Open (Nearly) All Hours

1419565616_fbafd085a4_oThis year Heart of England NHS Foundation Trust became one of the first to introduce open visiting.  Dr Helen Chamberlain, a Consultant Geriatrician at Good Hope Hospital (one of the three sites run by the Trust), shares her experience of this innovation.

One of the drivers for our recent change in visiting hours was John’s Campaign.  This was started by Observer journalist Nicci Gerrard in November 2014 after death of her father Dr John Gerrard.  He had dementia, but during his admission for infected leg ulcers declined badly.  Nicci felt that had his family been allowed to visit as often as they wished, he would have been less distressed.

In April 2015 open visiting was introduced by Head Nurse Sam Foster (@SafetySamFoster).  Relatives are welcome to visit from early morning until late evening.  We have had a few stay overnight: I located a fold-up bed which allowed a patient’s wife to stay with him throughout his stay.  It’s interesting to note that NIcci based her argument for open visiting on the need for parents to stay with their children in hospital.  With slight irony, the spare bed was sitting unused on the paediatric ward!

At the start of the project there was a bit of trepidation. There is a Visitors’ Charter which asks relatives to come no more than two at a time and respect meal times unless they are helping their loved one to eat.  All of us were worried we would be inundated with visitors and would not be able to get our work done, but this has not been the case.

Are there any downsides?  Well, I have to be more wary of confidentiality and do ask visitors to leave the bay if I’m having a sensitive discussion.  Overnight stays only work if the patient is in a side room, and we do not have bathroom facilities except the visitors’ toilets.  As John’s Campaign states, relatives should have the right to visit during a hospital stay but we need to respect that they may also need a bit of respite if they are the main caregiver.  We have had a lot of support from families of patients with dementia and delirium, but we know from other work we have done that seeing a loved one in distress can be very upsetting.

We have had a norovirus outbreak on my ward since the change in policy and so had to restrict visiting again.  This was accepted and understood, although the outbreak wasn’t too bad and we didn’t have to be too strict with the lockdown procedures.  If/when we have a more serious situation, we accept we will have to restrict visiting more than we would like.

And the upsides?  Ward rounds may take a bit longer, but I can get the vital collateral history much more quickly, the therapy staff can make assessments more easily, and the nurses don’t have a queue of people between 2pm and 4pm demanding updates.  We think the rate of falls has reduced, and there is a hint that the more open communication has reduced formal complaints.  Visitors have been able to see the activities our volunteers lead, which they were not aware of before.

It’s early days, and a more formal evaluation is underway.  Would I go back to formal visiting hours?  No.  What’s more, there is no longer a traffic jam in the car park every afternoon!

Image credit: ericvv via Flickr

1 thought on “Open (Nearly) All Hours

  1. Dear Helen, I was very interested to read this, which is so in line with attempts to improve communication with families and carers. 2 questions: is yours an acute ward, or a rehab setting? and I wonder whether you have any other specific comments on the impact on nursing staff:
    did they like the idea- did it cause them any difficulty, or did it help?

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