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UWHC,

Policies,Clinical,UWHC Clinical,Department Specific,Emergency Department

Patient and Family Centered Care (8.0)

Patient and Family Centered Care (8.0) - Policies, Clinical, UWHC Clinical, Department Specific, Emergency Department

8.0

 
Revision:  Effective:  October 1, 2014 
I. PURPOSE:

Define guidelines for family presence during medical procedures, traumas, and medical resuscitation. Family
presence during these times is supported by multiple national professional organizations.

II. POLICY:

A. Care that is consistent with UWHC Emergency Department patient and family centered care philosophy involves
keeping families together during crisis, where a family member can be the greatest advocate for the patient.
B. The family member should be allowed to support the patient during any part of his/her ED evaluation, including
all procedures.
C. Family member(s) may opt out after explanation of their role.
D. In some circumstances, staff may deem it unsuitable for family presence (for example for privacy concerns).
E. Patients should be given the opportunity to decline having a family member present. If this is the case or if the
family members do not wish to be present, the designated caregiver will keep the family informed regarding the
patient’s status.
F. A designated caregiver will be assigned to provide family support as described below. For the most common
procedure, such as an IV start for an adult patient, a designated caregiver may not be needed.

III. DEFINITIONS:

A. Patient and Family Centered Care: Patient- and family-centered care is an approach to the planning,
delivery, and evaluation of health care that is grounded in mutually beneficial partnerships among health care
providers, patients, and families. (Defined by the Institute for Patient- and Family-Centered Care)
B. Procedures: A course of action that is diagnostic (such as phlebotomy, radiology, ultrasound, lumbar
punctures, bronchoscopy, etc.) or therapeutic (PIV placement, fracture reductions, laceration repair, central line
placement, etc.) or rehabilitative (casting).
C. Trauma: Any physical damage to the body caused by either intentional or unintentional injury, reported by the
patient and/or family or care givers.
D. Medical Resuscitation: Emergency evaluation and management of an acutely ill patient.
E. ‘Family’: Immediate family member, guardian, or key support person.
F. Designated Caregivers: ED Social Worker, Triage Social Worker (576-5218), On-Call Social Worker (CTL
pages), Child Life Services, ED Tech, Chaplain, Resident, RN, MD, etc. (a care provider in the hospital who works
with patients and families and has understanding of ED procedures).
1. Optimally, the same person will stay with the family.
2. If at all possible, someone with clinical expertise should provide
explanation of the procedure and care plan.
3. When available, Child Life should serve as the designated caregiver for
pediatric patients.
4. Designated caregiver will assess family at all times to assure that they
choose to remain in the room with the patient.
5. Designated caregiver, to the best of their knowledge, will provide honest
information to family about the patient’s condition.

IV. PROCEDURE:

A. Family Preparation:
1. Confirm family’s level of understanding of patient’s current medical
status.
2. Explain what they can possibly expect to see with respect to their family
member (who will be there, interventions/ procedures in progress, etc).
3. Inform the family of how their reaction affects the patient.
4. Explain to family that patient care is the priority and they will need to

leave the room if their presence interferes with that care.
5. Instruct the family member to inform designated caregiver in case of any
dizziness, headache, light-headedness, etc.
6. Explain to family member that if he/she wants to leave at any time,
he/she will be allowed to do so.
7. Care team is to communicate with his/her family whenever possible.
8. Explain to the family the provider may not be able to answer questions
during procedure.
9. Inform the family that the designated caregiver will be there to answer
questions throughout duration and will identify appropriate staff member to
answer clinically related questions if they are unable to answer them.
B. Define limits for family members:
1. Clarify to family members that one support person may be in the room
with the patient during procedures, trauma, or medical resuscitation.
2. Define where the family member can sit or stand.
3. Have a chair readily accessible if possible. Begin near door and move
closer to bedside by invitation of care team.
4. Explain potential need for Personal Protective Equipment (PPE).
5. Absolutely no pictures or video are allowed to be taken, including those
from cell phones during procedures.
C. While in Room:
1. Care team members will introduce themselves to the child/patient and
family support person as available and appropriate.
2. If family member requests to leave, designated caregiver is to
accompany family member to waiting room or designated area.
3. Designated caregiver to debrief family member about the medical
treatment and access further resources as needed to support the family.
D. Family Support if Death is Outcome:
1. Offer family time alone with loved one with approval by the attending
physician. In certain circumstances, such as non-accidental trauma cases,
staff may need to consult with others prior to allowing family time alone with
patient.
2. Assure privacy as soon as death is declared.
3. Provide support as needed. Consult Pediatric Bereavement Box and
Binder for additional information (in Pediatric Emergency Care Coordinator
Office).

V. UWHC CROSS REFERENCE:

A. UWHC Hospital Administrative Policy 7.44, American Family Children’s Hospital (AFCH) Admissions
B. UWHC Hospital Administrative Policy 7.33, Guidelines for Participation of Patients’ Primary Supports and
Guidelines for Visitors
C. Nursing Practice Guidelines – Patient and Family Centered Care
D. UWHC Ambulatory Service Standards

VI. REFERENCES:

A. American College of Emergency Physicians. (n.d.). Family member presence in the emergency department.
Retrieved October 13, 2010, from http://www.acep.org/patients.aspx?id=25904.
B. Clark AP, Calvin AO, Meyers TA, et al. (2001). Family presence during cardiopulmonary resuscitation and
invasive procedures. A research-based intervention. Critical Care Nursing Clinics of North America, 13(4);569-575.
C. Gold KJ, Gorenflo DW, Schwenk TL, et al. (2006). Physician experience with family presence during
cardiopulmonary resuscitation in children. Pediatric Critical Care Medicine, 7(5):428-433.
D. Guzzetta CE, Clark AP, Halm MA (Eds.). (2007). Presenting the Option for Family Presence, 3rd Ed. Des Plaines,
IL: Emergency Nurses Association.
E. Guzette CE, Clark AP, Wright JL. (2007). Family presence facilitation. In: BJ Ackley, GB Ladwig, BA Swan, SJ
Tucker, eds. Evidence-Based Nursing Care Guidelines: Medical-Surgical Interventions. Philadelphia: Mosby, Inc.
F. MacLean SL, Guzzetta CE, White C, et al. (2003). Family presence during cardiopulmonary resuscitation and
invasive procedures: Practices of critical care and emergency nurses. Journal of Emergency Nursing, 29(3):208-
221.
G. Dunst, C. J. , Trivette, C. M. & Deal, A. G. (Eds.)(1994). Supporting and Strengthening Families, (pp224-225).
H. Leape L, Barnes J, Connor M, Gershanoff MD, Jernegan G et al. “When Things Go Wrong: Responding to
Adverse Events” MA Coalition for the Prevention of Medical Errors, 2006.
I. Reid Ponte, P., Connor, M., DeMarco, R., Price, J. Linking Patient and Family-Centered Care and Patient Safety:
The Next Leap. Nursing Economics. July/August 2004;22:211-215.
J. Reid Ponte P, Donlin G, Conway JB, Grant S, Medeiros C, Nies J, Shulman L, Branowicki P, Conley K. Making

patient-centered care come alive, achieving full integration of the patient's perspective JONA Feb 2003;33:82-90
K. Institute of Medicine (IOM). 1996. Primary Care: America’s Health in a New Era. Molla S. Donaldson, Karl D.
Yordy, Kathleen N. Lohr, and Neal A. Vanselow, eds. Washington, DC: National Academy Press.
L. Institute of Medicine (IOM). 2001. Envisioning the National Healthcare Quality Report. Margarita P. Hurtado,
Elaine K. Swift, and Janet M. Corrigan, eds. Washington, DC: National Academy Press.

VII. REVIEWED BY

Emergency Department Clinical Ops Committee
Pediatric Emergency Medicine, Emergency Department
Pediatric Champion Team, Emergency Department

VIII. SIGNED BY

Denise Cole-Ouzounian, MS, APN, CNML, CCRN
Nurse Manager, Emergency Department

Jeffrey Pothof, MD
Clinical Services Chief, Emergency Medicine

Joshua C. Ross, MD
Medical Director, Pediatric Emergency Medicine