Noble's Hospital

Smoke Free DHSC Policy

The Department of Health and Social Care will launch their new smoke free policy starting 2021. All Island Hospital sites will be Proud to Be Smoke Free.
As of 1st April 2021 Smoking will no longer be permitted anywhere on the grounds of any Isle of Man Hospital.

For further information, advice regarding temporary abstinence from smoking whilst on DHSC premises or Specialist advice regarding quitting smoking please contact the Quit4You service by calling 642404 or email quit4you@gov.im

Quicklinks

• Hospitals Visiting Policy
• Registration and Health Declaration Form
• Ambulance Transfer
• Emergency Department
• Outpatient Areas and Day Case Areas
• Obstetric & Gynaecology Appointments
• Oncology Day Unit
• Inpatient Wards
• Ward 2
• Ward 7
• Children's Ward (Ward 3)
• Jane Crookall Maternity Unit (Ward 10)
• Neonatal Intensive Care Unit (NICU)
• Manannan Court
• Mortuary Department
• Personal Protective Equipment for all Visitors
• Ward information

Hospitals Visiting Policy

Whilst we recognise that friends and family members are a vital support, the utmost care and consideration must be given to the safety of other patients, visitors and staff by maintaining infection prevention and control procedures at all times. However due to the current level of community spread of Covid-19 within the Isle of Man, both Noble’s and Ramsey and District Cottage Hospitals have increased visiting precautions in order to protect vulnerable patients receiving treatment.

Thank you for your understanding and co-operation over recent months as we have worked to protect the vulnerable people in our care from potential exposure to COVID–19. We do need to remain vigilant and will continue to consider who can and cannot visit our hospitals as per the attached Visitor Registration form.

Religious and spiritual support is available for patients, either face-to-face or by telephone.

During the current phase of the COVID-19 pandemic, visiting at Noble’s and Ramsey and District Cottage Hospitals will be as outlined below:

• All visiting must be arranged in advance with the Nurse in charge of the ward prior to coming to the hospital
• Patients can only receive one visitor around a bed at any one time.
• All visitors must wear a mask at all times in the hospital. If a visitor is unable to tolerate wearing a face mask, they should communicate with ward or outpatient clinic staff (if possible prior to their visit) so that a risk assessment can be undertaken. Social distancing must be maintained
• A Visitor Registration Form must be completed for all visitors entering the ward and given to the Ward Clerk or a member of nursing staff for Contact Tracing purposes

All visitors are required to sanitize their hands on entry and exit to the hospitals and again when entering and leaving wards.

Registration and Health Declaration Form

• All visitors must complete the registration form and health declaration form for each time a visit takes place. They must consent for their information to be retained by Manx Care for the purposes of containing the spread of COVID-19.
• Registration and health declaration forms will be placed at the entrance to each ward/clinical area.
• Completed registration and health declaration forms MUST be checked by a Registered Nurse or Health Care Assistant prior to visiting taking place.
• Registration and health declaration forms will be kept in a file on each ward/clinical area for 21 days after the visit (to enable contact tracing if required).

Ambulance Transfer

Escorts for patients arriving by Ambulance will be limited to one essential person. However, any escort who meets the criteria for exclusion as per the Visitor Registration form will not be permitted to travel with the patient or enter the Emergency Department. Additional family members or friends wishing to travel to the hospital in their own transport should note that they will not be permitted to enter the Emergency Department as detailed below.

Emergency Department

1. No visitors are permitted in adult Emergency Department areas. However, based on the clinical team’s judgment, other visitors/escorts may be permitted in exceptional circumstances.
2. One parent/escort per child will be permitted for the duration of the child’s stay in the Emergency Department.
3. A clinical decision must be made for any patient who requires additional assistance.

Outpatient Areas and Day Case Areas

The majority of Outpatient clinics and procedures/treatments in day case areas are operating as normal – however, some are operating in a virtual capacity.

1. All patients to attend outpatient clinics or day case areas alone unless under exceptional circumstances.
2. All patients to wait in their cars until five minutes before their appointments.
3. One parent/escortper child will be permitted for the duration of the child’s stay in the Outpatient area.
4. A clinical decision must be made for any patient who requires additional assistance.
5. Any visitor who is coughing or shows other signs of illness will be asked to leave.
6. Any visitor who…
   1. has been identified as a high risk, low risk or closecontact by 111 within the previous 14 days;
      or
   2. has tested positive for Covid-19 using a Lateral Flow Device (LFD) or lab test;
      or
   3. have been legally instructed to self isolate by 111 Team as part of a travel pathway to enter the island;
      or
   4. is displaying symptoms of Covid-19 e.g. new continuous cough, loss of taste and/or smell, new shortness of breath or a temperature of 37.8^oC or above;
      
      …will not be permitted to enter the Outpatient Areas or Day Case Areas.
      
      
7. Staff at the clinics will assess patients prior to them entering the waiting rooms.

On arrival at the outpatient clinics/day case area entrance, ALL VISITORS will be required to complete a registration and health declaration form (for each visit made) before entering the outpatient clinics/day case area.

However, if it is deemed that you are unwell or have not completed the form in full, you will not be permitted to enter.

Obstetric & Gynaecology Appointments

Patients are permitted to bring 1 person to accompany them to all antenatal appointments, ultrasound scans and early pregnancy assessments.

Patients are permitted to bring 1 person to accompany them in  exceptional circumstances for gynaecology appointments.

On arrival at the appointment, ALL PATIENTS AND ESCORTS will be required to complete a registration and health declaration form (for each visit made) before entering the outpatient clinics / ward area. 

However, if it is deemed that you are unwell or have not completed the form in full, you will not be permitted to enter.

Oncology Day Unit

To protect our vulnerable patients whilst they undergo Oncology treatment, visitors are restricted from attending the Oncology Day Unit, except in exceptional circumstances.

Inpatient Wards

For all wards except Ward 2, Ward 7, Children's Ward and the Jane Crookall Maternity Unit:

1. Visiting will be via prior appointment only with the Nurse in charge of the ward
2. Visiting will be restrictedto between the hours of 2pm – 4pm and 7pm – 8pm daily. There is no restriction on the number of visitors as long as ALL VISITORS complete the registration and health declaration form for each visit made. ALL VISITORS must report to the nurse’s station prior to visiting their relatives/friends
3. There should be no more than one visitor around a bed at any one time.
4. Visiting out of restricted visiting times will be reviewed in exceptional circumstances. Visiting out of restricted visiting times will be at the discretion of the Senior Nurse/Site Manager in consultation with the Nurse in charge of the shift prior to visiting taking place.

Ward 2

Individual visitors will only be allowed to visit their relative if they are deemed to be imminent end of life or visiting on compassionate grounds, and with prior approval.

The utmost care and consideration must be given to the safety of other patients, visitors and staff by maintaining infection prevention and control procedures at all times.

1. The hospital will allow and facilitate each relative one visit to allow them to see their relative. The time duration of visits will be at the discretion of the Senior Nurse and Senior Sister for the Ward area.
2. Only 1 person must visit their relative at any one time – all other visitors must wait in a location as directed by ward staff.
3. Visitors must be advised that the following will be discussed and agreed by the Director of Operations (or in their absence another member of the Executive Leadership Team) in consultation with the relevant Senior Nurse and Senior Sister for the Ward area: 
   1. Number / frequency and duration of any further visits.
   2. Time and where visits will take place within a ward area.

Before entering their relative’s room, staff from the ward must ensure that the relative has been shown how to correctly don and doff full PPE (eye protection, gloves, IIR mask and apron).

Relatives must be informed that at no time must they remove their PPE whilst in the room.

Any subsequent amendments to the original agreed arrangements must be approved by the Director of Operations (or in their absence another member of the Executive Leadership Team).

Ward 7

To maintain a full rehabilitation programme for stroke patients admitted to Ward 7, visiting will be:

• 1pm to 8pm – and only for next of kin or those who will be involved in the future direct care and support of the person affected by stroke. This will be restricted to one visitor per person
• There should be no more than one visitor around a bed at any one time
• Visiting out of restricted visiting times will be reviewed in exceptional circumstances. Visiting out of restricted visiting times will be at the discretion of the Senior Nurse/Site Manager in consultation with the Nurse in charge of the shift prior to visiting taking place.
• ALL VISITORS complete the registration and health declaration form for each visit made. ALL VISITORS must report to the nurse’s station prior to visiting their relatives/friends.

Children’s Ward (Ward 3)

1. Two parents can visit at any time
2. Maximum of another two visitors at any one time in addition to the parents between 3pm and 7pm
3. ALL VISITORS complete the registration and health declaration form for each visit made. ALL VISITORS must report to the nurse’s station prior to visiting their relatives/friends.

Jane Crookall Maternity Unit (Ward 10)

1. Partners are permitted between 10am and 8pm
2. Two birthing partners can accompany an expectant mum once she has transferred to the delivery suite and stay with her until her baby is born. Prior to this, only one support person is permitted to stay on the ward area
3. If an expectant mum is having an elective caesarean section, because these are planned for during the day, the birthing partner can stay with her from the time they are admitted until the end of visiting time for birth partners (10am – 8pm)
4. Birth partners are permitted onto the maternity unit between 10:00 and 20:00 each day to enable them to spend time with their partner and new baby following the birth. They are requested to remain at their partner's bedside and not walk around or go on and off the unit
5. Siblings can also visit following prior arrangement with the Lead Midwife for one hour per day
6. ALL VISITORS must complete the registration and health declaration form for each visit made. ALL VISITORS must report to the nurse’s station prior to visiting their relatives/friends. IIR masks must be worn by all visitors at all times.

Neonatal Intensive Care Unit (NICU)

1. Two ‘essential visitors’ only per baby will be permitted on the Neonatal Intensive Care Unit (NICU). Both parents may visit for a block period each day; multiple daily visits are not permitted
2. No siblings can visit.

Manannan Court

1. Visiting will be typically be restrictedto between the hours of 2pm to 4pm and 7pm to 8pm daily, however, there may be some variation to this influenced by the individual need of the patient or visitor.
2. Two visitors per patient will be permitted as long as ALL VISITORS complete the registration and health declaration form
3. ALL VISITORS must report to the reception area prior to visiting their relatives/friends.

Mortuary Department

Two 'essential visitors' will be permitted to the viewing facility within the Mortuary Department at Noble’s Hospital.

Mortuary viewing appointments to be arranged in accordance with the following process:

• Please contact the Relatives Support Service (RSS) on (01624) 650615. RSS typically operates between the hours of 8am and 4:30pm, Monday to Friday
• An appointment will be made for a mutually convenient time
• Viewing appointments will usually be arranged for Monday to Friday afternoons
• The RSS staff will meet the visitor(s) in the main reception area of Noble’s Hospital  
• Once permission has been given to visit, the visitor(s) will be asked screening questions about their health in relation to COVID-19
• If requirements are met, a designated time will be agreed for the visit. The visitor(s) will need to bring a recognised form of photographic identification with them such as a passport or driving licence.  

Personal Protective Equipment for all Visitors

• All visitors are required to sanitisetheir hands on entry and exit to both hospitals, and again when entering and leaving wards
• All visitors must wear a medical grade mask supplied by Manx Care at all times in the hospitals. Visitors will not be permitted to wear their own mask
• If visitors require PPE, staff from the ward being visited will make sure they are shown how to correctly wear this (to include eye protection, gloves, IIR mask and apron) and will support them in making sure this has been put on correctly
• All visitors are to be reminded to practice good hand hygiene and wash their hands for at least 20 seconds with soap and water, or use the hand sanitiser provided on entry and exit to the area.

For people wishing to visit their relatives in Noble’s Hospital / Ramsey District Cottage Hospital, who have: Arrived on the Isle of Man and been legally instructed to self isolate by 111 Team as part of a travel pathway to enter the island; Tested positive for Covid-19 using either a Lateral Flow Device or a Laboratory (PCR) test; Been identified as a high or low risk contact of someone with confirmed Covid-19 (confirmation provided by the 111 Team) in the previous 10 days

Where visits are approved, the arrangements for each patient and their relatives will be agreed on a case by case basis to reflect the individual circumstances of the situation. The relative should contact the relevant ward to advise the nurse in charge of their planned arrival on Island.

1. The hospitals will allow and facilitate each relative one visit to allow them to see the patient. The time duration of visits will be at the discretion of the Senior Nurse and Senior Sister for the Ward area
2. Visits to patients who are imminent end of life can take place even whilst an individual is waiting for the results of their Covid-19 swab
3. Only one person must visit their relative at their bedside at any one time. All other visitors must wait in a location as directed by ward staff. Visitors who are isolating must not visit at the same time as other visitors.

Visitors should be aware that the Site Manager and other relevant Senior Managers will discuss the following topics, in consultation with the Senior Sister for the Ward area:

a)       Number, frequency and duration of any further visits

b)      Time and where visits will take place within a ward area.

Prior to arriving, relatives will be asked to make sure they are wearing an IIR facemask on entering hospital premises. The relative must be met at the Main Entrance by a member of the ward staff.

The relative will then be escorted to the ward by the staff member (who will also be wearing an IIR facemask).

Before entering their relative’s room, staff from the ward will make sure that all relatives have been shown how to correctly wear this (to include eye protection, gloves, IIR mask and apron) and will support them in making sure this has been put on correctly

Relatives should be clear they should not remove their PPE whilst in the room AT ANY TIME.

Once the visit is over, ward staff must escort the visitor(s) out to the Main Entrance. Visitors should be advised not to go to any other departments or locations within the hospital after visiting. 

Any subsequent amendments to the original agreed arrangements must be approved by the Site Manager/relevant Senior Nurse in consultation with the Senior Sister for the Ward area.

If a patient meets any of the above criteria, individual visitors will only be allowed to visit their relative if they are deemed to be imminent end of life or visiting on compassionate grounds, and with prior approval. 

The utmost care and consideration must be given to the safety of other patients, visitors and staff by maintaining infection prevention and control procedures at all times.

Where visits are approved, the arrangements for each patient and their relatives will be agreed on a case by case basis to reflect the individual circumstances of the situation. The relative should contact the relevant ward to advise the nurse in charge of their planned arrival on Island.

1. The hospitals will allow and facilitate each relative one visit to allow them to see the patient. The time duration of visits will be at the discretion of the Senior Nurse and Senior Sister for the Ward area
2. Visits to patients who are imminent end of life can take place even whilst an individual is waiting for the results of their Covid-19 swab
3. Only one person must visit their relative at their bedside at any one time. All other visitors must wait in a location as directed by ward staff. Visitors who are isolating must not visit at the same time as other visitors.

Visitors should be aware that the Site Manager and other relevant Senior Managers will discuss the following topics, in consultation with the Senior Sister for the Ward area:

a)       Number, frequency and duration of any further visits

b)      Time and where visits will take place within a ward area.

Prior to arriving, relatives will be asked to make sure they are wearing an IIR facemask on entering hospital premises. The relative must be met at the Main Entrance by a member of the ward staff.

The relative will then be escorted to the ward by the staff member (who will also be wearing an IIR facemask).

Before entering their relative’s room, staff from the ward will make sure that all relatives have been shown how to correctly wear this (to include eye protection, gloves, IIR mask and apron) and will support them in making sure this has been put on correctly

Relatives should be clear they should not remove their PPE whilst in the room AT ANY TIME.

Once the visit is over, ward staff must escort the visitor(s) out to the Main Entrance. Visitors should be advised not to go to any other departments or locations within the hospital after visiting. 

Any subsequent amendments to the original agreed arrangements must be approved by the Director of Operations (or in their absence another member of the Executive Leadership Team).

Nobles Hospital floor plan

Ward information

If you do not know which Ward a friend or relative is on, please ring the hospital switchboard.

Ward	Visiting Arrangements
Ward 1 – Acute Medical ward +44 1624 650021	All visiting must be arranged in advance with the Nurse in charge of the ward prior to coming to the hospital. Visiting will be restrictedto 15 minutes per person between the hours of 2pm - 4pm and 7pm - 8pm daily. There is no restriction on the number of visitors as long as ALL VISITORS complete the registration and health declaration form for each visit made. ALL VISITORS must report to the nurse’s station prior to visiting their relatives/friends There should be no more than one visitor around a bed at any one time, with the period of the visit not lasting more than 15 minutes. Visiting out of restricted visiting times will be reviewed in exceptional circumstances. Visiting out of restricted visiting times will be at the discretion of the Senior Nurse/Site Manager in consultation with the Nurse in charge of the shift prior to visiting taking place.
Ward 2 – Female Surgical Ward +44 1624 650022	Visits to patients who are possible or confirmed case of COVID-19 have been asked to isolate by the 111 Team Individual visitors will only be allowed to visit their relative if they are deemed to be imminent end of life or visiting on compassionate grounds, and with prior approval. The hospital will allow and facilitate each relative one visit to allow them to see their relative. The time duration of visits will be at the discretion of the Senior Nurse and Senior Sister for the Ward area. Only 1 person must visit their relative at any one time – all other visitors must wait in a location as directed by ward staff. Visitors must be advised that the following will be discussed and agreed by the Director of Operations (or in their absence another member of the Executive Leadership Team) in consultation with the relevant Senior Nurse and Senior Sister for the Ward area. Number / frequency and duration of any further visits. Time and where visits will take place within a ward area. Before entering their relative’s room, staff from the ward must ensure that the relative has been shown how to correctly don and doff full PPE (eye protection, gloves, IIR mask and apron). Relatives must at no time remove their PPE whilst in the room.
Ward 3 - Children's Ward +44 1624 650023	2 parents can visit at any time Maximum of another 2 visitors at any one time in addition to the parents between 3pm-7pm
Ward 4 - Female / Gynaecology Ward +44 1624 650024	All visiting must be arranged in advance with the Nurse in charge of the ward prior to coming to the hospital. Visiting will be restricted to between the hours of 2 – 4 pm and 7-8 pm daily. Patients can only receive one visitor around a bed at any one time. There is no restriction on the number of visitors as long as ALL VISITORS complete the registration and health declaration form for each visit made. ALL VISITORS must report to the nurse’s station prior to visiting their relatives/friends. However there should be no more than 2 visitors around a bed at any one time. Visiting out of restricted visiting times will be reviewed in exceptional circumstances. Visiting out of restricted visiting times will be at the discretion of the Senior Nurse/Site Manager in consultation with the nurse in charge of the shift prior to visiting taking place
Ward 6 - Acute Medical Ward +44 1624 650026	All visiting must be arranged in advance with the Nurse in charge of the ward prior to coming to the hospital. Visiting will be restricted to between the hours of 2 – 4 pm and 7-8 pm daily. Patients can only receive one visitor around a bed at any one time. There is no restriction on the number of visitors as long as ALL VISITORS complete the registration and health declaration form for each visit made. ALL VISITORS must report to the nurse’s station prior to visiting their relatives/friends. Visiting out of restricted visiting times will be reviewed in exceptional circumstances. Visiting out of restricted visiting times will be at the discretion of the Senior Nurse/Site Manager in consultation with the nurse in charge of the shift prior to visiting taking place
Ward 7 - Stroke and TIA +44 1624 650027	To maintain a full rehabilitation programme for stroke patients admitted to Ward 7 visiting will be All visiting must be arranged in advance with the Nurse in charge of the ward prior to coming to the hospital. Patients can only receive one visitor around a bed at any one time 1pm – 8pm -only for next of kin orthose who will be involved in the direct care and support of the person affected by stroke in the future. This is normally 1 or 2 people per person. Other visitors to be able to visit between 6pm-8pm - to prevent conflict between therapy and contact with friends. Visiting out of restricted visiting times will be reviewed in exceptional circumstances. Visiting out of restricted visiting times will be at the discretion of the Senior Nurse/Site Manager in consultation with the nurse in charge of the shift prior to visiting taking place.
Oncology +44 1624 650025	To protect our vulnerable patients whilst they undergo Oncology treatments, visitors are restricted from attending the Oncology Day Unit, except in exceptional circumstances.
Ward 8 - Male Surgical Ward +44 1624 650028	All visiting must be arranged in advance with the Nurse in charge of the ward prior to coming to the hospital. Visiting will be restrictedto between the hours of 2 – 4 pm and 7-8 pm daily. Patients can only receive one visitor around a bed at any one time. There is no restriction on the number of visitors as long as ALL VISITORS complete the registration and health declaration form for each visit made. ALL VISITORS must report to the nurse’s station prior to visiting their relatives/friends. Visiting out of restricted visiting times will be reviewed in exceptional circumstances. Visiting out of restricted visiting times will be at the discretion of the Senior Nurse/Site Manager in consultation with the nurse in charge of the shift prior to visiting taking place
Ward 9 - Acute Medical Ward +44 1624 650029	All visiting must be arranged in advance with the Nurse in charge of the ward prior to coming to the hospital. Visiting will be restricted to between the hours of 2 – 4 pm and 7-8 pm daily. Patients can only receive one visitor around a bed at any one time. There is no restriction on the number of visitors as long as ALL VISITORS complete the registration and health declaration form for each visit made. ALL VISITORS must report to the nurse’s station prior to visiting their relatives/friends. Visiting out of restricted visiting times will be reviewed in exceptional circumstances. Visiting out of restricted visiting times will be at the discretion of the Senior Nurse/Site Manager in consultation with the nurse in charge of the shift prior to visiting taking place
Ward 10 - Jane Crookall Maternity Unit +44 1624 650030	Partners are permitted between 10am and 8 pm. Two birthing partners can accompany an expectant mum and stay with them until their baby is born. If an expectant mum is having an elective caesarean section, as these are planned for during the day, the birthing partner(s) can stay with the expectant mum from the time they are admitted until the end of visiting time for birth partners (10am-8pm). Birth partners are permitted onto the maternity unit between 10 am and 8pm each day to enable them to spend time with their partner and new baby following the birth. They are requested to remain at their partner's bedside and not walk around or go on and off the unit. All other visitors are between 7-8pm. Siblings can also visit but for short periods, they are not permitted to visit all day. ALL VISITORS complete the registration and health declaration form for each visit made. ALL VISITORS must report to the nurse’s station prior to visiting their relatives/friends.
Ward 11 - Trauma & Orthopaedics +44 1624 650031	All visiting must be arranged in advance with the Nurse in charge of the ward prior to coming to the hospital. Visiting will be restrictedto between the hours of 2 – 4 pm and 7-8 pm daily. Patients can only receive one visitor around a bed at any one time. There is no restriction on the number of visitors as long as ALL VISITORS complete the registration and health declaration form for each visit made. ALL VISITORS must report to the nurse’s station prior to visiting their relatives/friends. Visiting out of restricted visiting times will be reviewed in exceptional circumstances. Visiting out of restricted visiting times will be at the discretion of the Senior Nurse/Site Manager in consultation with the nurse in charge of the shift prior to visiting taking place
Ward 12 - Trauma & Orthopaedics +44 1624 650032	All visiting must be arranged in advance with the Nurse in charge of the ward prior to coming to the hospital. Visiting will be restrictedto between the hours of 2 – 4 pm and 7-8 pm daily. Patients can only receive one visitor around a bed at any one time. There is no restriction on the number of visitors as long as ALL VISITORS complete the registration and health declaration form for each visit made. ALL VISITORS must report to the nurse’s station prior to visiting their relatives/friends. Visiting out of restricted visiting times will be reviewed in exceptional circumstances. Visiting out of restricted visiting times will be at the discretion of the Senior Nurse/Site Manager in consultation with the nurse in charge of the shift prior to visiting taking place
Ward 16 - Neonatal +44 1624 650035	Two ‘essential visitors’ only per baby will be permitted on the Neonatal Intensive Care Unit (NICU). Both parents may visit for a block period each day; multiple daily visits are not permitted. No siblings can visit.
Ward 17 - Intensive Care Unit +44 1624 650036	All visiting must be arranged in advance with the Nurse in charge of the ward prior to coming to the hospital. Visiting will be restrictedto between the hours of 2 – 4 pm and 7-8 pm daily. Patients can only receive one visitor around a bed at any one time. There is no restriction on the number of visitors as long as ALL VISITORS complete the registration and health declaration form for each visit made. ALL VISITORS must report to the nurse’s station prior to visiting their relatives/friends. Visiting out of restricted visiting times will be reviewed in exceptional circumstances. Visiting out of restricted visiting times will be at the discretion of the Senior Nurse/Site Manager in consultation with the nurse in charge of the shift prior to visiting taking place
Ward 18 - Coronary Care Unit +44 (0) 1624 650037	All visiting must be arranged in advance with the Nurse in charge of the ward prior to coming to the hospital. Visiting will be restrictedto between the hours of 2 – 4 pm and 7-8 pm daily. Patients can only receive one visitor around a bed at any one time. There is no restriction on the number of visitors as long as ALL VISITORS complete the registration and health declaration form for each visit made. ALL VISITORS must report to the nurse’s station prior to visiting their relatives/friends. Visiting out of restricted visiting times will be reviewed in exceptional circumstances. Visiting out of restricted visiting times will be at the discretion of the Senior Nurse/Site Manager in consultation with the nurse in charge of the shift prior to visiting taking place