By RENEE STOVSKY
CATHOLIC HEALTH EAST
Like most health care providers, the staff of St. Peter's Hospital in Albany, N.Y., strives to deliver the best possible care to its patients. As part of that commitment, the staff also is receptive to having a relative or close friend lend a hand or share observations relevant to the patient's status or safety.
In fact, the hospital's open visitation policy, implemented three years ago, allows the 24-hour presence of a broadly defined "patient support person." That policy received the highest marks in a 2012 report, "Sick, Scared and Separated from Loved Ones," by New Yorkers for Patient and Family Empowerment and the New York Public Interest Research Group.
The report found that 22 percent of hospital policies in the state didn't provide for any regular visiting hours in the morning — a period when many medical errors can occur — and failed to indicate any flexibility for visits by a patient's primary support person outside regular visiting hours.
To Kathleen Brodbeck, vice president and chief nursing officer at St. Peter's Health Partners, the hospital's regional parent, restrictive visitation guidelines are not only out of sync with the realities of 21st century family life, but can be dangerous to patients' welfare as well.
"From a quality advocacy standpoint, families who are engaged with the hospital staff can provide important information about patients who may be too ill or frail to speak for themselves. By providing a family-integrated environment, those support people can become part of our care system," she says. "And what difference is there between 2 a.m. and 2 p.m. if a person needs assistance and care? There should be no Ôforbidden' time for a designated support person to be involved."
Brodbeck's philosophy of care is shared by many others who have taken note of various studies, including the 1999 report, "To Err is Human: Building a Safer Health System," by the Institute of Medicine, which found that the number of Americans dying each year from medical errors — between 44,000 and 98,000 — was equivalent to the downing of one jumbo jet per day.
A 2010 report by the U.S. Department of Health and Human Services Inspector General also confirmed that one out of every seven hospitalized Medicare beneficiaries was seriously harmed in the course of his or her care — and that 44 percent of those events were preventable. One possible safeguard, it noted, was a patient support person who could provide important information, observations and warnings to medical personnel to avert wrongs such as prescription errors.
But many institutions have been slow to allow 24/7 access by their patients' designated support person.
That doesn't surprise Brodbeck.
"When we started discussing changes in visitation policies five years ago, there was a lot of noise from physicians who wanted to do their rounds quickly and without interruptions from 7 a.m. to 11 a.m. and from nurses who were afraid there would be 'free for alls' in the hallways without traditional protected times," she says.
"We needed to do a lot of reeducation about how health care has changed in the last 50 years. When hospital stays were long-er, patients convalesced here and visitation could become social time," she adds. "Now people who are hospitalized tend to be much sicker, and they need visitors who can be advocates."
A few months after St. Peter's adopted its new visitation policies, Brodbeck says, the "noise" disappeared. Staffers realized that most people were respectful of the hospital environment "without all the old barriers (to visitation) in place."
Physicians, she says, realized they could get helpful information about patients from family members, and with better communication there was less need for follow-up phone calls. And nurses were able to negotiate appropriate levels of family involvement.
"If it was helpful to have a family member present at night to calm a patient down, reduce agitation and help with bathroom visits, nurses were happy to accommodate people with comfortable loungers," she says. "If, on the other hand, a patient was sleeping well, nurses might suggest that it was in everyone's best interest for care-givers to go home and rest well so they would be able to care for their loved one after he or she was released."
The rule of thumb on visitation policies, she adds, is just to be "logical."
"We need to make things as comfortable as possible for patients and families. Working women need to be able to visit older parents and still be able to attend to their jobs; children and teens should be able to visit siblings, parents and grandparents," Brodbeck says. "Of course, there should be restrictions on visitors who have colds, rashes or fevers, but restrictions without justification are inappropriate."