SCHUYLER HOSPITAL POLICY & PROCEDURE

POLICY STATEMENT: Separation of patients and their loved ones during a hospitalization can cause significant stress and anxiety, and the opportunity to visit hospitalized patients must be done in a manner that continues to prevent the spread of COVID-19 and ensure the health and wellbeing of patients, staff, and visitors. In recognition of this need, and to ensure a safe environment of care while permitting is expanded, the following outlines our visitation procedure.

PURPOSE: COVID-19 has been detected in multiple communities around New York State. Visitors may introduce COVID-19 infection into the hospital. The New York State Department of Health (NYSDOH) issued visitor limitation guidance to hospitals to protect and maintain the health and safety of both patients and staff during the ongoing novel coronavirus (COVID-19) outbreak.

Definitions:

MEDICALLY NECESSARY/SUPPORT PERSON – The person is essential to the patients care.

Examples:

• • Vendors bring supplies for patient care.
  • Friend or family member who is the primary care giver of a patient being discharged and needs to be educated to patient care. This may be done through remote communication is feasible. If discharge instructions are complex (i.e. require return demonstration or hands on learning) consult with leadership on how to best accomplish the need.

NYSDOH allows us to permit a patient support person at the patient bedside for:

• • Patients in labor and delivery;
  • Pediatric patients;
  • Patients for whom a support person has been determined to be essential to the care of the patient (medically necessary) including patients with intellectual and/or developmental disabilities and patients with cognitive impairments including dementia. See under procedure section for details.

VISITOR– The person is non-essential to the patients care. Any stated patient care need can be managed by staff at the hospital.  This person is there for the comfort of the patient.

IMMINENT END OF LIFE SITUATION – Situation where death is imminent as determined by medical provider and anticipated within the next 24 hours.

NOTE: A PATIENT IS NOT A VISITOR

PROCEDURE:

Determine if the person is a Visitor or Medically Necessary/Support Person to the patient’s care.

Visitors and support people must undergo symptom and temperature checks upon entering the facility, and shall be denied entry if they report significant COVID-19 exposure or symptoms during the prior 14 days or have a temperature equal to or greater than 100.0 degrees Fahrenheit.

Upon entry into the facility all visitors and support people will be provided a badge that must be worn at all times.

Name and contact information for visitors, the date(s) of their visits, and the name of the patient(s) visited are maintained in an electronic format by the facility.

Follow entry screen protocol at all designated entrances.

MEDICALLY NECESSARY/SUPPORT PERSON

• For pediatric patients, the NYSDOH considers one support person at a time as essential to patient care in the emergency department or during hospitalization. For hospitalized pediatric patients, especially with prolonged hospitalizations, the patient or family/caregiver may designate two support people; but only one support person may be present at a time. This restriction must be explained to the patient’s family/caregivers in plain terms, upon arrival or, ideally, prior to arriving at the hospital. Hospital staff should ensure that the
  family/caregiver fully understand this restriction. Individuals age 70 years or older, are not encouraged to be support persons at this time due to increased risk of COVID-19 infection.
• For patients for whom a support person has been determined to be essential to the care of the patient (medically necessary) including patients with intellectual and/or developmental disabilities (I/DD), and patients with cognitive impairments including dementia, the NYSDOH considers one support person at a time as essential to patient care in the emergency room or during hospitalization. For these hospitalized patients, especially with prolonged hospitalizations, the patient or family/caregiver may designate two support people but only one support person may be present at a time. This support person can be the patient’s family, caregiver, or another person they chose. In these settings, the person will be the only support person allowed to be present during the patient’s care. This restriction must be explained to the patient and support person in plain terms, upon arrival or, ideally, prior to arriving at the hospital. Hospital staff should ensure that the patients fully understand this restriction, allowing them to decide who they wish to identify as their support person. Individuals age 70 years or older, are not encouraged to be support persons at this time due to increased risk of COVID-19 infection.
• For patients in imminent end-of-life situations, the NYSDOH considers one family member and/or legal representative at a time as a support person who should be permitted at the patient bedside. The NYSDOH defines imminent end-of-life situations as a patient who is actively dying, where death is anticipated within less than 24 hours. The patient and/or family/caregiver may designate up to two support people; but only one support person may be present at a time. In the event the patient is a parent of a minor child, one adult family member and one child may be permitted at the patient bedside. This restriction must be explained to the patient and/or support person in plain terms, upon arrival or, ideally, prior to arriving at the hospital. Hospital staff should ensure that patients and/or support person fully understand this restriction. Individuals age 70 years or older, are not encouraged to be support persons at this time due to increased risk of COVID-19 infection.

The support person of a patient with confirmed or suspected COVID-19 who has been a close contact of the patient has potentially already been exposed to COVID-19. These support persons should:

• Wear a surgical or procedure mask throughout their time in the hospital ,
• Practice scrupulous hand hygiene,
• Remain in the patient’s room except for entrance and exit from the hospital; and
• While in the room, a gown and gloves should be worn to prevent the person’s hands or clothes from becoming contaminated. Eye protection should be worn while in the room if available.

If the support person of a patient with confirmed or suspected COVID-19 has not been a close contact of the patient and does not have a history of confirmed COVID-19, the support person should:

• Wear a surgical or procedure mask throughout their time in the hospital,
• Practice scrupulous hand hygiene,
• Remain in the patient’s room except for entrance and exit from the hospital, and
• While in the patient’s room, a gown and gloves should be worn to prevent the person’s hands or clothes from becoming contaminated. Eye protection should be worn while in the room if available.
• Again, in these circumstances the risks of acquiring COVID-19 should be fully explained, so that the patient and support person can make an informed decision of whether or not the support person’s presence at the patient bedside is essential to the patient’s health.

If the patient does not have confirmed or suspected COVID-19, the support person should:

• Wear a surgical or procedure mask throughout their time in the hospital,
• Practice scrupulous hand hygiene, and
• Remain in the patient’s room except for entrance and exit from the hospital.

Hospital staff must screen the support person for symptoms of COVID-19 (e.g., fever, sore throat, runny nose, cough, shortness of breath, muscle aches, or diarrhea) and conduct a temperature check prior to entering the clinical area and every twelve hours thereafter for the remainder of their presence at the bedside. When providing Personal Protective Equipment (PPE) to a support person, instructions on PPE conservation strategies should be provided to minimize unnecessary waste (i.e. prolonged wearing).

If a support person has confirmed or suspected COVID-19 or presents with or develops symptoms of COVID-19, they should be excluded from the facility.  There are no exceptions to this rule. In this situation, through informed decision making the patient and family may choose to select a different support person. Signage will be placed at all hospital entries and parking lots to inform visitors of new COVID–19 visitation restrictions. This policy will be posted, and made available.

VISITORS

ALL INSTANCES WHERE “OTHERWISE AUTHORIZED” IS UTILIZED TO DEVIATE FROM THE SPECIFIC VISITATION  LIMITATION MUST BE AUTHORIZED BY THE Administrator On Call (AOC).

• Visits are limited to no more than four hours per day per patient, unless otherwise authorized by the hospital, depending on the patient’s status and condition;
• Total time for all visitors cannot exceed the four-hour maximum, unless otherwise authorized by the hospital. However, the facility can determine the appropriate visiting hours within this requirement;

• Visitors are limited to one person at a time unless at hospital’s discretion a limited number of additional persons is determined to be appropriate to allow at the bedside;

• Patients undergoing same day procedures may be accompanied to the facility by a companion and that companion may remain with the patient through the initial intake process; and may rejoin the patient for the discharge process;

• Visitors may not be present during procedures and recovery room except for pediatrics, childbirth, and patients with an intellectual, developmental, or other cognitive disability as listed in the NYSDH’s May 20th Revised Visitation Guidance;

• Visitors are provided with and must wear appropriate personal protective equipment as recommended by the NYSDH and the Centers for Disease Control and Prevention;

• Visitors must be advised how to perform meticulous hand hygiene and how to wear the PPE, and must adhere to such procedures;

• Visitors who fail to wear a face mask and other PPE will be asked to leave the facility;

• Visitors must undergo symptom and temperature checks upon entering the facility, and shall be denied entry if they report significant COVID-19 exposure or symptoms during the prior 14 days or have a temperature equal to or greater than 100.0 degrees Fahrenheit;

• Once in the facility, visitors must remain in the patient’s room throughout the visit except when directed by hospital staff to leave during aerosol-generating procedures or other procedures during which visitors are usually asked to leave;

• Health care providers should provide written information to visitors and/or discuss the potential risks and benefits of the visitor’s presence with the visitor and, depending upon the patient’s condition, the patient;

• All visitors are greater than 18 years of age except in rare exceptions as determined by the hospital;

• Name and contact information for visitors, the date(s) of their visits, and the name of the patient(s) visited are maintained in an electronic format by facility; and

• Details about the facility’s current visitation policy, including participation in the hospital visitation program, are posted on the facility’s webpage. 

Alternate methods of communication for patients in the hospital will be used as appropriate to individual patient ability and medical status (audio, visual). This may include use of electronic devices with video ability that are hospital owned, or patient owned devices. CDC recommendations for cleaning will occur after each patient use.

Any visitor with questions or concerns regarding the COVID – 19 visitation restriction policy will be referred to leadership.

Health Insurance Portability and Accountable Act (HIPAA) Considerations

The HIPAA Privacy Rule allows patient information to be shared to assist in nationwide public health emergencies, and to assist patients in receiving the care they need. This is important to consider when visitation is suspended and use of alternative remote methods of communication with family and friends is utilized.

Under Pandemic Public Health Crisis hospitals will not be penalized for failing to comply with HIPAA and the following requirements are waived to facilitate communication and patient care.

• to obtain a patient’s agreement to speak with family members or friends involved in the patient’s care • the requirement to honor a request to opt out of the facility directory
• to distribute a notice of privacy practices
• to request privacy restrictions
• the patient’s right to request confidential communications

The HIPAA Privacy Rule for releasing the minimum necessary for the care and treatment of a patient remains. Should detailed or complex medical information need to be relayed to a patient’s family or friend, medical staff should make effort to directly convey this information.

Effective June 29, 2020

Subject to Change