Ppt chapter 11

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Ppt chapter 11

  1. 1. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 11 Admission, Discharge, Transfer, and Referrals
  2. 2. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins • Entering a health care agency for nursing care and medical or surgical treatment Admission
  3. 3. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins • 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 Admission Process
  4. 4. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins • 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 Admission Process (cont’d)
  5. 5. 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.
  6. 6. 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.
  7. 7. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Admission Process (cont’d) • Medical authorization • The admitting department – Preliminary data collected – Addressograph plate
  8. 8. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Admission Process (cont’d) • Initial nursing plan for care • Medical admission responsibilities
  9. 9. 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
  10. 10. 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
  11. 11. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Types of Admissions
  12. 12. 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
  13. 13. 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
  14. 14. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Discharge Process )Refer to Skill 11-2 in the textbook.(
  15. 15. 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 life- threatening situation – Reduce health care costs – Provide less intensive nursing care
  16. 16. 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
  17. 17. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Advantages of Transfer
  18. 18. 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.
  19. 19. 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.
  20. 20. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Extended Care Facilities • Skilled nursing facilities • Intermediate care facilities • Basic care facilities
  21. 21. 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
  22. 22. 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
  23. 23. 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
  24. 24. 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
  25. 25. 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.
  26. 26. 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
  27. 27. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Community Services Where Referrals Are Made
  28. 28. 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.
  29. 29. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer True. Skilled nursing facility provides 24-hour nursing care under the direction of a registered nurse.
  30. 30. 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
  31. 31. 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
  32. 32. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Responsibilities Assumed by Home Health Nurses
  33. 33. 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.
  34. 34. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer True. Home care nursing services help shorten the time spent recovering in the hospital.
  35. 35. 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
  36. 36. 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
  37. 37. 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

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