Journal of Intensive Care Medicine

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Visiting policies in Italian intensive care units: a nationwide survey

Alberto Giannini, Guido Miccinesi, Stefania Leoncino
Original
Volume 34, Issue 7 / July , 2008

Pages 1256 - 1262

Abstract

Objective

To investigate visiting policies in Italian intensive care units.

Design and setting

Descriptive survey: a questionnaire was sent to all 303 units of the Italian Group for the Evaluation of Interventions in Intensive Care Medicine.

Results

Response rate was 85% (257/303). All ICUs except one had restricted visiting-hour policies. In five ICUs (2%) visits were not allowed. Median daily visiting time was 60 min (range 15 min–18 h); 55% of ICUs had one daily visiting slot. There were restrictions on number (92% of units) and type (17%) of visitors, and on child visits (69%). Policies were not modified for child patients in 9% of ICUs, nor for a dying patient in 21%. No waiting room was provided by 25% of ICUs. Gowning procedures were compulsory for visitors in 95% of units. In 35% of ICUs visitors were not required to wash their hands. A formal process for revision of visiting policies was underway in 33% of ICUs. In 66% of ICUs informative material on the unit was provided to the family on patient admission. Phone information on the patient was given relatively frequently (often/always, 34% of ICUs). Regional area and volume of admissions significantly influenced visiting hours. A visiting period longer than 60 min/day was significantly associated with more “open” attitudes towards visitors.

Conclusions

Italian ICUs have very restrictive visiting policies, which are only partially liberalized when the patient is dying or is a child. However, one-third of ICUs are rethinking their policies. This survey may contribute towards the liberalization of visiting policies in Italy's ICUs.

Keywords

References

  1. Burchardi H (2002) Let's open the door! Intensive Care Med 28:1371–1372
  2. Berwick DM, Kotagal M (2004) Restricted visiting hours in ICUs: time to change. JAMA 292:736–737
    • View reference on PubMed
    • View reference on publisher's website
  3. Nelson JE, Meier DE, Oei EJ, Nierman DM, Senzel RS, Manfredi PL, Davis SM, Morrison RS (2001) Self-reported symptom experience of critically ill cancer patients receiving intensive care. Crit Care Med 29:277–282
    • View reference on PubMed
    • View reference on publisher's website
  4. Biancofiore G, Bindi ML, Romanelli AM, Urbani L, Mosca F, Filipponi F (2005) Stress-inducing factors in ICUs: what liver transplant recipients experience and what caregivers perceive. Liver Transpl 11:967–972
    • View reference on PubMed
    • View reference on publisher's website
  5. Molter NC (1979) Needs of relatives of critically ill patients: a descriptive study. Heart Lung 8:332–339
    • View reference on PubMed
  6. Leske JS (1986) Needs of relatives of critically ill patients: a follow-up. Heart Lung 15:189–193
    • View reference on PubMed
  7. Mendonca D, Warren NA (1998) Perceived and unmet needs of critical care family members. Crit Care Nurs Q 21:58–67
    • View reference on PubMed
  8. Bijttebier P, Vanoost S, Delva D, Ferdinande P, Frans E (2001) Needs of relatives of critical care patients: perceptions of relatives, physicians and nurses. Intensive Care Med 27:160–165
  9. Davidson JE, Powers K, Hedayat KM, Tieszen M, Kon AA, Shepard E, Spuhler V, Todres ID, Levy M, Barr J, Ghandi R, Hirsch G, Armstrong D, American College of Critical Care Medicine Task Force 2004–2005, Society of Critical Care Medicine (2007) Clinical practice guidelines for support of the family in the patient-centered intensive care unit: American College of Critical Care Medicine Task Force 2004–2005. Crit Care Med 35:605–622
    • View reference on PubMed
    • View reference on publisher's website
  10. Fumagalli S, Boncinelli L, Lo Nostro A, Valoti P, Baldereschi G, Di Bari M, Ungar A, Baldasseroni S, Geppetti P, Masotti G, Pini R, Marchionni N (2006) Reduced cardiocirculatory complications with unrestrictive visiting policy in an intensive care unit: results from a pilot, randomized trial. Circulation 113:946–952
    • View reference on PubMed
    • View reference on publisher's website
  11. Simon SK, Phillips K, Badalamenti S, Ohlert J, Krumberger J (1997) Current practices regarding visitation policies in critical care units. Am J Crit Care 6:210–217
    • View reference on PubMed
  12. Roland P, Russell J, Culpepper Richards C, Cox Sullivan S (2001) Visitation in critical care: processes and outcomes of a performance improvement initiative. J Nurs Care Qual 15:18–26
    • View reference on PubMed
  13. Youngner SJ, Coulton C, Welton R, Juknialis B, Jackson DL (1984) ICU visiting policies. Crit Care Med 12:606–608
    • View reference on PubMed
    • View reference on publisher's website
  14. Biley FC, Millar BJ, Wilson AM (1993) Issues in intensive care visiting. Intensive Crit Care Nurs 9:75–81
    • View reference on PubMed
    • View reference on publisher's website
  15. Plowright CI (1996) Revisiting visiting in intensive therapy units. Intensive Crit Care Nurs 12:231–238
    • View reference on PubMed
    • View reference on publisher's website
  16. Quinio P, Savry C, Deghelt A, Guilloux M, Catineau J, de Tinteniac A (2002) A multicenter survey of visiting policies in French intensive care units. Intensive Care Med 28:1389–1394
  17. Knutsson SE, Otterberg CL, Bergbom IL (2004) Visits of children to patients being cared for in adult ICUs: policies, guidelines and recommendations. Intensive Crit Care Nurs 20:264–274
    • View reference on PubMed
    • View reference on publisher's website
  18. Lautrette A, Darmon M, Megarbane B, Joly LM, Chevret S, Adrie C, Barnoud D, Bleichner G, Bruel C, Choukroun G, Curtis JR, Fieux F, Galliot R, Garrouste-Orgeas M, Georges H, Goldgran-Toledano D, Jourdain M, Loubert G, Reignier J, Saidi F, Souweine B, Vincent F, Barnes NK, Pochard F, Schlemmer B, Azoulay E (2007) A communication strategy and brochure for relatives of patients dying in the ICU. N Engl J Med 356:469–478
    • View reference on PubMed
    • View reference on publisher's website
  19. Lee MD, Friedenberg AS, Mukpo DH, Conray K, Palmisciano A, Levy MM (2007) Visiting hours policies in New England intensive care units: strategies for improvement. Crit Care Med 35:497–501
    • View reference on PubMed
    • View reference on publisher's website
  20. Berti D, Ferdinande P, Moons P (2007) Beliefs and attitudes of intensive care nurses toward visits and open visiting policy. Intensive Care Med 33:1060–1065
  21. Bertolini G, Rossi C, Anghileri A, Livigni S, Addis A, Poole D (2007) Use of Drotrecogin alfa (activated) in Italian intensive care units: the results of a nationwide survey. Intensive Care Med 33:426–434
  22. Beccaro M, Costantini M, Giorgi Rossi P, Miccinesi G, Grimaldi M, Bruzzi P; ISDOC Study Group (2006) Actual and preferred place of death of cancer patients. Results from the Italian survey of the dying of cancer (ISDOC). J Epidemiol Community Health 60:412–416
    • View reference on PubMed
    • View reference on publisher's website
  23. Azoulay E, Pochard F, Chevret S, Jourdain M, Bornstain C, Wernet A, Cattaneo I, Annane D, Brun F, Bollaert PE, Zahar JR, Goldgran-Toledano D, Adrie C, Joly LM, Tayoro J, Desmettre T, Pigne E, Parrot A, Sanchez O, Poisson C, Le Gall JR, Schlemmer B, Lemaire F (2002) Impact of a family information leaflet on effectiveness of information provided to family members of intensive care unit patients: a multicenter, prospective, randomized, controlled trial. Am J Respir Crit Care Med 165:438–442
    • View reference on PubMed
  24. Cuttini M, Rebagliato M, Bortoli P, Hansen G, de Leeuw R, Lenoir S, Persson J, Reid M, Schroell M, de Vonderweid U, Kaminski M, Lenard H, Orzalesi M, Saracci R (1999) Parental visiting, communication, and participation in ethical decisions: a comparison of neonatal unit policies in Europe. Arch Dis Child Fetal Neonatal Ed 81:F84–F91
    • View reference on PubMed
  25. Meyer EC, Kennally KF, Zika-Beres E, Cashore WJ, Oh W (1996) Attitudes about sibling visitation in the neonatal intensive care unit. Arch Pediatr Adolesc Med 150:1021–1026
    • View reference on PubMed
  26. Plowright C (2006) Just who actually benefits from restricted visiting hours is not clear. Nurs Times 102:12
    • View reference on PubMed
  27. Levy MM (2007) A view from the other side. Crit Care Med 35:603–604
    • View reference on PubMed
    • View reference on publisher's website
  28. Jones C, Skirrow P, Griffiths RD, Humphris G, Ingleby S, Eddleston J, Waldmann C, Gager M (2004) Post-traumatic stress disorder-related symptoms in relatives of patients following intensive care. Intensive Care Med 30:456–460
  29. Azoulay E, Pochard F, Kentish-Barnes N, Chevret S, Aboab J, Adrie C, Annane D, Bleichner G, Bollaert PE, Darmon M, Fassier T, Galliot R, Garrouste-Orgeas M, Goulenok C, Goldgran-Toledano D, Hayon J, Jourdain M, Kaidomar M, Laplace C, Larche J, Liotier J, Papazian L, Poisson C, Reignier J, Saidi F, Schlemmer B; FAMIREA Study Group (2005) Risk of post-traumatic stress symptoms in family members of intensive care unit patients. Am J Respir Crit Care Med 171:987–994
    • View reference on PubMed
    • View reference on publisher's website
  30. Slota M, Shearn D, Potersnak K, Haas L (2003) Perspectives on family-centered, flexible visitation in the intensive care unit setting. Crit Care Med 31(Suppl 5):S362–S366
    • View reference on PubMed
    • View reference on publisher's website
  31. Spuhler VJ (2007) Review of literature on open visiting hours in the intensive care unit. Available at: http://www.ihi.org/IHI/Topics/CriticalCare/IntensiveCare/Tools/ReviewofLiteratureonOpenVisitingHoursintheIntensiveCareUnit.htm, accessed 2 May
  32. Rogers S (2004) Why can't I visit? The ethics of visitation restrictions—lessons learned from SARS. Crit Care 8:300–302
    • View reference on PubMed
    • View reference on publisher's website
  33. Guzzanti E (1998) L'autorizzazione e l'accreditamento nelle realtà delle strutture ospedaliere e delle tecnologie sanitarie in Italia: considerazioni e proposte. Ricerca per i Servizi Sanitari 2:3–24
  34. Guidelines/Practice Parameters Committee of the American College of Critical Care Medicine, Society of Critical Care Medicine (1995) Guidelines for intensive care unit design. Crit Care Med 23:582–588
    • View reference on publisher's website
  35. Ferdinande P (1997) Recommendations on minimal requirements for intensive care departments. Members of the Task Force of the European Society of Intensive Care Medicine. Intensive Care Med 23:226–232
  36. McClenathan BM, Torrington KG, Uyehara CFT (2002) Family member presence during cardiopulmonary resuscitation: a survey of US and international critical care professionals. Chest 122:2204–2211
    • View reference on PubMed
    • View reference on publisher's website
  37. Edward AE, McGann KA (2002) Steps to reduce nosocomial infections in children. Infect Med 19:414–424
  38. Levine C, Zuckerman C (1999) The trouble with families: toward an ethic of accommodation. Ann Intern Med 130:148–152
    • View reference on PubMed

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