitals are helping IPFCC disseminate information about the campaign and will serve as mentors to other hospitals beginning the process through an online learning community. In this article, 3 exemplar hospitals describe their processes, discussing the impetus for change, the process itself, including involvement of key groups, as well as outcomes to date and “lessons learned” to share with other hospitals. An example visiting policy is also presented ( Appendix).

Anne Arundel Medical Center

A regional not-for-profit hospital founded in 1902, Anne Arundel Medical Center in Annapolis, MD, provides acute inpatient and outpatient care to residents of 4 counties in Maryland. A 380-bed facility, Anne Arundel has a cancer institute, heart and vascular institute, joint center, spine center, and a women’s and children’s center. In April 2011, the hospital completed a $424 million expansion project, which included a pediatric emergency room, an expanded general emergency room, 50 new patient beds, and 8 new operating rooms.

In 2010, based on a desire to concretely implement the principles of patient- and family-centered care, leaders at Anne Arundel began working with patient and family advisors and initiated a process to change the hospital’s restrictive visiting policy. Now, there are no restrictions on family presence anywhere in the hospital, from ICUs to medical/surgical units to other clinical areas. Patients have the power to choose who they want to stay with them—24 hours a day, 7 days a week. According to Anne Arundel’s policy, each patient determines who is defined as “family.” A “Revisiting Visiting” task force, comprising support staff, providers, and patient and family advisors, worked for 9 months to develop the new family presence policy and support its implementation.

With Anne Arundel leadership encouragement and support, patient and family advisors participated in all phases of the development and implementation of the new family presence policy and in other ways to advance the practice of patient- and family-centered care. The advisors also participated in the process to change the way nurse change of shift report was conducted, and they made recommendations for changes in the directional signs throughout the hospital. New signs, featuring a pineapple (a symbol of hospitality) and the words “Welcome Families” replaced old ones displaying the former restrictive visiting policy.

Supporting patient and family involvement in transitions in care is an integral aspect of implementing family presence policies and practices. Through an “Always Events” grant from the Picker Institute (for information about the Always Events program, see www.ihi.org/Engage/Initiatives/PatientFamilyCenteredCare/Pages/AlwaysEvents.aspx), patient and family advisors, staff, and providers at Anne Arundel developed the SMART discharge protocol, which includes a simple 5-item checklist that is reviewed and discussed with the patient and family prior to discharge. SMART is an acronym for Signs, Medications, Appointments, Results, and Talk. In its work, the SMART team built on current evidence, created urgency and expectation for use with patients, families, and caregivers, disseminated findings, and promoted the protocol as a national standard. The tool is available at www.ihi.org/resources/Pages/Tools/SMARTDischargeProtocol.aspx.

Changing Hospital Visiting Policies: From Families as “Visitors” to Families as Partners

References

Anne Arundel Medical Center

Pages

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