Visiting patients on inpatient areas policy

1 Introduction

This policy has been reviewed and amended with regard to the recommendations following the Metropolitan Police Service Investigation Operation “Yew Tree” (October 2012) and the subsequent Independent Oversight of NHS and Department of Health Investigations into matters related to Jimmy Saville (Kate Lampard June 2014).

It is recognised that admission to hospital is very stressful, and people can quickly feel isolated from their family and friends. Visiting patients in hospital is an integral part of health care and can promote the patient’s wellbeing. It is important that In-patients are able to maintain contact with family, friends, or anyone else they wish to see for the duration of their stay in hospital.

Due to the complexity of services within In-patient areas of the trust, visiting procedures may differ. It is up to each care group to have visiting procedures that meet the needs of their specific in-patient areas reflect best practice, promote the concept of patient and family centred care, and incorporate all relevant principles such as infection prevention and control and health and safety.

It is not practical to have open access to in-patient areas as this will pose a security problem and could also be disruptive to other patients.

Within the mental health (MH) and learning disability (LD) services, legal requirements must be met regarding patients, both informal and detained, being visited by children. This policy does not cover these requirements. Refer to the children visiting inpatient and residential units within the trust policy.

2 Purpose

The purpose of this policy is:

to facilitate appropriate visiting arrangements for in-patients, enabling them to keep in contact with family and friends
to enable staff to manage the ward and care safely and efficiently whilst balancing the therapeutic needs of patients and maintaining the patient’s privacy and dignity

3 Scope

This policy is applicable in all in-patient areas, including the Hospice. It is not applicable for children visiting mental health or learning disability areas (refer to section 1.4).

4 Responsibilities, accountabilities and duties

4.1 Board of directors

It is the responsibility of the board of directors to have policies and procedures in place that meet local and national legislation and support best practice.

4.2 Matrons or service managers

It is the responsibility of modern matrons or service managers to:

disseminate this policy to ward managers or team leaders
oversee the implementation of the policy
monitor compliance with the contents of this policy

4.3 Ward managers or nurse in charge

The ward manager or nurse in charge is responsible for:

staff in their areas being aware of the content of the policy
using their discretion, in the best interests of the patient for whom they are caring, in relation to visiting
having information on visiting times clearly displayed
maintaining a safe environment
reporting any accident or incidents involving visitors
completing the IR1 incident reporting form
notifying the area’s matron or service manager of any breaches in this policy or concerns in relation to the behaviour of a visitor at the earliest opportunity

4.4 Staff within in-patient areas

Staff in in-patient areas will be responsible for:

having an awareness of the policy and its content
the implementation of this policy
maintaining the patient’s privacy and dignity
the health and safety of any visitors to the area
reporting any incidents involving visitors to the ward manager or nurse in charge

5 Procedure or implementation

All patients have the right to maintain contact with, and be visited by, anyone they wish to see, subject to carefully limited exceptions. The value of visits in maintaining links with family and community networks is recognised as a key element in a patient’s care, treatment, and recovery. Article 8 of the European Convention on Human Rights (ECHR) protects the right to a family life. Every effort should be made to support parents to support their children. Patients should be able to see all their visitors in private, including in their own bedroom if the patient wishes (MHA Code of Practice 2015, 11.4 p 83). Consideration must be given to privacy and dignity, safety, and risk factors (see section 5.4, 5.5) when deciding on access.

In addition to visits, every effort should be made to assist the patient, where appropriate, to maintain contact with relatives, friends, and advocates in other ways.

5.1 Courtesy and respect

All healthcare professionals should always treat visitors with courtesy and respect, and it is also expected in return that staff and patients are treated with the same respect and courtesy by visitors.

5.2 Restriction or exclusion of visitors (at the patient’s request)

Refusal of access, and, or asking visitors to leave can occur when the patient expresses a request for an individual or group to be denied visiting rights, (for example, in cases of family dynamics, domestic abuse, or other similar scenarios).

5.3 Maintaining a secure or safe environment

If a visitor is presenting with anti-social behaviour, creating a nuisance, or is verbally aggressive, staff should consider asking them to leave to maintain the safety of the therapeutic environment on the ward. However, staff should also consider that, at times of stress and concern, people exhibit their frustrations in a number of ways.

It may be more beneficial to explore these concerns by talking privately; showing empathy; consider allowing the visitor to remain if the patient would also benefit from a longer stay; consider moving the patient and visitors to another location where their behaviour is not a concern.

Further examples of behaviour which may compromise security on the ward can include:

incitement to abscond
smuggling of illicit drugs or alcohol into the hospital or ward
transfer of potential weapons
unacceptable aggression
attempts by members of the media to gain unauthorised access
inappropriate use of mobile phones or other recording devices by visitors. Whilst the use of mobile phones or other electronic devices such as iPads is not prohibited on the inpatient wards it must be made clear to visitors that to maintain the privacy of patients, they are not to be used to record conversations or take photographs. In the event of staff suspecting that a visitor on the ward is using a device for recording or photographic purposes, they are to approach them and ask that they immediately stop doing so and delete any recordings or photographs they have taken due to privacy or confidentiality reasons.

If there is no clear reason for the anti-social, nuisance or aggressive behaviour then the visitor should be asked to leave.

Staff should not place themselves at risk to prevent access. If the visitor expresses physical aggression of any form, then call the police.

Physical violence is not acceptable under any circumstances, and they should be asked to leave. All physical violence should be reported to the police.

When asking someone to leave the ward staff must:

not place themselves at risk
report the situation to the manager or duty manager
take another member of staff with them when approaching the visitor
politely outline the behaviour which is not acceptable and ask them to leave
if their behaviour is aggressive, or they become aggressive, back away and call the police
not attempt to eject the aggressive visitor, once they refuse to leave but must call the police

Once the visitor has left staff must:

discuss the incident with the patient
complete an IR1 Report
inform the manager
make an entry in the patient’s notes
at the next MDT (multi-disciplinary team) meeting or sooner if required, discuss the management process for future visits

5.4 Restrictions or exclusion of visitors (on clinical grounds)

From time to time, the patient’s responsible clinician may decide, after assessment and discussion with the multi-disciplinary team, that some visits could be detrimental to the safety or wellbeing of the patient, the visitor, other patients, or staff on the ward.

In these circumstances, the responsible clinician may make special arrangements for the visit, impose reasonable conditions or if necessary, exclude the visitor. In any of these cases, the reasons for the restriction should be recorded and explained to the patient and the visitor, both orally and in writing (subject to the normal considerations of patient confidentiality). Wherever possible, 24-hour notice should be given of this decision.

5.5 Communication of decision to exclude

A decision to exclude a visitor on the grounds of their behaviour should be fully documented and explained to the patient orally and in writing. Where possible and appropriate, the reason for the decision should be communicated to the person being excluded (subject to the normal considerations of patient confidentiality and any overriding security concerns) (MHA Code of Practice 2015, 11.14 to 11.16 p.85).

If the ward managers decide that they wish to restrict the visitor’s future access, for any reason, then this will require discussion with the trust local security management service (LSMS) to ensure that a suitable and legal process has been followed.

As a minimum any decision to exclude a visitor will be subject to review at each subsequent MDT.

5.6 Visiting arrangements

Staff should refer to the intranet for the most up-to-date visiting guidance.

It is expected that in-patient areas will provide information on visiting arrangements, either on admission or as soon as is practical. This information can be provided verbally and supported by signs and information leaflets or booklets.

In cases where visitors may experience difficulty visiting during the ward visiting hours their individual requirements should be accommodated, where it is reasonably possible.

For patients who are deaf or do not have English as a first language visiting times need to be as flexible as possible to enable access to interpreters and family. These patients may often feel isolated as an in-patient, as they are unable to communicate with the people around them and this may have an impact on their wellbeing and mental health. Staff will also need to consider communication needs along with risk and benefits of facilitating longer visiting times or visits at a flexible time to allow for communicators to be available. This will be at the discretion of the nurse in charge of the shift.

When patient’s conditions give rise for concern, or they are terminally ill staff will use their discretion and be flexible with visiting arrangements.

In some service areas, for example, in-patient wards for people with Dementia, it is recognised that family members and close friends are often closely and directly involved in the planning and delivery of care. When appropriate, flexible visiting arrangements will be agreed locally to support and encourage this involvement.

Areas to which visitors have access should be clearly sign posted and are at the discretion of the nurse in charge. However, to allow for the privacy of other patients it is not desirable that visitors are given free access to sleeping or bedroom areas.

Where the patient is in a single bedroom, access to visitors will be at the discretion of the ward managers or nurse in charge.

Under no circumstances is a visitor to have access to the area’s clinical room.

It must be explained to visitors that they should not take their friend or relative off the area without informing staff beforehand.

5.7 Visiting celebrity or high profile person or fundraiser or MP or elected members

Any celebrity or high profile person or fundraiser or MP or elected member who requests to visit in-patient areas will be directed to the communications department.

The communication department will organise and facilitate the visit in collaboration with the relevant care group director. Any arrangements for the visit will consider issues, regarding, respect, dignity, patient consent the structure of the visit and any publicity arising out of the visit.

Celebrity or high profile or fundraising visitor will be accompanied at all times and will not under any circumstances have access to treatment or bathroom areas or observe any intimate care.

Please refer to the VIP visiting trust services and facilities (VIP, celebrity or governor) policy for further guidance.

5.8 Children visiting

In areas where the visiting of children is allowed on the ward areas:

children must be supervised at all times by an adult who is not the patient
staff will ask for children to be taken out of the area if this is not the case

Staff working in the mental health, learning disability and forensic in-patient areas should refer to their local protocols and the children visiting inpatient and residential units within the trust policy.

5.9 Family pets

Pets are allowed onto our wards. Please see the animals in healthcare settings policy for further information.

5.10 Refreshments for visitors

Due to limited supplies, ward areas may not be able to routinely provide refreshments to visitors.
However, if someone has travelled a long distance or becomes upset during a visit or is visiting the ward because they are more directly involved in the care planning and delivery process, then it may be appropriate to provide them with a drink on the ward (this is at the discretion of the staff on duty or nurse-in-charge).
Please refer to individual ward guidance around visitors accessing the kitchen areas.
Staff should inform visitors of the location of any cold or hot drinks machines and the location of any other facilities where drinks can be purchased.

5.11 Visitors and smoking

As all NHS premises are non-smoking, visitors are to be asked not to smoke whilst on the hospital site. There are no designated smoking facilities for visitors. Patients, visitors, and contractors to the trust will be made aware of the RDaSH smoke free policy through signs, posters, leaflets as well as conversations with staff. Patients and visitors will be provided with a list of the contraband items in the hospital which includes tobacco, cigarettes, lighters, matches, rechargeable e-cigarettes and chargers. Any visitor who is found to be supplying a patient in hospital with contraband items will be reminded about the policy and asked to support the patient’s treatment plan. The rationale for the policy will be explained and carers will be offered support to learn more about the harmful effects of tobacco dependence. If appropriate they will be directed towards their local stop smoking service.

Where a visitor repeatedly choses to ignore the no smoking requirements, or repeatedly provides an inpatient with contraband items a decision may need to be taken to exclude them from future visits. In these cases staff should refer to the guidance in section 5.5 of this policy.

5.12 Infection prevention and control considerations

It is important to minimise the risk of introducing infection into the ward areas as well as reducing the risks of visitors acquiring an infection. The following guidance should be followed:

alcohol hand gel dispensers must be at each ward entrance and posters must be in place asking visitors to use them on entering and leaving the area and demonstrating the technique to be used
in the event of an outbreak of diarrhoea +/- vomiting staff must advise visitors to clean their hands using soap and water instead of alcohol hand gel
visitors are requested not to sit on the beds, but use chairs provided
visitors are requested not to use patient’s toilets on the ward
anyone feeling unwell, or who has respiratory symptoms or has had any diarrhoea and, or vomiting within the previous 48 hours are asked to refrain from visiting
all visitors are expected to wear a mask on entering health premises during this pandemic
visiting restrictions may be put in place for infection prevention and control purposes on the recommendation of the Infection Prevention and Control team (IPCT) or consultant microbiologist or the director of infection prevention and control In the event that an outbreak of infection occurs, staff should refer to the infection prevention and control and associated procedures

5.13 Supporting visitors in the event they are witness to a serious incident whilst on the ward

There may be occasions when an incident occurs on one of the wards which is witnessed by a visitor to the ward. In these circumstances it is important that staff ensure the wellbeing of any visitors by moving them away from the immediate area of the incident and:

without breaching patient confidentially explain as far as possible what happened, and why staff responded in the way they did
allow the visitor time to discuss how they felt about what had happened
answer as far as possible, without breaching patient confidently any questions the visitor may have
establish if the person may need support to facilitate any future visits to the ward

5.14 Closure of wards

It is essential that prompt and effective measures are utilised in controlling the spread of infection between patients, visitors, and staff.

Where a ward has an outbreak of infection the director of infection prevention which is the director of nursing and allied health professionals have the right to close the ward to all visitors to manage and control the outbreak effectively, with the aim of resolving the situation as quickly as possible.

The ward manager or nurse in charge will use their discretion where there are requests to visit patients during an outbreak, for example where patients are receiving terminal care, if the patient has special needs or where visitors have travelled long distances.

6 Training implications

There are no specific training needs identified in relation to this policy. Inpatient and residential staff will be made aware of the policy and their responsibilities via:

local induction
supervision session
ward or team meetings
the trust’s daily communication emails will give details of the policy and any review
trust’s clinical policy website

7 Monitoring arrangements

7.1 Compliance with the policy

How: Observation.
Who by: Ward managers or nurse in charge.
Reported to: Matrons or service managers.
Frequency: Observation of daily routine.

7.2 Incidents involving visitors

How: IR1 reported incidents.
Who by: Ward managers.
Reported to: Head of patient safety.
Frequency: As incidents occur.

8 Equality impact assessment screening

To access the equality impact assessment for this policy, please email rdash.equalityanddiversity@nhs.net to request the document.

8.1 Privacy, dignity and respect

The NHS Constitution states that all patients should feel that their privacy and dignity are respected while they are in hospital. High Quality Care for All (2008), Lord Darzi’s review of the NHS, identifies the need to organise care around the individual, “not just clinically but in terms of dignity and respect”.

As a consequence the trust is required to articulate its intent to deliver care with privacy and dignity that treats all service users with respect. Therefore, all procedural documents will be considered, if relevant, to reflect the requirement to treat everyone with privacy, dignity and respect, (when appropriate this should also include how same sex accommodation is provided).

8.1.1 How this will be met

No issues have been identified in relation to this policy.

8.2 Mental Capacity Act

Central to any aspect of care delivered to adults and young people aged 16 years or over will be the consideration of the individuals’ capacity to participate in the decision-making process. Consequently, no intervention should be carried out without either the individual’s informed consent, or the powers included in a legal framework, or by order of the court.

Therefore, the trust is required to make sure that all staff working with individuals who use our service are familiar with the provisions within the Mental Capacity Act (2005). For this reason all procedural documents will be considered, if relevant to reflect the provisions of the Mental Capacity Act (2005) to ensure that the rights of individual are protected and they are supported to make their own decisions where possible and that any decisions made on their behalf when they lack capacity are made in their best interests and least restrictive of their rights and freedoms.

8.2.1 How this will be met

All individuals involved in the implementation of this policy should do so in accordance with the guiding principles of the Mental Capacity Act (2005).

9 Links to any other associated documents

10 References

Dept of Health-1999 HSC 1999/222: LAC (99) 32
Guidance on the visiting of Psychiatric In-patients by Children Pub: DoH, London
Mental Health Act 1983 Code of Practice (2015)
Kate Lampard (2014) Independent Oversight of NHS and Department of Health Investigations into matters related to Jimmy Saville (opens in new window)
Metropolitan Police Service (2012) Operation Yew Tree.

Document control

Version: 9.
Unique reference number: 34.
Approved by: Clinical policy review and approval group.
Date approved: 07 June 2022.
Name of originator or author: Head of patient safety (patient safety specialist).
Name of responsible individual: Executive director of nursing and allied health.
Date issued: 13 June 2022.
Review date: June 2025.
Target audience: Staff in inpatient areas.

Page last reviewed: November 13, 2024
Next review due: November 13, 2025

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