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Participation of Patients’ Primary Supports and Visitors (3.3.5)

Participation of Patients’ Primary Supports and Visitors (3.3.5) - Policies, Clinical, UW Health Clinical, Medical Records and Communication, Communication

3.3.5


UW HEALTH CLINICAL POLICY 1
Policy Title: Participation of Patients’ Primary Supports and Visitors
Policy Number: 3.3.5
Category: UW Health
Type: Ambulatory and Inpatient
Effective Date: June 21, 2016

I. PURPOSE

The purpose of this policy is to provide:
A. Expectations regarding persons spending time w ith patients in any setting
B. A mechanism to issue identif ication to authorized individuals visiting a patient in inpatient settings
C. Differentiation betw een primary supports and visitors.

The patient has the right to select a primary support regardless of race, creed, color, national origin,
ancestry, religion, gender, gender identity or expression, sexual orientation, marital status, age or disability.
In collaboration w ith the primary nurse, they are encouraged and supported to be involved in the care of the
patient. Primary supports are not visitors, rather they are recognized for the unique role they play as a
member of the patient's health care team, and as such are integral to the patient's healing process.

II. DEFINITIONS

A. Primary Support: Primary support is defined by the patient as the group of signif icant adults, 18 years or
older, who normally provide the patient w ith physical, psychological, or emotional support. A patient’s
primary supports are defined by the patient and are not limited to relatives. When the patient is unable to
define primary supports, the patient’s representative w ill provide this definition.
B. Visitor: Visitors are guests of the patient or family that do not provide primary support. In some cases,
visitors may be relatives. Visitors have restricted times during w hich they may see the patient as defined per
setting.
C. Adult: An adult is a person 18 years of age or older.

III. PHILOSOPY

UW Health promotes and supports a patient-and family-centered approach to care. The diagnosis and
treatment of illness and disease can result in a range of stressful circumstances and subsequent changes
for patients, as w ell as their families and signif icant others. Most patients and families require assistance
and support, at different times and in different w ays, from people important to them. This support may
involve someone to assist in decisions about medical care, provide companionship, or provide care in the
home after treatment. For some people, their primary support may come f rom immediate family members.
For others, the primary support may include relatives, a partner, neighbors, friends, co-w orkers, or clergy.
Staff members can help primary supports and visitors to offer effective assistance and emotional support
to the patient by providing clear explanations about their roles. This may include but is not limited to how
best they can support the patient, any limitations they need to be aw are of in supporting the patient and
an explanation of the unit environment as it relates to the primary supports and visitors.
The patient's plan of care as it relates to the role of the primary support person should be reevaluated w ith
the patient and primary support person on an ongoing basis and changed accordingly to respond to the
diverse and changing needs and preferences of each patient. Patients may need assistance altering the
primary support role as w ell as setting expectations for visitors.

IV. POLICY ELEMENTS

In collaboration w ith and support from the primary nurse, primary supports are usually w elcome at any time.
This is at the discretion of the patient or at the discretion of the patient's representative if the patient is a
minor or does not possess decision-making capacity.
The patient or patient's representative may make visitation limitations in conjunction w ith the primary
nurse and the health care team. The hospital or health care provider may restrict visitors/primary supports
if clinically necessary or establish a reasonable restriction consistent w ith Section VI.H.
Hours for visitors in inpatient settings (not primary supports) are 8 am to 9 pm. There are no age limitations



UW HEALTH CLINICAL POLICY 2
Policy Title: Participation of Patients’ Primary Supports and Visitors
Policy Number: 3.3.5

on visitors. Children younger than 16 must be accompanied and supervised by an adult w ho is not a patient.
Visitors requiring overnight accommodations should be referred to the Housing Coordinator (608-263-0315)
for assistance w ith reservations at a nearby facility. All persons in the hospital after 9 pm must w ear an
identif ication badge.
Neither primary supports staying overnight nor their belongings should obstruct health care providers'
access to or ability to care for the patient. Patients and visitors are responsible for all personal belongings.
UW Health is not responsible for replacing lost or misplaced items, so it is recommended that only essential
items be brought to the hospital.

V. INFECTION CONTROL CONSIDERATIONS

A. Primary supports and/or visitors w ith symptoms consistent w ith infectious illness (fever, rash, diarrhea,
conjunctivitis, and/or cough) should not come to the hospital.
B. Primary supports and/or visitors w ho have been exposed to chickenpox, measles, mumps, pertussis
(w hooping cough) or other infectious diseases should not visit patients. In addition, primary supports or
visitors w ho have been exposed to chickenpox, measles, mumps, or pertussis (w hooping cough) or other
infectious disease, should not accompany or visit the hospital until they have consulted w ith their primary
care provider to determine if they are susceptible to the communicable disease in question.
i. If exposed individuals are deemed susceptible, they should not visit the hospital for at least three
w eeks after their last know n exposure.
ii. If there is any question about w hether a person should be permitted to visit, Infection Control
should be consulted.

VI. PROCEDURE

A. Primary Supports in Inpatient Settings: Upon admission or anytime during the patient's hospitalization, the
patient or the patient's representative (in the case of minors or patients w ithout decision making capacity)
may determine w ho the patient's primary supports are. Typically, this w ill include a small number of people.
Due to space limitations, the number of overnight primary supports staying in the patient's room must be
limited.
i. In order to stay in the hospital after hours, primary supports w ill receive a badge from unit staff.
B. Visitors in Inpatient Settings
i. At 8:45 pm the Message Center w ill announce the end of v isiting hours.
ii. The patient's nurse w ill be responsible for clearing unauthorized visitors from her/his patients'
rooms by 9 pm. Security is responsible for checking w aiting areas. Staff should maintain an
aw areness of individuals in patient rooms and w aiting areas.
iii. Visitors (not primary supports) coming to the hospital after 9 pm must have approval of the hospital
staff on the unit caring for the patient. Visitor badges are provided by Security and are valid only for
one night.
C. American Family Children’s Hospital
i. One parent, guardian or designee (18 years of age or older) may stay overnight in the patient's
room. If the primary nurse, after discussion w ith the patient/parents, believes additional overnight
guests w ould better meet patient/family needs, she/he w ill discuss the case w ith the Clinical Nurse
Manager or Pediatric Director of Nursing or their designee on the next business day. With their
approval, additional overnight guests may be permitted.
ii. The parent, guardian or designee staying over w ill be expected to sleep on the cot or sleep chair
using the provided bedding. The parent, guardian or designee w ill be expected to w ear appropriate
sleepw ear. Neither the individual staying overnight nor their belongings should obstruct the health
care providers' access to or ability to care for the patient.
iii. When the patient is 18 years of age or older, she/he can designate the individual authorized to stay
overnight (overnight guest must be 18 years of age or older). For purposes of this policy, an
emancipated minor w ill be treated as a patient w ho is 18 years of age or older. An emancipated
minor generally is defined as a minor w ho is or has been married or w ho otherw ise has established
that he or she has been freed from the care and custody of his or her parents (w ith the parents'
consent, i.e., not a run-aw ay) w ith little likelihood of returning. If there is any doubt about w hether a
minor is emancipated, contact the Legal Department (608-261-0025) or, during non-business
hours, page the attorney-on-call through the paging operator (608-262-2122).
iv. Families, primary supports, and/or visitors are discouraged from sleeping overnight in the lounge or



UW HEALTH CLINICAL POLICY 3
Policy Title: Participation of Patients’ Primary Supports and Visitors
Policy Number: 3.3.5

w aiting areas, and w ill be offered assistance in f inding suitable lodging (for more information refer
to the Financial Support for Patient/Family Hotel Lodging Guidelines).
v. Upon inpatient admission parent (RN) w ill complete primary support card and report to security to
obtain a primary support badge. Badges should be returned at time of discharge.
vi. Upon arrival to the AFCH, all family and visitors w ill be screened against a sex offender database
by security, prior to gaining access to the inpatient units. All visitors must w ear a visitor pass at all
times w hile visiting the inpatient units.
vii. Upon arrival to the AFCH, family and visitors w ill complete a health screening. If the adult and/or
sibling does present w ith symptoms, hospital security w ill contact the patient's nurse. The nurse w ill
advise on the adult/sibling visit. If it is deemed that visiting the patient w ould not pose a risk, the
adult w ill be informed of the limits of the visit, i.e., only the patient's room and not the playroom to
protect other patients and siblings. The parent/caregiver/visitor w ill have a yellow sticker attached
to their visitor pass as a w ay to identify limits of the visit, i.e., interactions to be w ith the patient only.
viii. Parents of siblings visiting Tyler’s Place w ill be asked daily if there have been any health changes
since their last visit. If there is a change in the sibling’s health, the parent/sibling w ill be directed to
security. Security w ill then contact the primary nurse for guidance on visiting the patient.
D. Psychiatric Unit
i. Due to space limitations, care plans, and safety issues, it is not alw ays possible to accommodate
overnight stays in the psychiatric unit. When the primary nurse determines that an overnight stay is
appropriate, one adult primary support may be permitted to stay overnight in the patient’s room.
ii. Primary supports w ho are interested in staying overnight should inform the nursing staff as soon as
possible during the day to help facilitate arrangements.
E. Forensic Patients
i. The forensic unit and forensic patients have visitation guidelines tailored to the special
circumstances of the patient population. The agency that has taken custody of the patient should
be consulted prior to granting visitation, therefore, the Forensic unit staff should be consulted for
any questions about visitation for these patients.
F. The American Center
i. After hours, w hen public entrances are closed, visitors w ill enter through the Emergency
Department and check in w ith security. Security w ill keep a log w here visitors w ill sign-in and w ill be
issued a visitors badge. Security w ill call the Overnight Care Unit (ONC) nursing station and report
the name of the visitor to request patient approval prior to escorting the visitor to the ONC nursing
station for a visual check-in before escorting the visitor to the patient room.
ii. Visitors already in-house w ill get a badge from the inpatient unit and ONC w ill keep a clipboard w ith
a sign-in sheet so associates know w ho is on the unit overnight.
iii. Security w ill complete a w alk through at 2330 on ONC to collect the logged list of visitors on ONC
and w ill create a CESI incident report w ith the log attached to keep record of the overnight visitor
list.
iv. Visitors needing assistance w ith hotel accommodations should contact Guest Services at 608-440-
6242
G. Ambulatory Settings
i. Primary Supports: During outpatient visits the patient or patient’s representative may determine
who the patient’s primary supports are.
ii. Due to space limitations in clinic exam rooms, the number of primary supports in the room during
the visit may need to be limited.
iii. The patient should be given the opportunity of privacy if sensitive information w ill be discussed
during a visit.
H. Exceptions and Restrictions on Visitation
No exceptions to this policy shall be made regarding the requirement that all primary supports and visitors
w ear badges authorizing them to be in the building after 9 pm in inpatient settings. Persons refusing to w ear
a badge w ill be refused visitation. When off icially informed of such orders, UW Health w ill comply w ith court
orders or other legal documentation that restricts or limits visitors. If the validity or applicability of the
documentation is in question, please contact the Legal Department (608-261-0025) or page the attorney on
call (608-262-2122). During regular visiting hours, UW Health w ill not deny visitation to any person identif ied
by the patient as a person w ith w hom the patient w ishes to visit. Visitation shall not be denied on the basis of
race, creed, color, national origin, ancestry, religion, gender, gender identity or expression, sexual
orientation, marital status, age or disability. How ever, UW Health reserves the right to deny visitation in the
follow ing circumstances (this determination to not allow visitors is discouraged and should typically only be



UW HEALTH CLINICAL POLICY 4
Policy Title: Participation of Patients’ Primary Supports and Visitors
Policy Number: 3.3.5

made for good reason such as those described below ):
i. The hospital or health care provider determines that the patient may not receive any visitors;
ii. The hospital or health care provider determines that the presence of the person w ould endanger
the health or safety of the patient;
iii. The hospital or health care provider determines that the presence of the person w ould interfere w ith
the operations of the hospital or clinic, including but not limited to w here the person’s behavior is
unreasonable and disruptive or abusive to patient, other visitors, or staff and providers of UW
Health;
iv. Security Services perceives the individual(s) as a risk to the patient and or facility. Note that AFCH
visitors to inpatient units are screened against a sex offender registry.
v. The patient has subsequently expressed that he or she no longer w ishes to visit w ith the person
(UW Health shall not deny visitation based on a claim by someone other than the patient or the
health care provider that the patient no longer w ishes to visit w ith that person);
vi. Outside of regular visiting hours in inpatient settings, UW Health may deny visitation to any
individual w hose presence it determines is not in the best interest of the patient or is disruptive of
hospital operations, or for any other legally valid reason;
vii. UW Health reserves the right to exclude anyone from its facilities at any time for infection control or
operational reasons, or for any other law ful reason;
viii. Decisions to restrict visiting should be documented in the medical record and/or the records of the
security department, except w hen alternatives are authorized by the Legal Department.

VII. GUIDELINES FOR HEALTHCARE PROVIDERS

A. The primary nurse (or team nurse if the primary nurse is not available) should review the primary support
and visitor guidelines w ith the patient upon arrival or shortly after admission in inpatient settings so the
patient may make choices about primary supports and visitors. The nurse should let the patient know that
they are free to make changes to their choices at any time. The nurse should also discuss the balance
betw een providing support to the patient and the patient’s need for suff icient rest and privacy. When
appropriate, the nurse may also discuss the risk of caregiver fatigue.
B. At AFCH, Primary supports are limited to tw o. At all other locations, the number of primary supports is
determined by the patient and staff.
C. The primary nurse w ill document the patient's primary support and visitor preferences in the electronic health
record. If the patient choses to be Confidential in inpatient settings, the primary nurse w ill notify the Health
Unit Coordinator or Admissions to change the status in the electronic health record. The primary nurse w ill
also document the patient chosen passw ord for approved callers/visitors in the electronic health record.
D. The primary nurse should offer and provide information to primary supports and visitors (according to the
patient's w ishes) so they can become know ledgeable about how they can be most helpful to the patient.
E. The healthcare team should be f lexible in order to respond to the needs and preferences of each patient and
because time and treatment alters patients needs and/or w ants. The team should help patients to modify the
visiting schedule or expectations w hen needed (for example, w hen the patient needs a rest period).
F. When potential problems are identif ied, staff should utilize a multidisciplinary approach to problem solving
and are encouraged to seek consultation early. Consultation is available from any of the follow ing:
i. Managers and Coordinators
ii. Nursing Directors
iii. Clinical Nurse Specialists
iv. Geriatric Care or Acute Care for the Elderly (ACE) Team
v. Health Psychology
vi. Palliative Care
vii. Patient Relations
viii. Social Work
ix. Spiritual Care

VIII. COORDINATION

Author(s): Manager, Patient Relations; Director, Nursing Practice Innovation
Senior Management Sponsor: SVP, Patient Care Services and CNO
Review ers: Director, Access Services; HR Compliance Coordinator; Nursing Practice Council;
Approval committees: UW Health Clinical Policy Committee; Medical Board



UW HEALTH CLINICAL POLICY 5
Policy Title: Participation of Patients’ Primary Supports and Visitors
Policy Number: 3.3.5

UW Health Clinical Policy Committee Approval: May 16, 2016

UW Health is a cohesive, united and integrated academic medical enterprise comprised of several entities.
This policy applies to facilities and programs operated by the University of Wisconsin Hospitals and Clinics
and the University of Wisconsin Medical Foundation, Inc., and to clinical facilities and programs
administered by the University of Wisconsin School of Medicine and Public Health. Each entity is
responsible for enforcement of this policy in relation to the facilities and programs that it operates.

IX. APPROVAL

Peter New comer, MD
UW Health Chief Medical Officer

J. Scott McMurray, MD
Chair, UW Health Clinical Policy Committee

X. REFERENCES

UWHC policy #4.34, Patient Rights and Responsibilities
UWHC policy #9.58, Workplace Violence Reporting, Investigation and Discipline

XI. REVIEW DETAILS
Version: Revision
Next Revision Due: June 2019
Formerly Know n as: Hospital Administrative policy #7.33, Guidelines for Participation of Patients’ Primary
Supports and Guidelines for Visitors