University Medical Center Patient Visitation Policy

Rationale

Establish general procedures to support patient-centered visitation in all care settings while maintaining a safe, healing and supportive environment for all patients. 

Definitions

1. Care Partner:  A person 18 years of age or older identified by the patient or the patient’s surrogate decision maker, who actively supports the patient’s wellbeing in the hospital.
   (“Surrogate decision maker” may be used interchangeably with such terms as “legal representative,” “Healthcare agent,” “legally authorized representative,” and “patient’s authorized agent” appearing in other Medical Center policies, unless otherwise noted in the policy.)
2. Designated Support Person: Is defined by Va. Code § 32.1-137.08 as a person who is 18 years of age or older; knowledgeable about the needs of a person with a disability; and designated, orally or in writing, by the person with a disability, the person’s surrogate decision maker or care provider  to provide support and assistance necessary due to the specifics of the person's disability to the person with a disability at any time during which health care services are provided.
   (Person with a disability: for the purposes of this policy, a person who, prior to admission to the Medical Center, had a physical, sensory, mental, or emotional impairment that substantially limits one or more activities of daily living or has a record of such impairment.
   “Care provider” means any person or entity responsible for the care of a person with a disability prior to admission of the person with a disability to the Medical Center. See Code of Virginia 32.1-137.08)
3. Visitor: For the purposes of this policy, refers to the family, friends, or other persons (e.g., doula, companion, Care Partners) who provide support to patients while receiving care in the hospital, emergency department, or outpatient care setting, which includes without limitation clinics, procedure areas, and infusion centers.

Policy

The University of Virginia Medical Center recognizes the presence of family members, friends, and other persons plays a vital role in supporting patients’ emotional well-being and improving health outcomes across both inpatient and outpatient settings. The Medical Center does not restrict, limit or otherwise deny Visitation privileges or Care Partner designations on the basis of race, age, color, national origin, religion, disability, sexual orientation, gender, gender identity, or gender expression.

Patient Rights and Visitation Decisions

Patients have the right to decide who may or may not visit and when visits may occur, including while receiving care in an emergency department or outpatient setting. If an adult patient is incapacitated and has an advance directive, the patient’s surrogate decision maker named in an advance directive (also referred to as the Health Care Agent or Agent) may restrict Visitors only if the patient has given the Agent the authority to make Visitation decisions in the advance directive, see Advance Directives Medical Center Policy (Code of Virginia Sections 54.1-2984 and 54.1-2986.1.). Per Virginia law, if the adult patient does not have an advance directive, surrogate decision makers cannot restrict Visitors. 

Upon admission, patients have the right to identify up to two individuals – family, friends or others – to serve as Care Partners during the inpatient’s admission. If an adult patient is incapacitated, the patient’s surrogate decision maker may designate Care Partners for the patient in accordance with Informed Decision-making Medical Center Policy . A Care Partner is a specific type of Visitor with a distinct role; therefore, both terms are used throughout the policy for clarity.  

Clinical Restrictions and Limitations

Visitors and Care Partners may be present to provide emotional support during the course of a patient’s hospital stay or provision of care, unless the health care team determines the presence of Visitors or Care Partners is medically or therapeutically contraindicated; or infringes upon the rights, safety, or privacy of the patient or others.

Health care providers will inform patients and surrogate decision makers, on a case-by-case basis, of any clinical restriction or limitations that may be imposed on visitation. Circumstances which may create a need for limits or restrictions may include, but are not limited to:

• Infection control issues or isolation precautions 
• Public safety concerns
• Confidentiality concerns or visitation that interferes with, or violates, a patient’s wishes for privacy 
• Interferences with the care of the patient or other patients, including space limitations (e.g., room capacity issues, physical distancing needs
•  When the Medical Center is, or becomes, aware of an existing court order restricting contact, or of other legal status that may affect visitation 
• Visitors and/or Care Partners engaging in disruptive, threatening, or violent behavior of any kind 

Support for Patients With Disabilities

Per Virginia law, patients with disabilities may be accompanied by a Designated Support Person throughout an inpatient admission. If admitted for more than 24 hours, the patient may identify more than one Designated Support Person, but only one may be present at a time when visitation is otherwise restricted pursuant to this policy.

Designated Support Persons are subject to the requirements set forth in this policy for Visitors, but are generally exempt from standard visitation limits. However, access may be restricted to specific areas by the Medical Center or the patient’s care team if necessary to protect the health and safety of the patient, staff, visitors, or others. The Medical Center, at this discretion, may request documentation to confirm the patient has a disability and requires the assistance of a Designated Support Person. 

Applicable Procedures

1. General Procedures
1. Employees and individuals providing health care services at the Medical Center are responsible for communicating the visitation guidelines to patients and Visitors and Care Partners, and for helping to maintain a safe environment.
2. The Medical Center shall provide information regarding patient visitation and the Care Partner role to patients in admission materials, patient education resources, and on the UVA Health public website.
3. The Medical Center shall provide information to Care Partners about the Care Partner role and responsibilities. Care Partners are provided a unique, confidential code that allows them to receive information and status updates about the patient’s care. To protect the patient’s privacy and health information, the code must not be shared with anyone outside the designated Care Partners.
4. Visitors under the age of 18, and adults who are unable to function independently, must be supervised by an adult, 18 years of age or older at all times. This adult must be someone other than the patient. Patients cannot be responsible for caring for or supervision others – including patients who are nursing mothers.
5. Visitors and Care Partners are expected to treat patients, staff, others with respect in accordance with the Patient Rights and Responsibilities Health System Policy. Violent, threatening, or disruptive behavior will not be tolerated. University Security (PIC 1647) is available at all times to assist in such circumstances.
6. Restrictions on Visitation – whether initiated by the patient, the patient’s Health Care Agent, or health care providers – and the reasons for those restrictions, are documented in the electronic health record. General restrictions are documented by the unit RN. Security is responsible for documenting any behavioral restrictions imposed following a threat assessment.
7. The Medical Center’s medical equipment, supplies and medications must be reserved for patient use. If a Visitor or Care Partner requests assistance obtaining durable medical equipment (DME), oxygen, and/or prescription medication for an existing medical condition, staff shall:
1. Refer the Visitors or Care Partner to the UVA Pharmacy located on Lee Street for assistance with prescription refills related to existing medical conditions.
2. Contact the Medical Center’s contracted Preferred DME Provider, ABC Health Care, at 434-326-0900, to assist the Visitor or  Care Partner in obtaining DME and/or oxygen for an existing medical condition. ABC Health Care is available 24/7.
8. If a Visitor or Care Partner is in need of emergency care, activate an emergency response in accordance with Medical Emergency Response Medical Center Policy.
9. Pet visitation is only permitted for inpatients, and must be approved by the patient’s Attending Physician and conducted in accordance with Animal-Assisted Interventions and Pet Visitation Medical Center Policy.
2. General Limits/Restrictions on Visitation
1. Children are generally not permitted to spend the night unless there are extenuating circumstances collaboratively determined by the health care team and the patient/surrogate decision maker and/or Care Partners.
2. The health care team may require groups to limit the number of Visitors and Care Partners with a patient at one time to protect the rights, privacy, and care needs of the patient, as well as those of patients nearby or sharing the same room. The exact number allowed may vary based on clinical judgment and space availability. 
3. Visitors and/or Care Partners may be asked to vacate a patient’s room or the patient care area to ensure patient confidentiality.
4. Only one adult Care Partner or Visitor may be at the patient’s bedside overnight, generally between 2100 and 0500 hours to support patient rest, safety, and clinical care. Exceptions:
1. Minor patients or patients admitted to pediatric units: Both Care Partners may be at the patient’s bedside overnight if approved by unit leadership due to clinical conditions and/or discharge teaching requirements. (For the purposes of this policy, minors is defined as children under the age of 18 (except emancipated minors and minors who are receiving surgical or medical treatment relating to the delivery of a baby.)
2. Obstetric patients and healthy newborns: Up to two adult Visitors and/or Care Partners may be present at the bedside overnight post-labor and delivery until discharge to prioritize newborns bonding with their families.
   Additional exceptions may be made at the sole discretion of unit leadership.
5. Up to two Visitors and/or Care Partners may be present during labor and delivery and the immediate period post-delivery. In addition, any one person identified as the patient’s doula may also be present for support. In situations where restrictions or limitations are clinically necessary and appropriate, only one Visitor or Care Partner is permitted. Examples include, but may not be limited to:
1. Pre-labor evaluation and triage
2. Operative and/or sterile procedures
   Exceptions may be made at the sole discretion of unit leadership.
3. Passes and/or Care Partner Bands – University Hospital and Emergency Department
1. Adult Patients: All Visitors and Care Partners visiting adult patients in the emergency department or University Hospital must obtain a “Visitor” pass from the University Hospital lobby information desk or emergency department registration area, as applicable. Visitor passes must be worn and visible at all times. Visitors may not enter the room of a patient for whom they do not have a Visitor’s pass. 
2. Minor Patients: Visitors of minor patients who are not designated Care Partners must obtain a “Visitor” pass from the University Hospital lobby information desk or emergency department registration area and follow standard Visitor Pass requirements.
   Care Partners for pediatric patients will be issued Care Partner bands rather than obtaining daily Visitor Passes. These bands must remain on the Care Partner for the duration of the patient’s stay and must be visible at all times while in the Medical Center. Care Partner Bands may not be transferred, shared, or used by any individual other than the person to whom the band was issued. 
3. Clergy and pastoral Visitors may visit patients from their respective congregations only, and only at the convenience of the patient, and are required to obtain a Visitor pass like other Visitors.
4. UVA Health ID Badges may not be used in place of a Visitor pass. Individuals with a UVA Health ID Badge must obtain a visitor pass before visiting a patient.
4. Infection Control
1. All Visitors and Care Partners are expected to perform hand hygiene upon entering and exiting a patient room.  Concerns regarding compliance shall be escalated to unit leadership and the patient’s primary care team. 
2. The health care team will explain appropriate infection prevention and control measures to Visitors and Care Partners visiting patients on isolation precautions.
1. Visitors and Care Partners, except those Care Partners spending the night in the patient’s room, are required to follow isolation precautions and wear Personal Protective Equipment (PPE) as outlined in Overview of Isolation Precautions for Visitors.
2. Care Partners who are spending the night in the patient’s room (also referred to as “Rooming In”) are not required to follow the same isolation precautions for Visitors and other Care Partners if they adhere to the infection prevention and control measures outlined in the Isolation Precautions for Rooming-In Care Partners.
3. Visitors and Care Partners who have recently been exposed to a contagious illness or have signs and symptoms of a communicable disease should not visit patients in the hospital, emergency department, or other care settings (e.g. fever, cough, sore throat, vomiting, respiratory infection). During community outbreaks of communicable disease (such as influenza), notices will be posted to inform the public that they present a special risk to patients during these times and request that if they are symptomatic, visits be postponed.
4. Visitors to patient care areas with especially vulnerable patient populations may be screened before being permitted to spend time with patients.
5. Due to concerns for their safety, infants and young children may not visit patients on isolation without approval from unit based leadership.  If there are concerns about a visitor’s safety when visiting a patient on isolation, the patient’s health care shall escalate those concerns to unit based leadership. HE/IPC is available for guidance and questions.