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Visitor Policy - Inpatient & Outpatient

PURPOSE:
To provide safe, high quality healthcare that meets the visitation needs and rights of patients and their family or designated support person during inpatient and outpatient services. Unit specific guidelines are described below.

SCOPE:
Who:
This policy applies to Bristol Hospital’s physicians, clinical staff members and all Hospital personnel involved in the decision-making process with respect to patient visitation.

Where:
Level F Medical/Surgical/Gynecology Unit Level G Medical/Surgical/Gynecology Unit Families Are First Maternity Unit
Intensive Care Unit
Inpatient Behavioral Health/Barnes III Emergency Care Center Perioperative Services

POLICY STATEMENTS:
Statement of Patient Visitation Rights: At Bristol Hospital we recognize the importance of support from family, loved ones and friends in the patient’s recovery process. Bristol Hospital’s visiting hours have been established to be as convenient as possible for family and friends, while providing appropriate time for patients to receive care and recover. The following are guidelines. Please know that they may be modified at any time based on specific patient needs.

Bristol Hospital ensures that all visitors enjoy visitation privileges consistent with patient preferences. Patients (or support person where appropriate) have the right to receive the visitors whom he or she designates, including, but not limited to a spouse (including a same-sex spouse), a domestic partner (including a same sex domestic partner), another family member (including same-sex parents), or a friend.

Bristol Hospital will not deny visitation privileges based on race, religion, ethnicity, language, culture, gender, sexual orientation, gender identity, or expression.

The patient is notified of their rights to have visitors and designate a “support person” of their choosing. The patient has the right to change his or her mind about such designation, in which case he or she should notify the health care provider that he or she no longer wants a particular person to visit.

The welfare of the patient and other patients in the hospital must always be taken into consideration. Certain restrictions may be imposed on visitation if the patient’s rest, medical treatment and/or procedures would be compromised by having visitors at any time during the patient’s hospital stay.

In respect for patient privacy and well-being, the number of visitors is limited to two at a time.

Children under the age of 12 years must be accompanied and supervised at all times by an adult other than the patient. Children who visit must be free of communicable diseases (to the best knowledge of the adult accompanying them). Visitors should maintain a quiet environment and avoid unnecessary noise.

Selection of Visitors: The hospital will document the individuals who should be denied visitation as identified by the patient. In the event the patient is a minor, the legal parent of the minor shall be given the opportunity to verbally designate the individuals permitted to visit the minor patient.

Selection of Visitors: The hospital will document the individuals who should be denied visitation as identified by the patient. In the event the patient is a minor, the legal parent of the minor shall be given the opportunity to verbally designate the individuals permitted to visit the minor patient.

Selection of a Support Person: A patient may verbally designate a Support Person to exercise the patient’s visitation rights on his or her behalf, should the patient be unable to do so. In the event the patient is unable to exercise his or her patient visitation rights, the Hospital shall recognize the Support Person’s verbal directive as to who should have visitation rights and who should be denied for that patient.

Incapacitated Patients: In the event a patient is unable to select visitors due to incapacitation and such patient has not designated a Support Person to exercise the patient’s visitation rights, the Hospital may consider the following non-exhaustive forms of proof to establish the appropriateness of a visitor or to designate a Support Person for the incapacitated patient when two or more individuals claim to be the incapacitated patient’s Support Person capable of exercising the patients’ visitation rights: (i) an advance directive naming the individual as a support person, approved visitor, or designated decision make (regardless of the State in which the directive is established); (ii) shared residence; (iii) shared ownership of a property or business; (iv) financial interdependence; (v) marital/relationship status; (vi) existence of a legal relationship (may be a legal relationship recognized in another jurisdiction, even if not recognized in the Hospital’s jurisdiction, including: parent-child, civil union, marriage, or domestic partnership); (vii) acknowledgement of a committed relationship (e.g., an affidavit); or (viii) written documentation of the patient’s chosen individual(s) even if it is not a legally recognized advance directive.

Justified Clinical Restrictions on Patient’s Visitation Rights: The Hospital may impose Justified Clinical Restrictions on a patient’s visitation rights. When restricting visitation rights, the Hospital shall explain to the patient (or Support Person as applicable) the reasons for the restrictions or limitations on the patient’s visitation rights and how the Hospital’s visitation policies are written to protect the health and safety of all patients. The Hospital shall not restrict, limit or otherwise deny visitation privileges on the basis of race, color, national origin, religion, sex, gender identity, sexual orientation or disability.

Grievance: If any patient of the Hospital believes that his or her patient visitation rights have been violated, they may file a complaint or grievance with the Patient and Customer Relations Department.

DEFINITIONS:
Justified Clinical Restrictions: Any clinically necessary or reasonable restriction or limitation imposed by the Hospital on a patient’s visitation rights necessary to provide safe care to patient or other patients.

A Justified Clinical Restriction may include, but need not be limited to one or more of the following events: (i) a court order limiting or restraining contact; (ii) behavior presenting a direct risk or threat to the patient, Hospital staff, or others in the immediate environment; (iii) behavior disruptive of the functioning of the patient care unit; (iv) reasonable limitations on the number of visitors at any one time;
(v) patient’s risk of infection by the visitor; (vi) visitor’s risk of infection by the patient; (vii)extraordinary protections because of a pandemic or infectious disease outbreak; (viii) substance abuse treatment protocols requiring restricted visitation; (ix) patient’s need for privacy or rest; (x) need for privacy or rest by another individual in the patient’s shared room; or (xi) when patient is undergoing a clinical intervention or procedure and the treating health care professional believes it is in the patient’s best interest to limit visitation during the clinical intervention or procedure.

Support Person: A family member, friend or other individual who is at the Hospital to support the patient during the course of the patient’s stay. This individual may exercise the patient’s visitation rights on patient’s behalf if patient is unable to do so. Such individual may, but need not be, an individual legally responsible for making medical decisions on the patient’s behalf.

The main role of the support person is to help their loved one heal through support, encouragement and communication during their stay. Because of the importance of the support person’s role we believe they are a critical member of the patient’s health care team and will have access to the patient.

PROCEDURE:
Patients (or Support Person, where appropriate) will be informed of his or her visitation rights, including any clinical restriction or limitation on such rights upon admission.

RECOMMENDED VISITING HOURS ARE:

Level F and G Medical/Surgical/Gynecology Units:

All visitors: 11 a.m. - 8 p.m.
(In special circumstances, alternate visiting hours may be arranged in advance with the nursing staff.)

Families Are First Maternity Unit: Identified Support Person: Unlimited Visiting All others: 11 a.m. - 8 p.m.

Intensive Care Unit:
Visiting is restricted to immediate family members or identified Support Person- two at a time - who must be 12 years or older. Immediate family members or identified Support Person may visit between 11 a.m. - 8 p.m. Patient rest period is 2 p.m. - 4 p.m. daily.

Inpatient Behavioral Health/Barnes III:
Special restrictions may apply to this area. Please check with the nursing staff for guidelines.

Emergency Care Center:
Visitation is based upon a 24 hour time period. Patients are allowed up to two visitors, immediate family or identified Support Person unless specifically requested by the patient not to have them.

Perioperative Services:
Per-operative visitation is limited to two support persons.

Post-operative visitation should be brief, quiet and pleasant to allow patients time to fully recover from anesthesia. Visitation in the recovery area will be determined by patient needs and defined by the patient in collaboration with the recovery room nurse. Visits from children under the age of 12 will be under special circumstances only and at the discretion of nursing leadership.

SPECIAL CONSIDERATIONS:
Overnight Visitors: Requests by patients for an overnight visitor may be accommodated if possible in a private room setting. After-hours visiting in semi-private rooms will be allowed under limiting circumstances at the discretion of nursing leadership.

There may be individual patient circumstances which will require changes to these guidelines. Inappropriate behavior or refusal to follow Hospital policy which might compromise patient health and safety may result in visitors being asked to leave the Hospital.

REFERENCES:
§ 482.13 Condition of participation: Patient’s rights.

Visitation Policy and Procedure

PURPOSE:
To define the visiting policy on the Behavioral Health Units.

POLICY STATEMENT(S):
It is the policy of the Behavioral Health Units to allow contact with family, friends, and significant others in a manner that would not interfere or disrupt the normal ongoing treatment activity on the unit.
Patients being treated for psychiatric disorders may have visits with significant others according to the following procedure.

Patients being treated for detoxification from drugs or alcohol or for co-occurring disorders of mental health and addiction issues may involve family members and important community supports in their treatment. No routine, informal visitation will be allowed unless this is deemed medically necessary/approved by the treatment team.

Visitation tours, professional visitors or open house events will be conducted in a manner that respects patient confidentiality.

SCOPE:
Who:
Behavioral Health treatment teams

Where:
Inpatient Behavioral Health Units

PROCEDURE:
  1. Normal visiting hours shall be posted on the unit. They are:
    1. Barnes: Monday thru Friday 5:30pm – 6:30pm; Weekends and Holiday 1-2pm and 5:30pm-6:30pm
    2. Seniors: Monday thru Sunday 12:30 - 1:30pm and 5:30pm - 6:30pm
    3. The treatment team may amend these hours to include supports not regularly available during these hours.
  2. Visitors will be greeted at the entrance door by staff. Visitors will be requested to show personal identification and secure all of their personal items (cellphone, keys, etc.) in an assigned visitors’ locker located in the secured entryway to the unit.
  3. Visitors will be asked to sign in on the visitation log prior to entering the unit and visiting the patient. All items brought onto the unit will be reviewed by staff before visitors give them to patients. Items not allowed will be returned to the visitor. This is to assure the safety of all patients and staff on the unit.
  4. Patients may visit in assigned areas, such as the solarium on the Barnes unit, group rooms or patient lounge. The visiting areas will be monitored by staff, video monitored, and monitored by Security camera.
  5. Nursing staff will continue their routine observation checks on each patient.
  6. Limitations on visitors may be imposed by the attending psychiatrist, multidisciplinary treatment team, or nursing staff on duty for clinical reasons. The clinical reason(s) will be documented in the patient’s progress note.
  7. Visits from patient’s physicians, clergy, Mental Health professional, court representative, patient’s attorney, or other person whose intended communication involves matters which are or may be the subject of legal inquiry shall not be limited. However, the duration of these visits shall be reasonable so as not to seriously tax the effective functioning of the unit or the patient’s treatment. The patient’s privacy will be protected during these visits.
  8. The Charge RN, Operations Manager, ANM or Nursing Supervisor may limit visits at any time if the disruption on the unit so warrants. Visitors who smell of alcohol or whose behavior is loud and disruptive or threatening in any way will be asked to leave. Assistance of Security personnel may be sought, if needed. This action will be documented in the patient’s progress record and communicated to the attending psychiatrist as soon as possible.
  9. Restrictions are subject to appeal. A patient may contest the justification, extent or duration of a limitation to the Medical Director.
  10. Physical contact between visitor(s) and patient is limited to the moment of greeting and the moment of parting, and must be appropriate to that purpose. All other physical contact is to be curtailed.
  11. Patients and visitors will be educated of the importance of maintaining confidentiality. All visitors are required to wear a mask at all times during the visit during special circumstances. Failure to comply will result in termination of the visit.

REFERENCES:
Halter, Margaret Jordan (2022). Varcarolis’ Foundations of Psychiatric Mental Health Nursing - A Clinical Approach. (9th Edition). St. Louis, MO; Saunders Elsevier.

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