Blood & Marrow Transplant Unit Child Visitation Guidelines Promote Patient-Centered Care

Abstract

Topic Significance & Study Purpose/Background/Rationale The Blood & Marrow Transplant (BMT) Unit cares for severely immunocompromised patients and has restricted child visitation to minimize infection. Age-based visitor restriction is neither evidence-based nor recommended by any professional organization and it interferes with the provision of patient-centered care. The purpose of this initiative was to promote patient-centered care by implementing guidelines allowing for safe child visitation for BMT patients. Methods, Intervention, & Analysis Extensive literature review showed no evidence supporting age-based visitation restrictions. Ten national BMT units were surveyed; 70% allowed child visitation. A staff survey was completed in June 2018. Seventy percent of staff believed that restricting child visitation did not support patient-centered care, 40% believed that healthy children present a higher risk of infection to immunocompromised patients, and 50% agreed that children on the unit would be disruptive to care. In August 2018, 100% of staff members received in-service training to align perception with evidence-based practice. This initiative was implemented in September 2018. Findings & Interpretation As of September 2019, there were a total of 48 child visits. There has been no increase in healthcare-associated infections (HAIs) nor in patients' average length of stay (ALOS) since implementation. The ALOS from April to September 2018 was 18 days and was 15.52 days post-implementation. From January to September 2018, Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient satisfaction top box scores on taking patients' preference into account was 61% and increased to 77% from October to December 2018 while this initiative was in effect. From January to June 2019, when child visitation was suspended following hospital-wide visitor restrictions during influenza season, top box scores decreased to 58%. A post implementation staff survey conducted in September 2019 demonstrated that 95% of staff believes child visitation supports patient-centered care. Staff perception that healthy children present a higher risk of infection to patients decreased to 26%, and 81% disagreed that having children visit is disruptive to care. Discussion & Implications This process improvement project provided a new evidence-based guideline for child visitation. HAIs and ALOS were not negatively affected by allowing children to visit. In addition, child visitation may have a positive effect on HCAHPS patient satisfaction scores.