Chapter 11 Admission Discharge Transfer and Referrals Copyright

Admission • Entering a health care agency for nursing care and medical or surgical

Admission Process • Admission involves: – Authorization from a physician that the person requires

Admission Process (cont’d) • Completion of the agency’s admission data base by nursing personnel

Question • Is the following statement true or false? The first step of admission

Answer False. The first step of admission is the authorization from a physician that

Admission Process (cont’d) • Medical authorization • The admitting department – Preliminary data collected

Admission Process (cont’d) • Initial nursing plan for care • Medical admission responsibilities Copyright

Nursing Admission Activities • Preparing the client’s room • Welcoming the client • Orienting

Psychosocial Responses on Admission • Anxiety; Fear • Decisional conflict • Situational low self-esteem

Types of Admissions Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

The Discharge Process • Discharge is the termination of care from a health care

Steps in the Discharge Process • Discharge planning • Obtaining a written medical order

Discharge Process (Refer to Skill 11 -2 in the textbook. ) Copyright © 2013

The Transfer Process • Transfer: discharging a client from one unit or agency; admitting

Steps Involved in Transfer • Informing client and family about the transfer • Completing

Advantages of Transfer Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question • Is the following statement true or false? Transfer involves discharging a client

Answer False. Transfer involves discharging a client from one unit or agency and admitting

Extended Care Facilities • Skilled nursing facilities • Intermediate care facilities • Basic care

Determining the Level of Care • Minimum data set (MDS) – Standard form developed

Determining the Level of Care (cont’d) • Minimum data set factors – Cognitive patterns,

Determining the Level of Care (cont’d) • Minimum data set factors (cont’d) – Mood

Question • What is the appropriate action for the nurse to take with a

Answer d. Place them in the hospital’s safe temporarily The nurse should place the

The Referral Process • A referral is the process of sending someone to another

Community Services Where Referrals Are Made Copyright © 2013 Wolters Kluwer Health | Lippincott

Question • Is the following statement true or false? Skilled nursing facility provides 24

Answer True. Skilled nursing facility provides 24 -hour nursing care under the direction of

Home Health Care • Health care provided in the home by an employee of

Home Health Care (cont’d) • Factors contributing to the increased demand for home health

Responsibilities Assumed by Home Health Nurses Copyright © 2013 Wolters Kluwer Health | Lippincott

Question • Is the following statement true or false? Home care nursing services help

Answer True. Home care nursing services help shorten the time spent recovering in the

General Gerontologic Considerations • Older adults may minimize their symptoms • Consider methods to

General Gerontologic Considerations (cont’d) • Early discharge planning and appropriate community resources may return

General Gerontologic Considerations (cont’d) • Barriers to use of community-based services: – Lack of

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Admission Process • Admission involves: – Authorization from a physician that the person requires specialized care and treatment – Collection of billing information by the admitting department of the health care agency Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Admission Process (cont’d) • Completion of the agency’s admission data base by nursing personnel • Documentation of the client’s medical history and findings from physical examination • Development of an initial nursing care plan • Initial medical orders for treatment Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question • Is the following statement true or false? The first step of admission is the collection of billing information by the admitting department of the health care agency. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer False. The first step of admission is the authorization from a physician that the person requires specialized care and treatment. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Nursing Admission Activities • Preparing the client’s room • Welcoming the client • Orienting the client • Safeguarding valuables and clothing • Helping the client undress • Compiling the nursing data base Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Psychosocial Responses on Admission • Anxiety; Fear • Decisional conflict • Situational low self-esteem • Powerlessness • Social isolation • Risk for ineffective therapeutic regimen management Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

The Discharge Process • Discharge is the termination of care from a health care agency • Discharge planning • Special considerations related to discharge planning Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Steps in the Discharge Process • Discharge planning • Obtaining a written medical order • Completing discharge instructions • Notifying the business office • Helping the client leave the agency • Writing a summary of the client’s condition at discharge • Requesting that the room be cleaned Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

The Transfer Process • Transfer: discharging a client from one unit or agency; admitting him or her to another without going home in the interim • Transfers are used when there is a need to: – Facilitate more specialized care in a lifethreatening situation – Reduce health care costs – Provide less intensive nursing care Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Steps Involved in Transfer • Informing client and family about the transfer • Completing a transfer summary • Speaking with a nurse on the transfer unit to coordinate the transfer • Transporting the client and his or her belongings, medications, nursing supplies, and chart to the other unit Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question • Is the following statement true or false? Transfer involves discharging a client from one unit or agency and allowing him to go home. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer False. Transfer involves discharging a client from one unit or agency and admitting him or her to another without going home in the interim. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Determining the Level of Care • Minimum data set (MDS) – Standard form developed by the Health Care Financing Association – MDS is repeated every 3 months or whenever a client’s condition changes – Problems identified on the MDS are then reflected in the nursing care plan Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Determining the Level of Care (cont’d) • Minimum data set factors – Cognitive patterns, communication/ hearing patterns, vision patterns – Physical functioning and structural problems – Continence patterns in the last 14 days – Psychosocial well-being Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Determining the Level of Care (cont’d) • Minimum data set factors (cont’d) – Mood and behavior patterns, activity pursuit patterns, disease diagnoses – Health conditions, oral/nutritional/dental status, skin condition – Medication use – Special treatments and procedures Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question • What is the appropriate action for the nurse to take with a client’s valuables? a. Hand them over to the supervisor b. Ask the client to keep them with himself or herself c. Hand them over to the admitting department d. Place them in the hospital’s safe temporarily Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer d. Place them in the hospital’s safe temporarily The nurse should place the client’s valuables in the hospital’s safe temporarily. Losing a client’s personal items can have serious legal implications for both the nurse and health care agency; therefore the nurse should not hand them over to the supervisor, ask the client to keep them himself, or hand them over to the admitting department. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

The Referral Process • A referral is the process of sending someone to another person or agency for special services • Referrals generally are made to private practitioners or community agencies Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question • Is the following statement true or false? Skilled nursing facility provides 24 -hour nursing care under the direction of a registered nurse. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Home Health Care • Health care provided in the home by an employee of a home health agency • Home care nursing services – Help shorten time spent recovering in hospital – Prevent admissions to extended care facilities – Reduce readmissions to acute care facilities Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Home Health Care (cont’d) • Factors contributing to the increased demand for home health care: – Outcome of limitations imposed by Medicare and insurance companies on number of hospital and nursing home days for which they reimburse care – Growing number of chronically ill older adults in need of assistance Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question • Is the following statement true or false? Home care nursing services help shorten the time spent recovering in the hospital. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

General Gerontologic Considerations • Older adults may minimize their symptoms • Consider methods to facilitate/minimize alterations: planning a transfer to an institutional setting • Allow additional time when admitting, discharging, or transferring older adults • Pets are an integral social support system Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

General Gerontologic Considerations (cont’d) • Early discharge planning and appropriate community resources may return older adults to their own homes Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

General Gerontologic Considerations (cont’d) • Barriers to use of community-based services: – Lack of finances or reluctance to spend for service payment – Unwillingness to admit need; mistrust of service providers – Lack of time, energy, or ability to find appropriate services Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins