COVID – 19 VISITATION

Visiting Hours

Monday – Friday: 9 am-7 pm
Saturday and Sunday: 9 am – 7 pm
Holidays: 9 am- 5 pm
*Limit of 2 visitors at a time

Policy:

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 to ensure a safe environment of care for our patients, staff and community in general, hospital visitation is restricted to a maximum of 4 hours with no more than 2 visitors at a time.

As recommended by the NYS Department of Health and the Centers for Disease Control and Prevention; Visitors/Support are provided with and must wear appropriate personal protective equipment

Visitors / Support who fail to wear a face mask and other PPE will be asked to leave the Facility.

Purpose:

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.

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. Cognitive impairment may also be temporary as in a patient needing emergent treatment in the ED. (Example not all inclusive: patient with alerted mental state due to a multitude of conditions such as stroke, TIA, shock, sepsis, major trauma, drug overdose, altered electrolyte imbalances, etc.) See under procedure section for details.

The support person of a patient with confirmed or suspected COVID-19

These support people must pass screening (see procedure section)

Wear a surgical or procedure mask throughout their time in the hospital

While in the room, a gown, gloves, eye wear and mask will be worn to prevent the person’s hands or clothes from becoming contaminated.

Practice scrupulous hand hygiene,

Remain in the patient’s room except for entrance and exit from the hospital

Clergy

Clergy will be permitted as a support person. If the patient already has a support person and a visitor in their room one will need to leave to allow clergy in. Clergy are not permitted in Covid rooms unless patient is at end of life and approved by House Supervisor

VISITOR – The person is non-essential to the patients care. The patient care need can be managed by staff at the hospital.  This person is there for the comfort of the patient. Visitor “status” is typically, but not always, associated with inpatients due to the nature of their extended stay.

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. House supervisor may be contacted to make the decision.

Support people and visitors must undergo symptom and temperature checks upon entering the facility, and shall be denied entry if they report significant COVID-19 exposure, during the prior 10 days, or symptoms in the past 72 hours, and/or have a temperature equal to or greater than 100.0 degrees Fahrenheit. 

Anyone entering New York who has visited another country within the last 10 days must:
• Complete the New York State Traveler Health Form, AND
• Asymptomatic individuals must quarantine (remain in your home or the place you are staying except for emergencies or to seek medical care) for 10 days upon arrival or 7 days after arrival if they have had a negative test on day 3-5 after return.

IDENTIFY ALTERNATIVE METHODS FOR COMMUNICATION WITH SUPPORT PERSONS TO ENSURE PATIENT NEEDS ARE MET. FOR END OF LIFE PATIENTS, CONTACT HOUSE SUPERVISOR.  May not enter if on isolation or quarantine by their local health department

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

Name and contact information, the date(s) of the visit, and the name of the patient(s) seen are maintained in an electronic format by the facility.

Follow entry screen protocol at all designated entrances.

MEDICALLY NECESSARY/SUPPORT PERSON

  • For labor and delivery, the NYSDOH allows any patient giving birth to have present with them: a support person (spouse, family, friend), who does not have symptoms of COVID-19, for the labor, delivery and also the remaining duration of the patient’s stay; and/or a doula, who does not have symptoms of COVID-19 for the labor, delivery, and the remaining duration of the patient’s stay. The presence of a support person and/or doula will be subject to exceptions for medical necessity. This restriction must be explained to the patient in plain terms, upon arrival or, ideally, prior to arriving at the hospital. Hospital staff should ensure that patients fully understand this restriction, allowing them to decide who they wish to identify as their support person and/or doula. Neither support person nor doula may come and go while the labor and delivery patient is here. Once on site they may remain until they leave, and or the patient is discharged, but may not enter and leave the unit, and then return to the unit.
  • For pediatric patients, the NYSDOH considers one support person at a time as essential to patient care in the emergency room 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 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. Note In the ED a patient may have one support person present. They will not be permitted to accompany the patient to the floor unless they continue to meet the definition of a support person as outlined above.
  • 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. One to two people may be present at bedside at end-of-life.
  • Patients that are positive for Covid-19 and PUI’s (patients under investigation for Covid-19) will not be allowed visitors unless it is an end-of-life circumstance. Staff will instruct visitor on proper application of PPE (personal protection equipment) if it is end-of-life visit

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.

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.

Use alternate methods of communication for patients in the hospital 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 person with questions or concerns regarding the COVID – 19 visitation restriction policy will be referred to leadership.

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
  • the requirement to distribute a notice of privacy practices
  • the patient’s right 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.

References: HIPAA requirements found in 45 CFR NYSDOH Health Advisory March 18, 2020 update March 21, 2020 and update April 10, 2020. Centers for Disease Control and Prevention Coronavirus Disease 2019 Guidance.  NYS DOH Health Advisory on Visitation, March 18, 2020, March 21, 2020 and April 10, 2020 and June 17, 2020.

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