Chapter 45 Admission, Transfer, and Discharge

1. Chapter 45Admission, Transfer, and Discharge

2. Admission • Admission to the healthcare facility • Activities surrounding a client’s arrival at the facility for the purpose of receiving healthcare. • One admission • Each continuous period of time a client spends in a facility. • Admitting department • Proper identification of each client is vital. • Enter information about age, sex, marital status, next of kin, employer, healthcare provider and health insurance

3. The HIPAA Legislation • Health Insurance Portability and Accountability Act (HIPAA) • Guidelines must be followed to protect client privacy. • Client or responsible person signs a document confirming that agencies policies were discussed. • Protect the client’s privacy. • Confirm • Advance directives or living will • Donor status

4. The Client’s Arrival on the Nursing Unit • Purpose of admission process is to help establish how they feel about the admission* • Assist in changing to hospital gown or robe. • Areas such as chemical dependency or psych may encourage clients to wear street clothes • Inspect for skin integrity.

5. The Client’s Arrival on the Nursing Unit • Assist the client into bed • Should wear gown • This allows easier visualization of the body, facilitates wound care • Orient the client to the facility. • Care for the client’s personal belongings. • Prevent dehumanization.

6. **Performing the Admissions Interview • Verify the clients name and birth date as printed on the ID band • Measure wt. and ht to determine if client if over/underwt. • Measure v/s, assess pain level

7. Orienting client to facility • Intercom • Explain purpose of system, alleviates fear and anxiety* • Toiletries • Gown • Advisable for clients who are bleeding, incontinent, or having wound drainage to wear • Equipment • Client identification • Check info on all ID bands to make sure info correct!!

8. KEY CONCEPT* • Anxiety levels may be estimated as: • +1 • +2 • +3 • PANIC

9. Caring for the clients personal belongings • Clothing • Storage space • Valuables • Jewelry, credit cards and cash should not be brought into the facility*

10. Dehumanization • Depriving a person of personality, spirit, privacy and other human qualities • The nurse should develop rapport and trust with the client before delving into personal matters or procedures that may embarrass the client*

11. Assessment, Reporting, andDocumentation • Weight • Height • Vital signs • Pulse oximetry • Collecting specimens • Radiology and laboratory examinations • Pediatric admissions • Check with child to determine how much he or she understands, you may need to find an alternative way to relay information

12. Reporting the Admission • The Joint Commission • An RN performs formal admission assessments and formulates nursing diagnoses. • LPN/LVN • Client orientation and admission procedures. • Client’s vital signs, weight, and client-reported symptoms.

13. Need for Transfer to Another Unit • Assignment to a certain unit is temporary. • A change in client acuity necessitates placing the client in another department. • The client’s condition requires transfer to the ICU or specialized care. • Postpartum area • Postsurgical unit • Psychiatric unit

14. Preparation for the Transfer • Explain the need for transfer to the client and family. • Assemble client’s personal belongings and medications and take these to the new unit. • Transfer the client’s information to the computer in the new location. • Determine how the client will be moved. Provide for client safety. • Review the health record and check for completeness • Collect medications and check MAR to make sure info complete • Record the transfer in a transfer note. Make sure the receiving unit is ready.

15. Transporting the Client • Keep the client safe during the move. • Introduce the client to the staff at the new nurses’ station. • Give a report to the staff on the new unit, make sure the transfer is completed in the computer. • Take the client to the room and assist the client into bed. • When returning to the nursing unit, notify all necessary departments of the transfer. • Request assistance from security personnel if necessary. • Observe procedures for isolation as required.

16. Educating the Client • Explain the safe change of dressings. • Describe the amount of rest and suggested exercises. • Detail dietary restrictions. • Show how to perform personal care. • Demonstrate the operation of equipment. • Emphasize the importance of self-care and building the client’s independence and self-esteem.

17. Educating the Client (cont’d) • Describe medication administration. • Identify situations that require the client to be seen by the primary care provider. • Write down the phone number of the hospital unit. • Communicate the date, time, and location of the next scheduled examination, if known. • Discuss with the physician the need for a public health nursing referral. • Make sure the client has all personal property.

18. The Client’s Discharge and Nursing • Client’s discharge (D/C) • Plans begin at admission. • Involves the total nursing care team, client, and family. • Nursing students and LPNs/LVNs assist with teaching the client and family before discharge. • Client and family should verbalize information and perform return demonstrations of procedures. • Carefully document all discharge teaching. • Client should return demonstrate any procedures prior to discharge!!

19. Against Medical Advice (AMA) • AMA: Client leaves the facility without permission. • Report to the team leader ASAP!! • The client is asked to sign a dated release form. • A licensed nurse witnesses the client’s signature. • The primary provider documents the AMA discharge. • Client refusal to sign must be noted on the form. • The form is signed by at least two witnesses.

20. AWOL • AWOL (absent without leave) • The client walks off the unit to go home or to leave the facility without being discharged. • The client usually needs to be readmitted on return if they return the next day or after midnight. • This is considered a new admission for the client. • Long-term facilities usually identify vulnerable clients who are likely to leave without permission. • WanderGuard or other special transmitter alert • Important for safety if the client is confused or otherwise vulnerable