Ch. 11: Admission, Transfer, and Discharge Flashcards
Admission to a hospital or other health care facilities
Is an anxious time for patients
The nurse’s responsibility is to
Assist the patient in maintaining dignity and a sense of control and in becoming comfortable in the new environment
Upon admission, some patients may experience
Disorientation, fear of the unknown, loss of identity, or separation anxiety
What can help alleviate a patient’s fear and anxiety?
Orienting the patient to the new environment
Only address a patient’s first name
At the patient’s request
Empathy
Ability to recognize and to some extent share the emotions and significance of that person’s behavior
If the patient does not speak English, and is not accompanied by a bilingual family member on admission
contact the social services department to secure an interpreter
Medicare and Medicaid reimbursements are required to present information on
patient’s right to refuse or accept medical treatment and information regarding advance directives
Some hospitals have telephone admitting
the day before a planned admission, a representative from the admitting office calls the patient at home and gathers all the information needed to begin the records
Patient room orientation
Explanation of policies applicable to the patient, how to adjust the bed and the lights, how to call the nurse form the bed and the bathroom, how to operate the telephone and the radio, how to operate the television, how to use the intercom system if one is present, the location of lounge areas, the locations of shower and bathroom facilities, the relationship of the room to the nurses’ station
To introduce yourself
give your name and title, a person who is warmly welcomed is more at ease in a new enviorment
What expedites the admission process in the admitting department and on the nursing unit?
The EHR
The admitting procedure on the patient care unit is much more extensive than that in the
admitting department
The nurse must verify information
found in the EHR
Assess immediate needs
such as pain, shortness of breath, or severe anxiety
Steps associated with patient admission
- Perform hand hygiene
- Prepare the room before the patient arrives
- Courteously greet the patient and family
- Check the ID band and verify its accuracy
- Assess immediate needs
- Orient the patient to the unit, the lounge and the nurse’s station
- Orient the patient to the room. Explain the use of equipment, call system, bed, telephone, and television
- Explain facility routines, such as visiting hours and meal times
- Provide privacy if the patient desires or if abuse is suspected
- Follow facility policy for care of valuables, clothing and medications
- Obtain the patient’s health history and perform the initial nursing assessment.
- Provide for safety
- Begin care as ordered by the health care provider
- Invite family back into the room if they left earlier
- Perform hand hygiene
- Record the information on the patient’s health care record according to agency policy
- Allow patient and family time alone together, if desired
- Perform patient teaching
TJC requires each hospitalized patient to have an admission assessment prepared by a registered RN within
24 hours of admission
The initial assessment includes
level of consciousness, vital signs, height, weight, and a review of body systems
When is a hospitalist assigned to the patient’s care?
If the primary health care provider chooses not to follow patient care in the hospital setting
The role of the LPN/LVN in the nursing process
participate in planning care for patients based on patient needs, review patient’s plan of care for patients based on patient needs, review and follow defined prioritization for patient care, use clinical pathways, care maps, or care plans to guide and review patient care
Assessment of the patient begins at
admission
Subjective and objective data are collected
during the assessment
The patient being admitted to most health care facilities is required to have a nursing care plan initiated by the RN within
the first 24 hours of admission
Common patient problems for a newly admitted patient include
anxiousness and potential for injury, insufficient knowledge regarding admission process/illness, and fearfulness, related to admission to health care facility
Examples of patient-centered goals
Patient will voice understanding of care planned while in facility
Patient will not suffer accidental injury while in facility
Examples of nursing intervention/implementation
orient or acquaint the patient to the facility to ease the patient’s anxiety, establish nurse-patient rapport directed at fostering a therapeutic nurse-patient relationship, identify risk behaviors or limitations to assist the staff in making the environment safe, confirm though discussion and questions that the patient understands the diagnostic tests and procedures, monitor the patient’s ability to ambulate alone, monitor the patient’s ability to operate the hospital bed, the call light, and the emergency button
Determine whether the patient has met the previously established goals
Patient demonstrates understanding of procedure, Patient has remained injury free
The changing condition of a patient, whether improving or becoming more critical, frequently necessitates
transfer
Documentation of the patient’s condition before and during transfer and adequate communication among nursing staff ensures
continuity of care
Transfer combines
admission and discharge
Assessment for transfer
the patient’s condition must be assessed before transfer to determine the necessary method of transfer
Patient problems that the patient had before the transfer
may still be current after the transfer, the nurse’s assessment helps in determining whether revisions to the care plan are necessary
Examples of patient-centered goals with transferring
Patient will voice an understanding of the reason for and the process involved with the transfer
Patient will incur no injury during or after transfer
Implementation for transfer
explain to patient and family the reason for the transfer, when it is to occur, and what procedures are planned
encourage questions
confirm the patient understands the transfer and procedures through discussion and questions
inspect the patient’s positioning in or on transport vehicle
during final assessment, compare present data with previous findings
Evaluation for transfer
Patient state the reasons for the transfer
Patient is secured into wheelchair or gurney and remains injury free
Discharge planning
is defined as the systematic process of planning for patient care after discharge from a hospital or health care facility
Effective discharge requires
careful planning and continued assessment of the patient’s needs during the stay in the facility
The Joint Commission suggest the following instructions be given to patients upon discharge from a health care facility
reason for the admission, safe and effective use of medications and medical equipment, instruction on nutrition and modified diets, rehabilitation techniques to support adaptation to or functional independence in the environment, access to available community resources as needed, when and how to obtain further treatment, the patient’s and family’s responsibilities in the patient’s ongoing health care needs, maintenance of good standards for personal hygiene and grooming
The social worker is often in charge of
discharge planning for the long-term care resident
Another approach to discharge planning is to perform
transitional care with transition specialists
A discharge summary is part of the
discharge plan
A discharge summary includes
the patient’s learning needs, how well they have been met, the patient teaching completed, short-term and long-term goals of care, referrals made, and coordinated care plan to be implemented after discharge
Referrals should be made
as soon as possible after the patient’s need is identified
The nurse is responsible to ascertain
whether the patient or family is able to provide any care still needed
AMA
when a patient leave a health care facility without a health care provider’s order for discharge
If the health care provider fails to convince the patient to remain in the facility
the provider asks the patient to sign an AMA form
Patient problem on discharge example
Compromised Maintenance of Health and Inability to Bathe Self.
Patient planning at discharge examples
Patient or family member will be able to care for individual needs
Health care resources regarding bathing and hygiene will be available at home
Evaluation at discharge examples
Home health agency has been notified of a patient’s needs on arrival at home
Home health agency’s initial visit is completed before discharge or soon thereafter
