Visitation

Visitors

For Patients with Disabilities or Impairment: One support person over the age of 16 will be allowed for patients with disabilities or impairments, regardless of the patient’s COVID-19 status. There are no restrictions on visiting hours.

Support persons must:

  • Meet clinical criteria used for general visitation, i.e., pass COVID-19 screening. The screening includes a temperature and symptom check, as well as no known COVID-19 diagnosis within the past 20 days, at least 24 hours fever free without the use of fever-reducing medications, and improved symptoms.
  • Use PPE appropriate for the patient they are supporting. In the event the patient is COVID-19 positive, the support person must use hospital-provided PPE. 

Issues related to access for support persons can be addressed promptly by speaking with the patient’s nurse or another health care professional involved in the patient’s care. If additional assistance is needed, you may dial “0” if you are at the facility or call the facility’s main number and ask for an administrator. 

Visitors who were previously COVID-positive may visit if 20-day Screening Criteria for Resolution of COVID are met. The 20-day timeframe is being used because we do not know the clinical course of the visitor’s COVID illness or their immune status.

  • 20-Day Screening Criteria for Resolution of COVID
    • 24 hours afebrile without the use of fever-reducing medications, AND
    • Improving symptoms, AND
    • 20 days since onset symptoms or initial date of positive test (if asymptomatic)

Masks with Exhalation Valves or Vents

  • The purpose of masks is to keep respiratory droplets from reaching others to aid with source control. However, masks with one-way valves or vents allow air to be exhaled through a hole in the material, which can result in expelled respiratory droplets that can reach others. This type of mask does not prevent the person wearing the mask from transmitting COVID-19 to others. Therefore, CDC does not recommend using masks for source control if they have an exhalation valve or vent."
Guidelines for Administration of Sacraments for Catholic Patients during COVID19

October 2020

Introduction and Background

During the COVID19 pandemic, Texas Health continues to screen for religious needs of patients of all faiths during admission. When needs are identified, CareConnect referrals are made to Pastoral Care for chaplain assessment and resolution. Since the institution of visitor restrictions, Texas Health board-certified chaplains strategically partner with nursing unit leadership to address additional spiritual patient needs.

In certain faith groups, such as the Catholic tradition, sacraments are exclusively administered by their own ordained clergy. Due to this specificity, Pastoral Care collaborates closely with Dioceses (church ruling bodies) to attend to the sacramental needs of Catholic patients. Chaplains continue to provide Pastoral Care (e.g., prayers, counseling) to Catholic patients and patients of all faiths throughout their hospitalization. Protestant traditions do not have the above-mentioned sacramental administration requirements. Throughout COVID19, Protestant and other clergy are connecting with hospitalized congregants through telephone or virtual communication, often facilitated by chaplains or nurses. Texas Health professional chaplains have successfully cared for Islamic, Hindi and Jewish patients during this crisis. For example, during the season of Ramadan earlier this year, chaplains were mindful of any Islamic patients and attentive to their dietary and other needs. The good collaboration between Pastoral Care and Nursing facilitates Chaplains ability to accommodate patients of all faiths. If patients from faith groups other than Roman Catholic request in-person visitation by their own clergy, nursing is to contact Pastoral Care for assessment.

The guidelines below provide steps for ensuring safe and seamless care to Catholic patients requesting sacraments. If you have further questions or need for clarification, please reach out to your entity Pastoral Care manager.

Guidelines

Administration of sacramental rites to Catholic patients is to be coordinated through entity Pastoral Care departments. Regional Catholic dioceses work closely with Texas Health to abide by our safety and risk protocols. While Texas Health usually does not allow visitors/providers to wear their own N95 masks, it is acceptable to allow Catholic priests to wear Diocese-issued and -fitted N95 masks into the room of patients appointed for sacrament administration. Before allowed access to the patient room, the priest is to confer with nursing to ensure knowledge of visitation protocols and proper donning and doffing of PPE.

Process:

  1. When a Catholic patient advises clinical care team, including chaplains, of request for administration of sacrament, the request is to be coordinated through the entity Pastoral Care department. The nursing unit is responsible for notifying the chaplain of the request.
  2. Pastoral Care will assess the patient or family need.
  3. If administration of sacrament is in order, Pastoral Care will consult with nursing leadership (e.g., nurse manager, charge nurse, house supervisor) to coordinate priest visit.
  4. In collaboration with nursing, a time frame for the visit will be determined.
  5. Pastoral Care will notify priest of the patient’s request, room number, and time frame for visit.
  6. Nursing leader will notify hospital-entrance screeners of priest’s arrival, name of patient, room number, and time frame for visit.
  7. Should a priest present unannounced to the screener, the screener will invite the priest to wait at the entrance and the screener will page the chaplain to assess the situation. If chaplain assesses that administration of sacrament is in order, the chaplain will follow steps 3-6 to provide safe and mutually agreed upon time for patient access.




COVID-19 Greeter Guidelines & Scripting for Patients and Visitors

Effective Tuesday, November 24, 2020

v19 Updates (noted in purple):
  • Reverted visitor guidelines to one visitor per patient per day (from one visitor at a time)
  • Strengthened visitor masking guidelines to require all visitors to wear the hospital- or THPG-provided mask
  • Strengthened visitor masking guidelines to require visitors to wear the mask we provide at all times, including when in the patient’s hospital room or a THPG’s exam room
  • Clarified L&D visitor guidelines to state that the L&D support person must remain for the entirety of the experience; no switching with another support person

Notes:

  • These guidelines are for patients and visitors ONLY (NOT employees).
  • Updates to the policy appear in purple.
  • Scripting appears in blue italics.

GENERAL GUIDELINES

A staff member will greet every patient and potential visitor entering a Texas Health facility and:

  1. Provide a face mask to every patient,
  2. Determine if a visitor may be allowed (pending screening). Generally:
    • For patients with disabilities or impairment, one support person is allowed, regardless of patient’s COVID-19 status, with no restrictions on visiting hours. Otherwise:
      • Clergy: Nursing leadership will notify hospital-entrance screeners if clergy have been approved for visitation for special situations. The screener will receive the clergy’s name, anticipated arrival time, name of patient, room number, and time frame for visit. When the clergyperson presents to the hospital, the greeter will call the chaplain so that the chaplain can escort the clergyperson to the nursing unit and patient room.
      • Behavioral Health: No visitors.
      • COVID-19 Patients (Positive or Suspected Positive): No visitors, except for special circumstances*.
      • Emergency Department: One visitor for patients who do not have COVID-19 or are not suspected of having COVID-19. See the Emergency Department section for details.
      • Hospital Inpatients: One visitor per patient per day for patients who do not have COVID-19 or are not suspected of having COVID-19. The single/one visitor for the day is allowed to come and go during the day.
      • ICU: One visitor per patient per day for patients who do not have COVID-19 or are not suspected of having COVID-19. Check with the nurse manager for visiting hours. The single/one visitor for the day is allowed to come and go during the day.
      • Labor & Delivery/Postpartum: One support person and/or doula may be allowed depending on the COVID-19 status of the mother, support person and/or doula. NOTE: The same support person must remain throughout the L&D experience. Switching with a secondary/alternate support person is not permitted.
      • NICU: Two parents/guardians may be allowed depending upon their COVID-19 status.
      • Outpatient Services (Radiology, Lab, Pre-Admission Testing, etc.): No visitors.
      • Outpatient Surgery/Procedure: One visitor only.

    * Visitor exceptions may be considered for special situations, such as labor & delivery, disabilities or impairment, or end-of-life. Call the nursing unit for information.
  1. Screen visitors:
    • Take their temperature (must be <100.0°F).
    • Ask about COVID-19 status:
      • For general visitors: No known COVID-19 diagnosis in past 20 days, at least 24 hours fever free without the use of fever-reducing medications, and improved symptoms
      • For L&D/Postpartum and NICU visitor/support person and/or doula: No known COVID-19 diagnosis in past 10 days, at least 24 hours fever free without the use of fever-reducing medications, and improved symptoms
      • Additional L&D visitor guidelines:
        • COVID-positive mother may not have a doula and one support person only
        • COVID-positive support person may attend only the delivery, and then must leave.
      • The same support person must remain throughout. Switching with a secondary/alternate support person is not permitted.
      • Ask about exposure to a COVID-19 positive person:
        • Visitor is not allowed if, within the last 14 days, have been within 6 feet of an infected person for a cumulative total of 15 minutes or more over a 24-hour period, when either the visitor or COVID-positive person was not wearing a mask.
          • A visitor who has been exposed is allowed if they have had a positive test in the last 90 days. However, that visitor is not allowed if the positive test was within in the last 20 days (or within the last 10 days for L&D/NICU).
      • Ask about presence of symptoms (cough, trouble breathing, fever, chills, sore throat, muscle aches, new loss of sense of taste or smell.
  2. Provide a mask and wristband to each hospital visitor who meets screening criteria; or a mask to each THPG visitor.
    • For the protection of patients, staff, and visitors, everyone entering the facility must wear the face mask that we provide. We no longer allow visitors or staff to wear their own mask.
    • Visitors who are permitted to visit a COVID-positive patient (e.g., patient with disabilities or L&D patient) must wear the PPE we provide.
    • THPG visitors must also wear the mask we provide.
    • Visitors who refuse to wear the mask we provide are not permitted in the facility. If the visitor has an existing condition (e.g., COPD), elevate to the shift leader.
    • Wristbands must be worn by visitors at all times.
    • Hospital visitors should exit at the same entry they came in, and have their wristband removed. However, if a visitor returns the next day wearing a wristband, the greeter must re-screen them, but the visitor can continue to wear the existing wristband.

GREETING

Greet patients with good morning, afternoon or evening.

[For patients:]

“To help protect our patients and staff, everyone who enters the building must wear a face mask we provide, and gloves are not permitted while you are here.”

[If patient or visitor is wearing gloves, advise:]

“I’m sorry. You’ll need to remove your gloves and use hand sanitizer. Please practice good hand hygiene as needed.” (Updated per Mary Robinson 5/5/2020 guidance)

[And continue:]

“Here is your mask. You must:

  • Wear your face mask at all times, in all places, including the patient’s room, hallways, elevators, lobby, restrooms, etc.
  • Ask for a new mask if your mask becomes damp, soiled, or contaminated.”

[For visitors wanting to enter:]

“For your safety, we are allowing some visitors. Let’s find out more about why you’re here to determine if you can visit.”

[See Visitor Clinical Guidance Manual, below]

 

VISITOR GUIDELINES SPECIFIC DEPARTMENTS

A visitor may be allowed (subject to passing the COVID-19/general health/exposure screening).

For Patients with Disabilities or Impairment: One support person is allowed for patients with disabilities or impairment, regardless of the patient’s COVID-19 status. There are no restrictions on visiting hours.

Support persons must:

  • Meet clinical criteria used for general visitation, i.e., pass COVID-19 screening. The screening includes a temperature, exposure, and symptom check, as well as no known COVID-19 diagnosis within the past 20 days, at least 24 hours fever free without the use of fever-reducing medications, and improved symptoms.
  • Wear the hospital-provided or THPG-provided mask at all times.
  • Use PPE appropriate for the patient they are supporting. In the event the patient is COVID-19 positive, the support person must use hospital-provided PPE. 

Issues related to access for support persons can be addressed promptly by speaking with the patient’s nurse or another health care professional involved in the patient’s care. If additional assistance is needed, you may dial “0” if you are at the facility or call the facility’s main number and ask for an administrator. 

For Patients Without Disabilities or Impairment: The general guidance in the Clinical Guidance Manual is as follows:

  • Behavioral Health: No visitors.
  • COVID-19 Patients (Positive or Suspected Positive): No visitors, except for special circumstances*.
  • Emergency Department: One visitor for patients who do not have COVID-19 or are not suspected of having COVID-19. Visitor must stay with the patient or in the treatment room at all times. Visitors will not be allowed to wait in the waiting room. Visitors are allowed to stay in the patient room overnight, and may remain with patient if they are admitted to the hospital, regardless of the time. No visitors will be allowed for COVID-19-positive or suspected positive patients, except for special circumstances*. Visitation may be limited if patient’s medical and/or COVID-19 status changes.
  • Hospital Inpatients: One visitor per patient per day for patients who do not have COVID-19 or are not suspected of having COVID-19. Visiting hours are 7 a.m. – 7 p.m. Visitors arriving after 7 p.m. will not be able to enter. Visitors are allowed to stay in the patient room overnight, as long as they arrive before 7 p.m. If patient was admitted from the Emergency Department, visitor is allowed to stay overnight, regardless of the time. No visitors are allowed for COVID-19-positive patients, except for special circumstances. Call the nurse manager for information.
  • ICU: One visitor per patient per day for patients who do not have COVID-19 or are not suspected of having COVID-19. Check with the nurse manager for visiting hours.
  • Labor & Delivery/Postpartum: One support person and/or doula may be allowed depending on the COVID-19 status of the mother, support person and/or doula. NOTE: The same support person must remain throughout the birth experience. Switching with a secondary/alternate support person is not permitted. COVID-19 guidelines for the support person and/or doula are as follows:
    • COVID-negative patients are able to have one support person who does not have symptoms of COVID-19 or exposure risk, plus one external, paid, professional care provider (a doula, for example).
      • For L&D/Postpartum doula: No known COVID-19 diagnosis in past 10 days, at least 24 hours fever free without the use of fever-reducing medications, and improved symptoms. No exposure to a COVID-19 positive person.
      • A support person who is COVID-19-positive is able to visit if:
        • At least 10 days have passed since first symptom(s) or date of initial positive test if having no symptoms AND
        • At least 24 hours have passed since last fever without fever-reducing medications AND
        • Symptoms have improved.
        • If the criteria above are not met, a COVID-19-positive support person can visit for delivery only. After delivery, support person will not be able to visit until criteria are met. If a support person is allowed:
          • Support person must wear hospital-provided mask at all times.
          • Support person must stay in mother’s room at all times.
          • If support person leaves mother’s room, they should be escorted out by staff and not allowed to return.
    • COVID-positive patients are able to have one support person who does not have symptoms of COVID-19 or exposure risk. No outside care provider or doula is allowed.
    • A support person who is COVID-19-positive is able to visit if:
      • At least 10 days have passed since first symptom(s) or date of initial positive test if having no symptoms AND
      • At least 24 hours have passed since last fever without fever-reducing medications AND
      • Symptoms have improved.
      • If the criteria above are not met, a COVID-19-positive support person can visit for delivery only. After delivery, support person will not be able to visit until criteria are met. If a support person is allowed:
        • Support person must wear hospital-provided mask at all times.
        • Support person must stay in mother’s room at all times.
        • If support person leaves mother’s room, they should be escorted out by staff and not allowed to return.
  • Neonatal ICU (NICU):
    • Two parents/guardians are allowed to visit as long as:
      • Neither parent/guardian has active COVID-19 disease.
      • Neither parent/guardian, in the past 14 days, has been within 6 feet of a COVID-19-positive person for 15 minutes or longer when either of them were not wearing a mask. If they have been exposed to a COVID-19-positive person, they must have had a positive COVID-19 test in the last 90 days, but not within the last 10 days.
        • Mother and partner must wear hospital-provided masks.
        • If both mother and partner are unable to visit, they may designate a single support person who has no COVID-19 symptoms and no exposure to COVID-19-positive persons in the previous 14 days.
      • A previously COVID-positive mother and/or partner are allowed to visit if:
        • They have gone 24 hours (1 full day) without any symptom(s) and without using fever-reducing medication AND
        • 10 days have passed since their first symptom or positive test date (if asymptomatic).
      • Exceptions to visitation by a COVID-positive mother and partner may be considered for special situations, such as infant end-of-life.
      • Mother and partner must wear hospital-provided masks.
      • If both mother and partner are unable to visit, they may designate a single support person who has no COVID-19 symptoms and no exposure to COVID-19-positive persons in the previous 14 days.
      • Check with the nurse manager for visiting hours.
  • Outpatient Services (Radiology, Lab, Pre-Admission Testing, etc.): No visitors.
  • Outpatient Surgery/Procedure: One visitor only.

* Visitor exceptions may be considered for special situations, such as labor & delivery, disabilities or impairment, or end-of-life. Call the nursing unit for information.

VISITOR SCREENING

[If visitor does not meet the visitor criteria as stated in the Clinical Guidance Manual, explain:]

“We’re sorry. We’re not able to allow you in today. A great way to stay in touch with your loved one is by phone or video chat.”

NOTE: consider having “How to Stay in Touch” flier available to share.

[If visitor does meet the visitor criteria as stated in the Clinical Guidance Manual,, the visitor must be screened:]

“Okay. We’ll need to ask you a few questions. We will also need to take your temperature:

Anyone who has a temperature over 100.0°F will not be allowed to come in today, because a fever can mean infection.”

[If visitor refuses temperature check, inform them that if we're unable to screen them, they are unable to enter]

“We’re sorry. If we are unable to screen you, you’ll not be able to come in today. A great way to stay in touch with your loved one is by phone or video chat.”

NOTE: consider having “How to Stay in Touch” flier available to share.

[If the forehead temperature is below 100.0 F, tell the visitor their temperature, and proceed:]

“Okay. Thanks. Are you younger than 16?”

[If visitor answers “YES”, visitor is NOT permitted in the facility]

“We’re sorry. We’re not able to allow you in today. A great way to stay in touch with your loved one is by phone or video chat.”

NOTE: consider having “How to Stay in Touch” flier available to share.

[If visitor answers “NO”, proceed with screening:]

“Okay. Let’s talk about how you are feeling.”

  • Have you been diagnosed with COVID-19 in the past 20 days (or 10 days for an L&D/NICU visitor)?
  • Have you had a fever in the last 24 hours?
  • Have you been taking fever-reducing medicines?

[If visitor answers “YES” to any of the 3 COVID-19 status questions, visitor is NOT permitted in the facility]

“We’re sorry. We’re not able to allow you in today. A great way to stay in touch with your loved one is by phone or video chat.”

NOTE: consider having “How to Stay in Touch” flier available to share.

[If visitor answers “NO” to all 3 COVID-19 status questions, proceed with screening:]

In the past 14 days have you been within 6 feet of a COVID-19-positive person for 15 minutes or longer when either of you were not wearing a mask?

[If visitor answers “YES”, ask about positive test in the last 90 days]

Have you been diagnosed with COVID-19 in the past 90 days?

[If visitor answers “NO”, visitor is NOT permitted in the facility for 14 days after exposure to a COVID-positive person]

“We’re sorry. We’re not able to allow you in today. A great way to stay in touch with your loved one is by phone or video chat.”

NOTE: consider having “How to Stay in Touch” flier available to share.

[If visitor answers “NO” to having been exposed to a COVID-19-positive person in the last 14 days, OR “YES” to having a positive test in the last 90 days, proceed with symptom screening:]

[Symptom Screening] (Restores CDC’s original 5/13/2020 guidance [simplified list] per Sharon W.)

Do you have:

  • Cough
  • Shortness of breath or trouble breathing?
  • Fever?
  • Chills?
  • A sore throat?
  • Muscle aches?
  • New loss of sense of smell or taste?

[If visitor answers “YES” to one or more symptom(s), visitor is NOT permitted in the facility]

“I’m sorry. We’re not able to allow you to enter the facility today. A great way to stay in touch with your loved one is by phone or video chat.”

NOTE: consider having “How to Stay in Touch” flier available to share.

[If visitor answers “NO” to all of the above screening questions, they may enter the facility.]

“To help protect our patients and staff, everyone in the building is required to wear a mask. Also, gloves are not permitted to be worn by patients or visitors in the facility.”

FOR HOSPITAL VISITORS:

[If HOSPITAL visitor is wearing gloves, advise:]

“I’m sorry. You’ll need to remove your gloves and use hand sanitizer. Please practice good hand hygiene as needed.”

[And continue:]

Here is your face mask and wristband. Please:

  • Wear your face mask at all times while in the building. This includes while you are in the patient’s room.
  • Ask for a new mask if your mask becomes damp, soiled, or contaminated.
  • Always wear your wristband, too. Please exit through this same door so we can remove your wristband.

Also:

  • Keep a safe distance of at least 6 feet from others.
  • Clean your hands often with hand sanitizer.
  • Follow all hospital staff instructions.”

[If HOSPITAL visitor refuses to wear the mask we provide and is visiting a non-COVID patient:]

“I’m sorry. You’ll need to wear the mask we provide. Otherwise, you’ll not be able to visit today. A great way to stay in touch with your loved one is by phone or video chat.”

NOTE: consider having “How to Stay in Touch” flier available to share.

[If HOSPITAL visitor IS VISITING a COVID-positive patient:]

“You’ll need to wear the mask we give you, and any other protective gear the nursing staff asks you to wear.”

FOR THPG VISITORS:

[If THPG visitor is wearing gloves, advise:]

“I’m sorry. You’ll need to remove your gloves and use hand sanitizer. Please practice good hand hygiene as needed.”

[And continue:]

Here is your face mask. Please:

  • Wear your mask at all times while in the building. This includes while you are in the waiting room or exam room.
  • Ask for a new mask if your mask becomes damp, soiled, or contaminated.

Also:

  • Keep a safe distance of at least 6 feet from others.
  • Clean your hands often with hand sanitizer.
  • Follow all staff instructions.”

[If THPG visitor refuses to wear the mask we provide:]

“I’m sorry. You’ll need to wear the mask we provide. Otherwise, you won’t be able to enter the building today.”

Closing

“Thank you for visiting Texas Health today, and for helping us to keep our community safe.”





Texas Health Visitation Guidelines: Lobby and other Public Areas

In an effort to provide a safe environment for our visitors and our care team, the following are recommended guidelines for Texas Health lobbies/public waiting areas:

Greeters and/or PAS Team:

  1. Screen patient and visitors in accordance with COVID-19 screening procedures.
  2. Provide both patient and visitor a Texas Health issued mask for the duration of visit (if visitor refuses to wear Texas Health issued mask, they will be required to wear a personal mask). If the visitor declines to wear as mask they will not be allowed to enter the facility.
  3. Provide patient and visitors with an identification wristband (patient ID band) to wear during their duration at the facility.
  4. Once patient checks-in, assign visitor a seat if there is not a private waiting area. Visitor will be expected to use the same seat for the entirety of their waiting time.
  5. Communicate the expectations of waiting visitation: No congregation of guests in waiting areas/lobbies, utilizing social distancing (minimum of 6-ft), and proper hand hygiene.

Waiting areas/ common areas and lobbies:

  1. Place seats 6-ft apart and number/identify each seat. If time allows, remove seats that will not be used for the day.
  2. Keep coffee and water behind the desk of the registration/surgical services greeter. If a visitor would like coffee or water, provide a single use cup.
  3. Ensure chairs in lobby will allow for proper sanitation. EVS will clean and sanitize routinely, and after discharge of every visitor/patient.
  4. Drinking from fountains is prohibited. Prefer to discontinue water to the fountains along with signage.
  5. Provide visualizations to promote social distancing (footprints available to be placed 6 feet from reception. Please contact your entity Facilities representatives to order the Social Distancing Decals for your entity).
  6. Visitors will be subject to re-screening if they leave the facility.

In an effort to provide a safe environment for our visitors and care team, the following are recommended guidelines for Texas Health cafeterias:

Entities with pre-existing safety precaution guidelines are encouraged to continue with those parameters.

Other options to consider:

  1. Limited tables with one chair, signage on booths to limit to one person per booth. Must be monitored by facility staff to prevent congregation of guest in the cafeteria.
  2. Provide visualizations to promote social distancing (footprints).




Elective Surgery Visitation Guidelines

Updated Monday, April 27, 2020

Tier One (1) Elective Surgeries

  1. Elective Surgeries/OR/ASC
  2. Interventional procedure areas (Cath Lab, IR, etc.)
  3. Routine/chronic clinical care

Pre-Admission Testing Visitation Guidelines

  • Visitors are not permitted. If required, one visitor will be allowed to support patients with impairment or mobility needs
  • If Visitor is accompanying patient to assist them, they will adhere to current Texas Health screening/masking guidelines

Pre-Admission Testing (PAT) Entity Arrival – Current State


Day of Surgery/Procedure ONLY Visitation Guidelines

  • Facilities using Surgery/Procedural Waiting Room
    • Pre-Screening/Registration
      • Only one Visitor allowed the day of the scheduled surgery/procedure and during procedure allotted time only
      • Visitor will be screened upon entry per current policy and will be denied entry if they are symptomatic.
      • Patient and visitor will be required to wear a Texas Health issued mask for the duration of visit (if visitor refuses to wear Texas Health issued mask, they will be required to wear a personal mask). Visitors refusing mask will be denied entry.
      • Visitors will be provided an identification wristband to wear during their duration at the facility.
      • Once patient checks-in, the visitor is assigned a seat in the waiting area, and expected to use the same seat while waiting for patient’s surgery.
    • During the procedure
      • Visitor is required to remain masked at all times
      • No congregation in waiting areas/lobbies, chairs will be arranged utilizing social distancing (minimum of 6-ft) between each seat and hand hygiene products should be readily available
      • Seats will be numbered/identified in each lobby to allow for easy identification of patient’s visitor (See Waiting Area Guidelines)
      • Visitors will be limited to lobby and cafeteria. Visitors will be subject to reassessment if they leave the entity.
      • Communications with visitor during procedure will occur via text message through CareConnect
    • Pre & Post procedure
      • Visitors are discouraged from visiting the preoperative area and recovery area. It is recommended to use virtual discharge or telephonic options (if applicable) to align with safety protocol (based on entity preference for discharge planning purposes)
      • Visitors are not allowed in PACU
      • If patient is admitted, inpatient visitation guidelines will be implemented, and visitor will leave the facility once the patient is moved to an inpatient unit.
      • Visitor’s armband should be removed when they leave the facility.
    • Facilities utilizing private Pre-op/Day Surgery Rooms (SADU)
      • Pre-Screening/Registration
        • Only one Visitor allowed during surgery/procedure and during procedure allotted time only
        • Patient and visitor will be screened upon entry per current policy and will be denied entry if symptomatic.
        • Patient and visitor will be required to wear a Texas Health issued mask for the duration of visit (if visitor refuse to wear Texas Health issued mask, they will be required to wear personal mask). Visitors refusing mask will be denied entry.
        • Visitors will be provided an identification wristband to wear during their duration at the facility.
        • Once patient checks-in, the patient and visitor will be escorted to their room.
      • During the procedure
        • Visitor is required to remain masked at all times and remain in room, unless using public restroom or going to the cafeteria.
        • Visitors will be limited to room and cafeteria. Visitors will be subject to reassessment if they leave the entity.
        • Communications with visitor during procedure will occur via text message through CareConnect
      • Pre & Post procedure
        • It is recommended to use virtual discharge or telephonic options (if applicable) to align with safety protocol (based on entity preference for discharge planning purposes)
        • Visitors are not allowed in PACU
        • If patient is admitted, inpatient visitation guidelines will be implemented.
        • Visitor’s armband will be removed when they leave the facility.




End of Life In-person Visitation Guidelines

In an effort to support our patients who are at the end of their life and provide their families and loved ones the opportunity to have a last visitation, the following guidelines were created. Out of respect for the care teams (the physicians and nurses) caring for these patients and their relationships with the families, we leave the number of visitors to their discretion if they receive a request to include more than 1-2 visitors. However, it is highly recommended to keep the number below five and to as few as possible.

  1. Identifying, screening of grieving visitors:
    1. For patients who are imminently dying, 1-2 visitors may be allowed at the bedside for a one-time 15-30 minute visit with the following exclusions:
      1. Those individuals who are symptomatic or who are COVID +
      2. Children younger than 16 years of age
    2. Potential visitors should be screened by a member of the primary care team or nursing staff by phone 1-2 hours prior to arrival with the following questions (Does not apply to ED patients):
      1. “Have you had a fever of greater than 100o, cough, shortness of breath, or other symptoms recently?”
      2. “Have you tested positive for COVID?”

        Answers to the questions above should be documented in Care Connect. If the answer to the questions above is “yes”, the family member should be informed that they will not be able to visit in person. (See Virtual options for end of life visitation)

        Additionally, visitors should be advised that they will be required to don personal protective equipment (PPE) including gloves, gown, face mask and face shield. Visitors who refuse this or have health conditions that hinder their ability to wear this equipment will not be allowed to visit in person. (See Virtual options for end of life visitation)
    3. Once visitors are identified by the family and have passed screening for increased infectious risk, nursing staff should enter the visitors’ names in the Visitor info section of the Demographics for the patient
  2. Procedure for visit:
    1. Visitors can enter through the approved hospital entrance where they will be met by a hospital representative, their temperatures will be checked (must be less than 100o), and they will again be screened for infectious symptoms prior to visitation. Visitors will be masked and escorted to the unit where the patient is located.
    2. Visitors escorted to the hospital unit should wait in the nursing unit family waiting room. The nurse should provide the following guidance to the visitors:
      1. There should be no touching of the patient above the neck which includes kissing of the face.
      2. We strongly advise against hugging the patient.
      3. The nurse should clean the patient’s hand so the visitors can hold their hand as it is the contact that provides the least risk to the visitor.
      4. The visit should be for the shortest time possible and should last no more than 15-30 minutes (any addendum to the timeframe is left to the patient’s care teams discretion).
      5. At minimum visitors should wear disposable gloves, gown, face mask, and face shield A nurse or physician should review the procedure for donning/doffing PPE with visitors before they enter the room and should then assist family members in donning PPE.
      6. Nursing staff should place a clean sheet over the patient’s body prior to any contact with the visitor.
      7. After a maximum of 15-30 minutes the visitors will be asked to exit the room and a nurse or physician will assist with the doffing of PPE. Hand hygiene should be performed after the removal of each article of PPE. After removal of gloves, hand hygiene should be performed. The visitor should be given a clean mask after doffing their PPE and before their walk back to the hospital exit.
      8. Once PPE has been removed, the visitor cannot reenter the room.
    3. Pastoral Care should be notified by the nursing unit of family’s arrival to hospital. A chaplain may deliver pastoral care to grieving visitors outside patient room, maintaining a distance of at least 6 feet to assure safety. The chaplain may deliver grief materials to the unit in person or electronically per the visitor’s preference.
    4. Visitors will be escorted to the hospital exit.
  3. Additional considerations
    1. Non-COVID patients
      1. The restrictions around physical contact with the patient for these visitors is at the discretion of the nursing staff.
      2. The care team caring for our Non-COVID patients know these patients and can apply their discretion to the PPE requirements around the visitors in order to reduce the usage of PPE. The visitors must remain masked however as they travel to the patient’s room and to the hospital exit.
    2. Patient belongings
      1. Patient’s belongings should be documented in Care Connect, should be placed in a bag and given to the spouse or family member of the patient at the end of the visit. The family should be instructed to handle the patient’s belongings with the utmost care using appropriate hand hygiene after handling, or to leave them inside the bag for a few days before handling them.
      2. The nurse should document in Care Connect the name of the individual that received the patient’s belongings.

NOTE: Hospital volume and PPE availability are being closely tracked and are informing the guidelines above. As the situation evolves, the number of visitors may be further restricted, or visitation may be eliminated altogether.


Scripting for In-Person End of Life Visitation

  • Family members are met at the ED entrance screened and masked and escort takes them to the family waiting area on the nursing unit they will be visiting.
  • The nursing staff will have the preliminary conversation with the visitors.

“Thank you for coming. Hi my name is ______ . I am a nurse and I am here to help guide you through this today. I can imagine that this is a very difficult time, but we are honored for you to have this time to say your final words to your loved one. We believe (patient’s name) may be able to hear you, so take comfort in knowing that your presence and love will be felt.

So, we encourage you to visit and say whatever you feel is needs to be said. If you are more comfortable sitting in silence that is alright as well.

Please remember that (patient’s name) would never want to cause you harm and if you do not feel comfortable or safe going in the room, we want you to know that is fine, too.

However, in this situation, it is very important that we keep you safe and you understand the risk involved. I know there is a lot of information out there on COVID-19, but I would like to moment to explain how it is spread. The COVID-19 virus is spread through droplet germs that are pushed out through breathing and coughing. These droplet germs can land on the (patient’s name), on any surfaces, or on you. If you touch (patient’s name) and then touch your face, you can also get sick.

With that in mind, here’s what we ask you to do in order to keep you and others safe:

Since your visit is limited to 15-30 minutes, think of some things that you would like to say to (patient name) before we go in. 15-30 minutes may seem like a long time, but it can also seem very quick. Also, keep in mind that once your visit is over, you will not be able to go back into (patient’s name)’s room for safety purposes. assisting you with putting on a gown, gloves, mask, and goggles before you enter the room.

Once in the room we will ask you to sit in the chair at the bedside. You can hold (patient’s name) hand.

For your safety and others, we ask that you do not touch (patient’s name) anywhere above their chest. Its preferable that you limit touching to holding (patient name)’s hand. However, if you would like to touch (patients name)’s arm or chest, please do so on top of the sheet. Please keep it mind that is not safe to reach under the sheet to touch or to lay your head on (patient name).

Since this is an emotional time it is common for people to cry. Many people want to wipe their tears, nose, or face when they cry. For your safety, we ask that you while you’re in the room that you allow your tears to roll down your face and to not use your hands to wipe them way or wipe your nose. This is important for keeping you and others safe. We will provide you with tissues outside of the room so you can wipe your eyes and nose.

At the end of your visit we will help talk you through hand washing as you remove your protective equipment.

Before we go in, what questions or concerns do you have?





Virtual Options for End of Life Visitation

Ensuring that family members are connected when losing a loved one at the end of their life is an important part of the grief process. When in-person visitation is not possible, Texas Health offers a virtual solution for the care team to offer to the families as an option for them to say goodbye to their loved one.

  1. Process for facilitation
    1. The nursing staff will obtain the email address of the primary family member they have been communicating with throughout the patient’s care and document it within Care Connect if it is not already there. A time for the visitation will be agreed upon with the family.
    2. If the patient’s family has requested a Chaplain be present during their virtual visit, please use the normal process of contacting the Chaplain on call via Vocera. The Chaplain will provide their email to be included in step c.iii. below.
    3. Immediately preceding the time agreed upon for the final visitation, the staff will perform the following steps.
      1. An iPad Language Line device will be taken to the patient’s room. These devices contain the app that will facilitate the virtual meeting.
      2. Any preparation of the patient should take place prior to the video call.
      3. The nursing staff will perform the appropriate steps to initiate a Microsoft Teams visit utilizing the primary family member’s email address (tip sheet located on the iPad device screen).
        1. The primary family member will receive an email immediately which they may forward to other members of the family.
        2. The family members may join the video call via the link provided within the email.
      4. The video call will commence between the family members and the patient.
  2. During the virtual interaction
    1. Use words of comfort/empathy and offer to serve as a physical extension of the patient’s loved ones (i.e. holding a patient’s hard) if possible
    2. Be quietly present while the family communicates
    3. Be your normal, best caring self… as you demonstrate our Promise, “Individuals Caring for Individuals Together”.
  3. After the visit
    1. Follow infection prevention protocol to properly sanitize the device at the conclusion of the visit.