Table 2.

Prioritized and refined restricted visitation policy recommendations for implementation

Domain 2: Recommendations
Theme 5: Ways to improve communication of restricted visitation policy and policy changes
Communicate policy changes to hospital staff during regular working hours and at least 24 hr before the change becomes effective or is communicated to the public (i.e., all staff should know the policy change before the media does).
Create multiple vehicles of communication of current restricted visitation policies at each institution (e.g., website, electronic messaging subscriptions, portal for families to ask questions or submit appeals to visitor restriction policies).
Theme 6: Strategies for restricted visitation policy implementation and consistency
Assign designated staff members to address questions regarding visitation and policy changes, address concerns, exceptions, and appeals, and consistently apply the policy (e.g., authoritative decision-makers that do not allow for special circumstances to occur, support from patient relations department, hospital liaison individual or team that families can contact, designated staff members to communicate outcome back to front-line staff).
Permit hospitals to adapt provincial policies for their facilities and individual units (e.g., ICUs are permitted to adjust their restricted visitation policies).
Include key stakeholders in policy development and adaptation (e.g., patients and families, nurses, physicians, spiritual care providers, allied health professionals, decision-makers, infection prevention and control expert).
Implement a clear, straightforward, timely and accessible process to request exceptions and appeals to restricted visitation polices (e.g., end of life, other adults that would benefit from being present).
Create proactive and staged implementation of restricted visitation policies that are dependent on community COVID-19 caseload or hospital capacity and patient circumstances (e.g., hospitals with no COVID-19 cases should be able to modify the policy). These policies may differ for essential care providers and visitors.
Theme 7: Facilitation of in-hospital visitation for families and visitors
Do not exclude children from visitation if they visit with an adult who ensures they comply with public health recommendations (e.g., PPE, hand washing, physical distancing).
Implement a straightforward process to appeal the restricted visitation policy.
Designate unit-level “visitor advisors” if feasible. The role of these “visitor advisors” may include the following: communicate the policy, demonstrate donning and doffing of PPE, teach proper handwashing, answer questions, inform visitor what to expect on the unit, communicate consequences for noncompliance with hospital PPE policies, etc.
Allow one designated visitor per patient at a time but allow the designated visitor to be changed to include multiple visitors throughout the patient's ICU stay.
Theme 8: End-of-life policy
Visitors are permitted at all times for end of life regardless of patient's COVID-19 status. If a patient is COVID-19 positive, this should be accompanied with a well-defined protocol (e.g., informing families of risk, requiring PPE, self-isolation, hand washing, and COVID-19 testing).
Create a clear policy for end of life. This should include clear rules on the number of people who can visit, consider end-of-life process for other cultural backgrounds, and when visitors are COVID-19 positive. This end-of-life policy should include a clear definition of end of life, which allows visitors while patient is lucid and able to interact (i.e., not comatose at end of life).
Theme 9: Criteria for visitation exceptions if no visitation is allowed
Allow visitation for all critically ill patients regardless of the patient’s COVID-19 status (e.g., implement clinical follow up with the family members who must agree to comply with confinement measures at home and to alert the healthcare team if symptoms appear in the next 14 days).
Consider family caregivers as an integral member of the healthcare team, and a distinct entity from visitors (e.g., consider family presence or families to be essential care partners).
Theme 10: Facilitation of out of hospital communication with family or visitors
Provide videoconferencing options to family members and patients who are separated.
An effort should be made to provide frequent (medical) updates (including allied healthcare) to the family and provide opportunities for families to ask questions.
Designate one to two identified family spokespersons to be notified in advance of daily virtual rounds, participate in clinical decision-making, and receive and disseminate family updates.
Theme 11: Technological supports to facilitate communication during restrictions
Increase availability of technological devices to facilitate family involvement in daily rounds, family conferences, virtual visits, and communication of family messages to patient (e.g., iPads, tablets, phones, etc.) including tech support for staff and family.
Theme 12: Organizational supports
Provide clear and consistent messaging to staff about visitation policy; clearly outline circumstances when policy exceptions can apply or defer designated visitor approvals to senior leadership.
Provide mental health supports (e.g., self-care and coping strategies, bereavement, wellness, etc.) for families, patients, and staff, including onsite support options for staff.

ICU = intensive care unit; PPE = personal protective equipment