Admit/Discharge Powerpoint

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This is part of the Nursing Skills powerpoints.

Admit/Discharge Powerpoint

  1. 1. ADMISSIONS/DISCHARGE/TRANSFER
  2. 2. ADMISSION <ul><li>(ENTERING A HEALTH CARE AGENCY FOR NURSING CARE AND MEDICAL/SURGICAL TREATMENT) </li></ul><ul><li>INVOLVES: </li></ul><ul><li>A. AUTHORIZATION FROM A PHYSICIAN </li></ul><ul><li>B. COLLECTION OF BILLING INFO FROM THE ADMITTING DEPARTMENT </li></ul><ul><li>C. COMPLETION OF THE ADMISSION PROCESS BY NURSING </li></ul><ul><li>D. DOCUMENTING PT’S MED HX & PHYSICAL EXAM </li></ul><ul><li>E. INITIAL MED ORDERS FOR TREATMENT </li></ul>
  3. 3. RESPONSIBILITIES OF THE ADMITTING DEPARTMENT <ul><li>GATHER INFO FOR BILLING </li></ul><ul><li>INITIATE MEDICAL RECORD </li></ul><ul><li>PREPARE ID BRACELET. THIS IS THE SINGLE MOST EFFECTIVE WAY OF IDENTIFYING THE PATIENT </li></ul><ul><li>MAY BYPASS IN EMERGENCY SITUATION </li></ul><ul><li>AN ADDRESSOGRAPH CARD IS MADE </li></ul><ul><li>CONSENT FORMS ARE SIGNED, EG. LIVING WILL, DIRECTIVES, WAIVERS </li></ul><ul><li>INITIAL ORDERS OBTAINED </li></ul><ul><li>VERBAL REPORT GIVEN TO FLOOR RN </li></ul><ul><li>PATIENT IS ESCORTED </li></ul>
  4. 4. NURSING RESPONSIBILITES <ul><li>PREPARE ROOM </li></ul><ul><li>IDENTIFY SELF </li></ul><ul><li>ORIENT PATIENT </li></ul><ul><li>GATHER INFO </li></ul>
  5. 5. PREPARE ROOM <ul><li>PROVIDE PERSONAL CARE ITEMS </li></ul><ul><li>SUCTION </li></ul><ul><li>OXYGEN </li></ul><ul><li>IV POLE </li></ul><ul><li>BED IN HIGH POSITION IF ARRIVING BY GUERNEY </li></ul><ul><li>BED IN LOW POSITION IF ARRIVING BY W/C </li></ul><ul><li>BLUE PADS IF NEC. </li></ul>
  6. 6. IDENTIFY SELF <ul><li>MAKES PT FEEL SECURE </li></ul><ul><li>MAKES PT FEEL WELCOME </li></ul><ul><li>ALLEVIATES ANXIETY/FEAR </li></ul>
  7. 7. ORIENT PATIENT <ul><li>LOCATION OF NURSE’S STATION </li></ul><ul><li>CLOTHES STORAGE </li></ul><ul><li>CALL LIGHT </li></ul><ul><li>BED CONTROLS </li></ul><ul><li>LIGHT SWITCHES </li></ul><ul><li>TELEPHONE POLICY </li></ul><ul><li>TV CONTROLS </li></ul><ul><li>MEALTIMES </li></ul><ul><li>SAFETY MEASURES SUCH AS BEDRAILS </li></ul><ul><li>VISITING HOURS </li></ul><ul><li>WHAT TESTS ARE SCHEDULED </li></ul><ul><li>DIET </li></ul><ul><li>ROOM BOUNDARIES </li></ul><ul><li>SCHEDULED SURGERY TIME </li></ul><ul><li>TIMES FOR DR VISITS </li></ul>
  8. 8. GATHER INFORMATION <ul><li>THE NURSE WILL GATHER INFO ABOUT: </li></ul><ul><li>MEDICAL ORDERS </li></ul><ul><li>TX’S </li></ul><ul><li>LABS </li></ul><ul><li>TESTS </li></ul><ul><li>DIET </li></ul><ul><li>ACTIVITY </li></ul><ul><li>PHYSICAL ASSESSMENT WITHIN 24HRS. </li></ul>
  9. 9. TYPES OF ADMISSION <ul><li>INPATIENT </li></ul><ul><li>OUTPATIENT </li></ul>
  10. 10. INPATIENT STAY <ul><li>LONGER THAN 24HRS </li></ul><ul><li>PLANNED : </li></ul><ul><li>NO IMMEDIATE THREAT </li></ul><ul><li>PLANNED ELECTIVE SURGERY, TESTS </li></ul><ul><li>PT IS PREPARED </li></ul><ul><li>EMERGENCY : </li></ul><ul><li>UNPLANNED </li></ul><ul><li>STABILIZE IN EMERGENCY ROOM (CHEST PAIN, TRAUMA) </li></ul><ul><li>DIRECT ADMISSION: </li></ul><ul><li>UNPLANNED </li></ul><ul><li>BYPASS EMERGENCY (VOMITING, DIARRHEA) </li></ul>
  11. 11. OUTPATIENT STAY <ul><li>LESS THAN 24 HRS </li></ul><ul><li>OBSERVATIONAL: </li></ul><ul><li>HEAD INJURY </li></ul><ul><li>PREMATURE LABOR </li></ul><ul><li>UNSTABLE VITAL SIGNS </li></ul>
  12. 12. VALUABLES <ul><li>WHEN DOCUMENTING VALUABLES, MAKE SURE TO USE WORDS LIKE: </li></ul><ul><ul><li>WHITE/YELLOW METAL NOT GOLD </li></ul></ul><ul><ul><li>CLEAR STONE NOT DIAMONDS, RUBIES, ETC. </li></ul></ul><ul><ul><li>HAVE A WITNESS </li></ul></ul><ul><ul><li>HAVE NURSE & PT SIGN VALUABLES LIST </li></ul></ul><ul><ul><li>DON’T FORGET DENTURES, GLASSES, ETC. </li></ul></ul><ul><ul><li>WHEN TRANSFERRING PT, SIGN-OFF WITH NURSE </li></ul></ul><ul><ul><li>KNOW YOUR FACILITY’S VALUABLES POLICY </li></ul></ul>
  13. 13. PATIENT COMFORT <ul><li>PROVIDE PRIVACY. (SHUT DOOR & PULL CURTAIN.) </li></ul><ul><li>ASSIST IF NEEDED TO REMOVE CLOTHING AND PUT GOWN ON. </li></ul><ul><li>PROVIDE EXTRA BLANKETS IF REQUESTED. </li></ul><ul><li>COLLECT INFO FOR DATABASE. </li></ul><ul><li>PERFORM INITIAL ADMISSION ASSESSMENT IF APPROPRIATE. (SOME FACILITIES REQUIRE AN RN TO DO INITIAL ASSESSMENTS). </li></ul><ul><li>OBTAIN PHYSICIAN ORDERS FOR TX’S, LABS, TESTS, MEDS, ACTIVITY, ETC. WITHIN 24HRS. </li></ul>
  14. 14. COMPONENTS OF A MEDICAL HISTORY <ul><li>IDENTIFYING DATA </li></ul><ul><li>CHIEF COMPLAINT </li></ul><ul><li>PERSONAL HX </li></ul><ul><li>PAST HEALTH HX </li></ul><ul><li>HX OF PRESENT ILLNESS </li></ul><ul><li>FAMILY HX </li></ul><ul><li>REVIEW OF BODY SYSTEMS </li></ul><ul><li>CONCLUSION </li></ul>
  15. 15. WHAT TO WATCH FOR IN NEWLY ADMITTED PATIENTS <ul><li>ANXIETY </li></ul><ul><li>LONELINESS </li></ul><ul><li>DECREASED PRIVACY </li></ul><ul><li>LOSS OF IDENTITY </li></ul>
  16. 16. ANXIETY <ul><li>APPEARANCE </li></ul><ul><li>Exhibits Separation Anxiety. </li></ul><ul><li>Sad. </li></ul><ul><li>Worried. </li></ul><ul><li>Restless. </li></ul><ul><li>Reduced Appetite. </li></ul><ul><li>Insomnia. </li></ul><ul><li>HOW TO HELP </li></ul><ul><li>Acknowledge feelings. </li></ul><ul><li>Provide explanations and instructions before performing procedures. </li></ul><ul><li>Inquire about stress due to children/pets/spouse at home. </li></ul><ul><li>Reassure. Separation Anxiety can cause the elderly to be confused and disoriented. </li></ul>
  17. 17. LONELINESS <ul><li>Make frequent contact with your patient. </li></ul><ul><li>Orient your client. </li></ul><ul><li>Allow liberal visitation. </li></ul>
  18. 18. DECREASED PRIVACY <ul><li>Pull curtain and close door. </li></ul><ul><li>Knock. </li></ul><ul><li>Identify room boundaries, esp. if sharing room. </li></ul><ul><li>Be careful of exposing patient. </li></ul><ul><li>Patient feels uncomfortable because of unkempt appearance, so announce visitors. </li></ul>
  19. 19. LOSS OF IDENTITY <ul><li>Call patient by name they prefer. </li></ul><ul><li>Allow patient to wear own gown. </li></ul><ul><li>Display pictures. </li></ul><ul><li>Give them some choices. (bathing, eating, etc.) </li></ul>
  20. 20. DISCHARGE <ul><li>TERMINATION OF CARE FROM A HEALTH CARE AGENCY </li></ul><ul><li>METHOD (ACRONYM) </li></ul><ul><li>M-MEDS </li></ul><ul><li>E-ENVIRONMENT </li></ul><ul><li>T-TREATMENT </li></ul><ul><li>H-HEALTH TEACHING </li></ul><ul><li>O-OUTPATIENT REFERRAL </li></ul><ul><li>D-DIET </li></ul><ul><li>AMA (Against Medical Advice) </li></ul><ul><li>PT LEAVES PRIOR TO OBTAINING A WRITTEN ORDER. NURSE REQUESTS PT TO SIGN FORM. IF REFUSES, NURSE MUST LET PT LEAVE AND NOTE REFUSAL TO SIGN AMA IN CHART. </li></ul>
  21. 21. NURSES RESPONSIBILITY FOR DISCHARGING A PATIENT <ul><li>GATHER BELONGINGS/CHECK INVENTORY </li></ul><ul><li>ARRANGE TRANSPORTATION </li></ul><ul><li>INFORM PT OF CHECKOUT TIME TO AVOID BEING BILLED FOR AN EXTRA DAY </li></ul><ul><li>ESCORT UNTIL PT SAFELY INSIDE VEHICLE </li></ul><ul><li>WRITE DISCHARGE SUMMARY </li></ul><ul><li>TERMINAL CLEANING. BED STRIPPED AND DISINFECTANT USED. BEDSIDE CABINET RESTOCKED/CLEANED. </li></ul>
  22. 22. TRANSFER <ul><li>DISCHARGING A PATIENT FROM ONE UNIT OR AGENCY AND ADMITTING THEM TO ANOTHER UNIT </li></ul><ul><li>INFORMS PATIENT/FAMILY </li></ul><ul><li>COMPLETE TRANSFER SUMMARY </li></ul><ul><li>SPEAKS WITH NURSE ON TRANSFER UNIT </li></ul><ul><li>TRANSPORTS PATIENT/BELONGINGS/SUPPLIES & CHART </li></ul><ul><li>CHECKS ORDERS/MAKES NEW ADDRESSOGRAPH CARD W/NEW ROOM # </li></ul>
  23. 23. WHO/WHAT IS INVOLVED IN A PLANNED DISCHARGE? NURSE-EXPLAINS DISCHARGE INSTRUCTIONS TO FAMILY/CARE GIVER PATIENT EXTENDED CARE FACILITY SAFEKEEPING RN OR SOCIAL WORKER CARE PROVIDER UNIT SECRETARY CALLS FOR TRANSPORT, COPIES CHART/ORDERS PHYSICIAN’S ORDER
  24. 24. SETTING STANDARDS <ul><li>* REMEMBER* </li></ul><ul><li>THE AMERICAN NURSE’S ASSOCIATION SETS THE STANDARD FOR PT CARE & DOCUMENTATION FOR RN’S </li></ul><ul><li>LPN’S ARE GOVERNED BY JCAH </li></ul><ul><li>DO NOT USE “SEEMS” OR “APPEARS” IN DOCUMENTATION. IMPLIES DOUBT AND LACK OF KNOWLEDGE. </li></ul><ul><li>STUDENTS DO NOT NEED TO READ P.126-129( EXTENDED CARE FACILITIES) BUT NEED TO READ NURSING GUIDELINES ON TRANSFERRING A CLIENT, P. 126, GENERAL GERONTOLOGIC CONSIDERATIONS & CRITICAL THINKING EXERCISES. </li></ul>

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