Background Visiting in a hospice setting during COVID-19 has been incredibly emotive and challenging, not only for patients and relatives, but also for staff. Restricting visiting conflicts with holistic patient-centred care, and the complexity of discussions and decision-making cannot be underestimated, impacting on the emotional burden for staff morale and resilience.

Method A three-pronged approach was taken. 1. A hospice visiting task and finish group was set up. 2. A new role was developed, using government COVID-19 funding- a ‘Visitor Co-ordinator’ for an initial three-month period. This role supported decision making, communication with families and screening/practical support in the use of PPE as well as facilitating virtual visiting. 3. A 3-tiered Visitors Traffic Light Guideline (green, amber, red) providing some clarity for staff around ‘essential visiting’ and adapting to fluctuating local government restrictions was developed, and implemented. Feedback was collated for the visitor coordinator role, and a survey is underway to evaluate the Visitor Traffic light guideline.

Results Feedback from staff members following the introduction of the Visitor co-ordinator role was extremely positive and demonstrated an improvement in wellbeing at work. Staff reported the role of the co-ordinator relieved a ‘huge burden and source of stress’ and as a consequence allowed them to ‘dedicate more time to patients‘. The hospice visiting tiered guideline has aligned with the ‘Visiting healthcare inpatient settings during the COVID-19 pandemic: principles’ NHS guidelines however, some staff still report that the application of guidelines remains extremely challenging.

Conclusions A Visitor Co-ordinator role was extremely beneficial during the first weeks of the pandemic. Although helpful, a guideline alone does not alleviate all the challenges associated with restricted visiting; it remains an uncomfortable oxymoron for hospice staff and a flexible individualised risk approach is still needed to ensure compassionate visiting at the end of life.