The considerations set out here aim to minimise the risk of infection whilst also allowing close family members or friends to accompany and say goodbye to their loved ones at the end of their life and for visits from faith leaders (including chaplains) if desired.
These measures relate to visits to people who are close to the end of their lives (24 to 48hrs), recognising this can be difficult to assess with accuracy.
In these circumstances, there is minimal additional risk to the dying person from contracting coronavirus.
Co-ordinate: The visit should be coordinated by ward team and or nurses in charge with the support of (if available) palliative care teams.
MDT Approach: Support for visitors can be provided across the whole team, including faith leaders.
PPE: Staff should take the necessary PPE when meeting the visitor and ensure that PPE is being worn by the visitor as appropriate to the area. Staff should explain the importance of PPE, particularly that the mask must not be touched or removed whilst the visitor is with their relative.
• The dying person should be asked, where possible, if they would like to receive a visit from a loved one or faith leader.
• The number of visitors at the bedside is limited to one close family contact or somebody important to the dying person. However, where it is possible to maintain social distancing throughout the visit, a second additional visitor (including a child) could be permitted.
• Other people who are in attendance to support the needs of the patient should not be counted as additional visitors.
• Anyone who is showing symptoms of coronavirus (a new continuous cough or a high temperature) should not visit, even if these symptoms are mild or intermittent, due to the risk they pose to others.
• Visitors are informed about what to expect when they see their loved one and practical advice related to wearing personal protective equipment (PPE), handwashing and risks associated with the removal of gloves to hold hands.
• Visitors must be made aware that good hand hygiene (handwashing) is needed to facilitate visiting. This is required to mitigate the risks to the visitor, other patients and staff.
• Where possible, the dying person should be accommodated in a single room with access to handwashing facilities.
In this situation, the main potential risk is to the family or friend visiting a loved one. They should be made aware of the increased risk to themselves and of precautions to be taken.
- Advise the visitor of their increased risk of infection from entering the high-risk zone.
- Personal Protective Equipment (PPE) is to be worn and taken off by the visitor as directed by staff.
- As long as PPE is worn, the visitor does not need to self-isolate afterwards as a result of the visit.
Advise the visitor to:
- Stay at least 2 metres away from others as they enter and leave the setting and avoid touching any surfaces
- Enter and leave the setting as quickly as possible using the most direct route
- Avoid touching their eyes, nose and mouth with unwashed hands
- Cover any coughs or sneezes with a tissue, then throw the tissue in a bin
- Wash their hands again with soap and water for at least 20 seconds when they are leaving the setting and then again as soon as they get home
- Follow stay at home guidance if they become unwell.
The main potential risk is to other people in the setting (residents, patients and staff) from visitors entering the setting, but there is also a risk to the visitors themselves, given the high prevalence of infection in healthcare and residential care settings. It is important that any such risk is kept to an absolute minimum through strict adherence to social distancing and rigorous respiratory and hand hygiene.
Anyone who is showing symptoms of coronavirus (a new continuous cough or a high temperature) should not visit, even if these symptoms are mild or intermittent, due to the risk they pose to others.
Visitors may attend if they are asymptomatic and adhere to the following:
• Stay at least 2 metres away from others as they enter and leave the setting and try not to touch any surfaces
• Avoid touching their eyes, nose and mouth with unwashed hands
• Cover any coughs or sneezes with a tissue, then throw the tissue in a bin
• Wash their hands again with soap and water for at least 20 seconds when they are leaving the setting and then again as soon as they get home.
If the visitor is in a household that is self-isolating as they have been in contact with someone else who is suspected/confirmed to have coronavirus:
• If symptomatic they must not visit the setting
• If the visitor is asymptomatic and wears PPE
• The risk to others is minimal; although they may pose a risk to the person they are visiting if they are less than 2 metres away and stay for longer than 15 minutes (FRSM, apron, gloves)
• Stay at least 2 metres away from others as they enter and leave the setting and try not to touch any surfaces
• Enter and leave the setting as quickly as possible using the most direct route.
If possible, the visit should take place in a side room.
Emotional support should be provided to visitors. This can take the form of
Preparation: Preparing the visitor for what they will see when they arrive in the care setting.
Transport: visitors can be advised to consider being driven to the hospital by a member of their household, if possible, to minimise the risk of exposure to others. They should avoid the use of public transport – especially after the visit. Visitors driven by a person close to them may welcome the support that person can offer once the visit has finished.
Planning: what to do on arrival and arrangements to escort the visitor to the care setting by the shortest possible route.
Personal belongings: visitors should minimise the number of personal belongings they bring with them, eg bags, handbags, electronic devices.
Clothing: the visitor should remove outer clothing, eg coat or jacket, roll up their sleeves and clean their hands before putting on PPE.
Tips: such as going to the toilet and having had a small drink before they don PPE helps to avoid the need to don and doff PPE more than once during the visit.
- Explaining any limits to the length of time the visitor can stay.
- Notifying the nurse caring for the person that a visitor has arrived and ensure that they know how to contact staff or signal when they want to leave.
- Providing comfort if the visitor is distressed, hold the persons hand(s), and provide further appropriate emotional support away from the care setting.
- Providing information to the visitor about what will happen next if their loved one has died.
- Reassuring the visitor that self-isolation is not required following the visit as they have been protected from the risk of transmission by using PPE and performing hand hygiene.
- Signposting opportunities to prepare for death, including emotional and spiritual support (chaplains and faith leaders may play an important role here).