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MICU adopts open visitation policy by Cindy Abole Public Relations Learning to accommodate patients and families, especially in their most desperate hours of need, is the mission of the Medical Intensive Care Unit (MICU).   MICU nurse Heidi Grund, from left, Dr. Karry Briones, and Meg Carsner discuss a patient's chart while nurse Tracy Conner and Tim Maddux review information.  Since its beginnings on the eighth floor unit and move in 2003, the MICU staff has done just that—combining a continuity of complete patient care and support for families. Now this level of excellent critical care has expanded with the adoption of a new open visitation policy for family and visitors.   For critically ill patients poised at the threshold of life and death, the MICU is a welcome respite. Patients entering its doors suffer from a variety of chronic and complex medical illnesses—from pulmonary hypertension to respiratory diseases, sepsis, diabetic emergencies and multisystem organ failure.   “Our spectrum of patients is  diverse and composed of very sick and critically ill people,” said Alice Boylan, M.D., associate professor of pulmonary and critical care medicine and MICU medical director. “MICU patients and their families are often from out-of-town and dealing with stressors relating to their loved one’s condition. Helping them cope during these sentinel moments can help make a situation bearable. Valuing that time together sends ripples of support for a family that they carry forever.”   The MICU is a 13-bed unit that operates with a staff of 70. Patients admitted to the unit are diagnosed with a non-surgical critical illness and may be transferred to the unit at any time. The MICU patient census is consistently more than 94 percent full. Patients receive 24-hour care and are monitored closely by a team of physicians, critical care nurses and specialty staff.   “The MICU staff shares a broad focus on excellent critical care and having families present at the bedside is a critical component of that,” said Janet Byrne, R.N., MICU nurse manager. “Our team, from unit secretaries to physicians, consists of excellent advocates who try to assist patients and families in all of their needs. Having a team of caring, compassionate caregivers is a critical component to overall patient satisfaction.”   What both Byrne and Boylan describe and are most proud of is the opportunity to work with a multidisciplinary team that is dedicated to providing the highest quality and full range of care to some of the hospital’s most critically ill patients. The team provides the right blend of critical care support, advanced technologies, evidence-based treatments and patient-family support that is considered invaluable.   Although the new open visitation initiative has been explored within the last year, the concept arose from an already committed workplace culture that’s dedicated to quality care and the result of continuing dialogue and collaboration between the MICU staff, which is composed of a multidisciplinary team of talented nurses, pharmacists, physicians, social workers, respiratory therapists and other health care professionals.   According to Byrne, critical care research shows that the presence of an open visitation policy can help to reduce stress among recovering patients, their families and housestaff. As family and staff increasingly interact with each other and spend time together, both groups experience a growing level of communication and trust that contribute to excellent patient care and an overall positive experience regardless of the outcome.   “Critically ill patients demand rest and comfort and it’s important that families are able to come and go according to a patient’s need versus restricted visitation guidelines,” Byrne said. “Moreover, overall visiting guidelines are subject to the discretion of each patient’s nurse.”   Previously, MICU visitation guidelines followed routine blocks of time, 6:30 to 10 a.m. and 6:30 to 8:30 p.m. Each patient's family received two permanent passes from the hospital’s admissions office. Adults and children, ages 12 and older, can visit patients.   The MICU’s new open visitation initiative makes family and visitor accessibility available 24/7, 365 days a year.   “We have an incredible staff that is so devoted to patient care,” Boylan said. “They're passionate about what they do, empathic and selfless in their support of their patients and their families with their needs.”   For some staff members, learning to adjust to the presence of a patient’s family at the bedside and family member interaction may require additional training, education and reinforcement. But everyone agrees that the change balances the immediate need to accommodate patients and families.   “The MICU staff received so many letters of appreciation and thanks from patient families thanking staff for allowing them to stay with their loved ones and come and go,” Byrne said. “At the same time, they’re also appreciative of the nurses and staff for being receptive to their needs. What some people may view as a small thing is a big deal to these already fragile families.” Empathy drives compassionate acts at MUSC's intensive care unit Often, a Medical Intensive Care Unit (MICU) patient’s outcome is not what a family hopes for. In life, the possibility of death is always imminent and is ever moreso when it is connected with a critical illness. Whatever the outcome, MICU staff is prepared.   “Our nurses and staff possess a bold, innovativeness when it comes to providing good patient care,” said Janet Byrne, R.N., MICU nurse manager. “They are always seeking education, training and collaboration in learning different aspects that enhance their role with patients and jobs.”   Meg Carsner, R.N., and Pam Canno, R.N., are the MICU staff’s bereavement leaders. Guided by Palliative Care consult nurse manager Winnie Hennessy, R.N., the pair recognized a need to further assist a patient’s family following death. About a year ago, they began to send out sympathy cards to the families of expired patients three months after their death.   “Everyone experiences grief in a unique way,” said Carsner, who completed formal training on handling grief and death/dying. “We sent these cards knowing that we weren’t expecting anything in return—a family’s response or acknowledgment. We just wanted them to know that we care.”   Their note also included medical and community resources to help individuals through the mourning period.   “The MICU staff develops a natural relationship and bond with some families because they stay with us so long,” Carsner said. “While their family member was hospitalized, they sought us out for guidance and advice almost daily. It’s a very special, unique relationship. When a patient dies, staff shares that same feeling of loss and grief. Finding closure for them is just as important to their well-being, and helps to balance the everyday work that we do.”     Friday, July 21, 2006 Catalyst Online is published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, catalyst@musc.edu. Editorial copy can be submitted to Catalyst Online and to The Catalyst in print by fax, 792-6723, or by email to catalyst@musc.edu. To place an ad in The Catalyst hardcopy, call Island Publications at 849-1778, ext. 201.