My previous experience in dialysis was not letting families to come in and out during turnover, (putting on and taking off patients). I want to implement this in my new unit with some material or guidelines to back me up. Does this have anything to do with infection control or client safety???

We also have this policy in place for the above mentioned and in addition; patient confidentiality.

new DON,

I guess it would fall under "safety" but, it would also minimize the number of people that are in a confined space during the busiest times of the day.

If you implement this policy you should make it across the board, ie. do not allow a visitor/family member to help with holding sites or help with bringing a patient ( sorry, I have never bought into the "client" thing ) in/out of the unit. If you still allow this but bar other visitors you are only asking for trouble.

To ageless:

How would visitors during turnover be a breach of confidentiality?

We are allowed in the area during takeoff and put on and I think it is a good thing. For one thing during takeoff; I do hold the sites and if we had to depend on the nurses and techs doing it for everyone it would take us forever to get out after the scheduled time.

This also gives me an opportunity to check that asceptic procedures are being properly done. In our unit we don't have much of a problem but there is 1 nurse who constantly tries to cut corners.

I could see limiting the visitors to one but I don't think they should be prohibited from being there.

There is nothing wrong with family members visiting on the floor .It is easy to control and often is a very important part of the Dialysis procedure for many new and elderly patients.I have found that after the family member feels comfortable with the Dialysis staff,the visits decrease.

I should have made my response more clear. We do not allow vistors in the patient area at any time for safety issues, for patient confidentiality, and privacy (i.e. femoral access).

ageless,
please give examples of, safety issues, patient confidentiality, and privacy. DOES THIS ALSO apply to the SW, dietitian, biotechs, deliverymen, workers' relatives and friends, corporation people and clergy?

safety issues: This is perhaps more of a legal issue. Only persons employed or under contract by the center are allowed access to the patient care areas. Safety issues include
sharps, possible wet floors, cross contamination, blood-borne pathogen exposure. The center does not have time or the resources to give in-services and HAZMAT to all potential visitors. Our focus is on the patient, we cannot be responsible for the possible actions/accidents of the public.

Cost containment: The cost of providing PPEs to various vistors would put us way out of budget eye shields/masks, aprons, shoe covers, etc.

Patient privacy and confidentiality: we have patients who prefer not to have the general public know they are our patient, that perhaps they do their treatments in the isolation room because of certain infections, or that they had a "bad run" that day. Our patients, some quite young with active professional and social lives are sometimes at their most vunerable time and they do not want to be displayed publicly. We respect that. I also have had to change colostomy bags, bed pans, sanitary napkins on teenage girls, external caths..etc. There is no way to protect the patient from visitors with prying ears and eyes. A curtain can only do so much. Femoral and subclavian accesses also pose an undo "exposure" for some patients. Especially to our more prim and proper patients.
If one has ever had to manage a code in any patient care setting where visitors were involved and no additional staff available for "crowd control"; or had domestic disputes happen in patient care settings, they will tell you of the nightmares.

We provide a waiting room for friends and family of employees and patients. No exceptions.
Hope this is helpful.

Well, thank God I am not a patient at your unit! It sounds more like a jail!

Visitors at my treatments are a welcome distraction from the discomforts of dialysis, and get my mind off of being 'sick' for a while. It reminds me that there is a life waiting for me once I get out of the unit! If I hadn't been 'allowed' any visitors when I started dialysis, I'd have quit within a month.

Privacy concerns? How 'private' can you be when you've got 15 other people sitting in the same room? And your doctor is discussing 'private' information within earshot of everyone else? Mighty selective use of the word 'privacy!'

As far as contamination, I'm a LOT more worried about the nurse coughing and sneezing all over the unit (and her scrubs!) than I am about catching something from a visitor who's only in the unit for an hour.

Dialysis is isolating enough... prohibiting visitors just reinforces the fact that you're sick and fragile, and that what goes on at dialysis is too intense for 'regular' people to witness.

For years I have heard the threat of law suits used to justify just about any policy a unit chooses to institute. However, in all that time I have NEVER heard of a law suit being filed against a unit due to visitors being allowed, food being allowed, or anything else for that matter. In fact I do not recall a dialysis provider being sued successfully by anyone except payers - Medicare or other insurers - having to do with billing practices. I think I read alot about the industry but I could of missed something, so correct me if I'm wrong. If lawsuits are such a threat can anyone point to even one example? Ever?

At some point common sense must prevail. we allow family and visitors in the units with the understanding that we reserve the right to ask them to leave if needed. I don't understand why a visitor would be required to don PPD's if they are not performing a task covered under your OSHA exposure plan.
Allowing families to view the care of their loved ones goes a long way towards decreasing anxiety levels. Interestingly the
reasons cited for enforcing those policies are some of the same ones that hospitals used
for a hundred years to keep spouses out of delivery rooms.

We allow visitors in the treatment area. We do ask they remain in the waiting area during change over or some other truely busy time. We are a very cramped unit so too many bodies can make care difficult. I have never considered keeping visitors out for lawsuit reasons. We have only refused one visitor in the last five years, and that was a daughter who would upset her mother (who was a psych patient) to the point she would need sedation. The entire family situation was reported to DFACS.
I think visitors are a welcome relief to most patients.
We do allow the patients to drink, in moderation and eat small snacks while on the machine. State surveyors stated yesterday, that this was acceptable as long as patients did not share, however they think best practice would be no food/beverage on the machine. We do not have families hold pressure. That is probably my phobia about have a few more people to worry about with cross contamination issues. Visitors do not dress out.

Federal regulations are being changed right now so that no visitors will be allowed in a dialysis unit where there are other patients HIPPA regulations concerning patient confidentiality - we don't like visitors in our acute unit as there is not enough room if something happens. Have you ever had to run a code on someone with other patient's family members gawking? I have also been the coded patient's family member and I highly resented the other visitors rubber-necking as the staff tried to resuscitate my step-mother. That is something I'll NEVER forget.

I would see no problem with allowing visitors, "for a short time"...10-15 minutes or so. Sure, not during turn-around...Hospitals have visitng hours, right? Dialysis centers can have visiting times during the slow parts of the day. Be glad there are people that want to visit. The problem I have noticed is that patient's families are not involved enough in the care of their family member on dialysis. A lot of times, family members drop off their parents, or siblings, etc and treat the unit like a day car center, leaving them waiting for hours when their treatment is done.

One long term goal of mine is to own and run my own clinic. I am a firm believer of aggressive action with a "very clear" set of goals for the clininc. One thing would hold true is the activity and involvement of the family members. I "expect" family members to be accessible during the treatment, pager, cell phone, etc...what if the patient codes and has to go to the ER, the family member would not want to know this??? The family member would also need to be an integral part of their family members dialysis treatments, etc. After all, it is your family. When my dad sufferred a heart attack and had quadruple bypass and was in the ICU, I was available and there to do anything needed, or anything I could do to help the nurses and patient providers give my dad the best care.

I could go on and on about dialysis clinic issues, but the main theme that seems evident is all these "legality" excuses.

I would love it if administrators would supply adequate staffing, but since they do not...sure, family members come on in the unit and help your family member hold sites, etc.