Hospital Visitation Policy

Purpose

To delineate the guidelines for in-person visitation of inpatients at the Nemours Children's Hospitals (NCH). Nemours supports family-centered care and strives to have the most liberal visitation possible, while ensuring the quality and safety of care provided.

Policy

All pediatric patients are permitted in-person visitors, and updates on visitor restrictions related to community transmission rates of infectious disease, including COVID-19, are posted on Nemours.org.

1. The following apply regardless of community transmission rates of infectious disease:

a. Pediatric patients will always be permitted at least one in-person visitor.
b. Visitors must abide by infection control policies in place. Current infection control measures for visitors can be found on the COVID-19 information page of the Nemours website.
c. Patients have the right to consensual physical contact with visitors. ¹
d. If a parent or legal representative is unable to be present or if the patient's duration of stay is greater than fourteen (14) days, a designated family caregiver ("Partner in Care"), who is 18 years of age or older may stay with the patient, once approved by charge nurse or nurse manager.

i. An adult must accompany and provide supervision to visitors under the age of 18 at all times. This adult companion cannot be a patient.
ii. Where at least one parent of the patient is a minor, one minor parent will be allowed to stay with the patient at a time. If both minor parents want to stay, an adult must be with them to provide supervision.

e. All parents, legal representatives and visitors 16 years of age and older, are required to wear a visitor badge for the duration of their visit or stay. Each visitor must produce a valid identification (ID) as per Nemours Policy #5.6.22, Verification of Identity, to obtain a visitor badge from security at the main hospital entrance. Nemours does not restrict, limit or otherwise deny visitation privileges on the basis of race, color, national origins, religion, sex, gender, identity, sexual orientation or disability.
f. Visitors who are ill are generally precluded from visiting, particularly those with communicable diseases. Limited exceptions may be made for parents or legal representatives with the approval of the care team.
g. Visitors will not be asked to show proof of immunization or vaccination.
h. Visitors must engage in self-screening for symptoms of infectious disease or communicable disease, including COVID-19, prior to visiting. These self-screening questions are available at visitor entrances and on Nemours.org.
i. Patients who are adults or emancipated minors may designate a visitor who is a family member, friend, or other individual as an essential caregiver.²
j. Nemours may suspend in-person visitation of specific visitors if they fail to comply with Nemours policies and procedures.
k. Designated "quiet hours" begin at 8 p.m. and end at 8 a.m. seven days a week to create the right environment for rest and recovery. Family and friends should be reminded of the following:

i. Be mindful of any neighbors sharing the room or in adjacent rooms.
ii. Tum down the television (TV)
iii. Set cell phones on vibrate. Be respectful of conversations in common areas.
iv. Check with the patient's nurse prior to giving the patient any food or refreshments.
v. If there is a change in patient condition during a visit and intervention is required, visitors may be directed by the patient's family, nurse or other Nemours associate to leave the patient room during this time.
vi. NCH has a zero tolerance of  vulgar language or inappropriate behavior.
vii. NCH may place reasonable limitations on the number of visitors at any one time.

2. Emergencies/natural disasters/public health crisis:

a. In severe weather, natural disasters, public health crisis, situations where there is a threat of violence and other emergencies, the hospital may temporarily be locked down.

i. All visitation will be suspended during this time, and at least one parent/legal representative will be permitted to stay with the patient until the lockdown is lifted.

b. During an emergency, please follow guidelines created by the
hospital's Incident Command Center or guidelines specific to individual patient care areas after Incident Command deactivation. Patients and visitors will be notified as soon as practicable of temporary visitor restrictions due to emergencies.

When deemed necessary, for example during periods of high community infectious disease transmission rates, Nemours will base its visitation on the level of community transmission rates, as defined by the Centers for Disease Control (CDC) as applied to the Nemours geographic regions. Limitations will be applied in cases of infectious disease outbreaks, epidemics or pandemics, including but not limited to COVID-19.

1. If infectious disease, including SARS-CoV-2, Community Transmission rates are HIGH:

a. Each patient may have one healthy caregiver who may visit at any time during the patient's stay. There are no other restrictions on visitation for parents or legal representative except as recommended by the Florida Department of Children and Families (DCF), the Delaware Department of Services for Children, Youth, and Their Families (DSCYF), or specific court order. Parents/Legal representatives are encouraged to spend as much time with their child as possible during their child's entire hospital stay.

2. If infectious disease, including SARS-CoV-2, Community Transmission rates are SUBSTANTIAL:

a. Each patient may have two healthy caregivers who may visit at any time during the patient's stay. There are no other restrictions on visitation for parents or legal representatives, except as recommended by the Florida Department of Children and Families (DCF), the Delaware Department of Services for Children, Youth, and Their Families (DSCYF), or specific court order. Parents/Legal representatives are encouraged to spend as much time with their child as possible during their child's entire hospital stay.

3. If infectious disease, including SARS-CoV-2, Community Transmission rates are MODERATE:

a. Each patient may have two healthy caregivers who may visit at any time during the patient's stay. There are no other restrictions on visitation for parents or legal representatives, except as recommended by the Florida Department of Children and Families (DCF), the Delaware Department of Services for Children, Youth, and Their Families (DSCYF), or specific court order. Parents/Legal representatives are encouraged to spend as much time with their child as possible during their child's entire hospital stay.
b. One of the patient's two healthy caregivers may be a sibling who is aged 12 or older.

i. Parents/Legal representatives are responsible for supervising and safeguarding sibling minors, regardless of age, at all times.
ii. Visitors who are ill, particularly those with communicable diseases, are specifically precluded from visiting. Exceptions may be made by the care team for end-of-life visits, or other extenuating circumstances.
iii. During Influenza Plan Activation, siblings must be 14 or older to visit in the Neonatal Intensive Care Unit (NICU).

4. If infectious disease, including SARS-CoV-2, Community Transmission rates are LOW:

a. There are no restrictions on length of visits or number of parent or legal representative visitors, except as recommended by the Florida Department of Children and Families (DCF), the Delaware Department of Services for Children, Youth, and Their Families (DSCYF), or specific court order. Parents/Legal representatives are encouraged to spend as much time with their child as possible during their child's entire hospital stay.
b. Siblings may visit between the hours of 8 a.m. and 8 p.m., as approved by parents or legal representatives. Exceptions to sibling visitation during quiet hours (8 p.m. to 8 a.m.) will be considered collaboratively between the parent/legal representative and the charge nurse/medical team.

i. Parents/Legal representatives are responsible for supervising and safeguarding sibling minors, regardless of age, at all times.
ii. Visitors who are ill, particularly children with communicable diseases, are specifically precluded from visiting. Exceptions may be made by the care team for end-of-life visits, or other extenuating circumstances
iii. During Influenza Plan Activation, siblings must be 14 or older to visit in the Neonatal Intensive Care Unit (NICU).

c. Extended family and friends are also encouraged to visit with approval from the parent/legal representative or partner in care between the hours of 8 a.m. and 8 p.m.

i. Exceptions to visitation during quiet hours will be considered collaboratively between the parent/legal representative and the charge nurse/medical team.
ii. It may be necessary to limit the number of visitors in the room, day or night, based on the clinical circumstances of the patient and or the needs of the hospital unit.
iii. Visitors who are ill, particularly children with communicable diseases, are specifically precluded from visiting. In some units, a screening tool will be used prior to allowing visitors (See documents linked below. This screening tool is to be used by health care providers to screen visitors less than (<) 18 years of age, who present with potential exposure and/or signs and symptoms of illness.).
iv. Visitors of NICU patients must be 14 or older in order to visit during Influenza Plan Activation.

General expectations for caregivers and other visitors:

5. Time away from inpatient bed with family/visitors:

a. Under caregiver supervision, patients may leave their unit after
consultation with the patient's nurse. The patient's nurse will ensure that the parent/legal representative or family-designated caregiver will accept responsibility for supervision of the patient during this time.
b. The status of the Tot Guard armband will be changed by the patient's nurse or designee, as necessary, when the patient leaves their unit.
c. During Influenza Plan Activation and times of pandemic, permission to leave the unit should be very limited and discussed with the provider and or infectious diseases before approval is given.

6. Infection prevention precautions:

a. Infection prevention precautions for special circumstances will be determined by the Infection Prevention and Control Department and the Infectious Diseases Division. During Influenza Plan Activation no child under the age of 6 may visit any inpatient.
b. These guidelines supersede any other unit specific visitation
guidelines.
c. Parents/Legal representatives/partners in care and all visitors will be provided education regarding isolation precautions and personal protective equipment (PPE) requirements.
d. Visit limitations or restrictions may be initiated for:

i. Infectious disease outbreaks within the hospital.
ii. Infectious disease precautions or outbreaks within the community.
iii. Emergency precautions initiated in response to CDC or Public Health communications/warning regarding specific contagious agents.

7. High acuity units:

a. Units for acutely ill patients or units with space restrictions may further limit visitation. Parents/Legal representatives and partners in care will be notified of these unit specific restrictions upon the patient's admission. All restrictions are intended to create an environment of safety and healing for the patient.

8. Related documents — Caregiver education:

a. Provide parents/legal representatives and partners in care with a review of pertinent information concerning the specific unit, visitation, hospital layout and resources.
b. Provide parents/legal representatives and partners in care with NCH Partnership/Family-Centered Care welcome materials.

Designated Contact

NCH, Florida: Martha McGill, SVP and Chief Operating Officer, Florida, Chief
Administrative Officer, NCH Florida or Administrator on Call.

NCH, Delaware: Mark Mumford, Executive Vice President, Chief Executive Delaware Valley Operations or Administrator on Call.

Compliance Helpline at: (866) 636-4685 or nemourshelpline.ethicspoint.com
 

Related Documents

Partnership Visitation Screening Tool

Nemours associates, please refer to PolicyTech for site-specific policies and
procedures.

References

Florida Statutes Section 408.823 (2022) 

Institute for Patient- and Family-Centered Care. (2010) Changing Hospital "Visiting" Policies and Practices: Supporting Family Presence and Practices. Bethesda, MD
http://www.ipfcc.ora/resourceslvisiting.pdf

Nursing Management (August 2006: Volume 37 Number 8, pages 20-24) Visitation Guidelines Promote Safe, Satisfying Environments: Encourage Patient and Staff Satisfaction by Implementing Family-Centered Care With a Flexible Structure and Effective Security.

Definitions

Family — A family is a group of individuals with a continuing legal, genetic and/or emotional relationship to the patient, American Academy of Family Physicians, (2009).

Influenza Plan Activation— A period of time in which influenza activity is noted to be widespread as determined by the local Centers for Disease Control & Prevention (CDC). During the Influenza Activation Plan screening of all visitors and certain visitation restrictions may apply based on assessed risk using the Nemours illness screening tool.

Partner in Care — Any individual a patient or parent identifies as important to the patient and family and for which they would like unlimited access to aid in the support and recovery of the patient.

Quiet Hours — A designated time in the day where we respect the need for quiet to allow time to commune or sleep without disruption.

Visitor —Anyone invited by the family to be present who does not meet the criteria for family or partner in care.

Tot Guard — Tot Guard is a child protection system designed to assist NCH associates in providing a high degree of safety for infants and children. The Tot Guard is a lightweight band applied to infants and children that emits a beacon every 12 seconds as to the child's whereabouts. A missing tag alarm occurs when the system cannot detect a band's beacon.

¹ In accordance with Florida law, SB 988.

² In-person visitation by the essential caregiver will be permitted for at least 2 hours daily in addition to any other authorized visitation. In accordance with Florida law, SB 988, essential caregivers are not required to provide care to a patient, nor are providers required to compel an essential caregiver to provide care.