This document discusses admission, discharge, and transfer procedures in a healthcare setting. It covers the admission process, responsibilities of admitting and nursing staff, types of admissions, discharge methods and planning, and nursing responsibilities for discharging and transferring patients. Standard procedures are outlined for admitting, orienting, and assessing new patients, as well as preparing patients for discharge or transfer.

1. ADMISSIONS/DISCHARGE/TRANSFER

2. ADMISSION (ENTERING A HEALTH CARE AGENCY FOR NURSING CARE AND MEDICAL/SURGICAL TREATMENT) INVOLVES: A. AUTHORIZATION FROM A PHYSICIAN B. COLLECTION OF BILLING INFO FROM THE ADMITTING DEPARTMENT C. COMPLETION OF THE ADMISSION PROCESS BY NURSING D. DOCUMENTING PT’S MED HX & PHYSICAL EXAM E. INITIAL MED ORDERS FOR TREATMENT

3. RESPONSIBILITIES OF THE ADMITTING DEPARTMENT GATHER INFO FOR BILLING INITIATE MEDICAL RECORD PREPARE ID BRACELET. THIS IS THE SINGLE MOST EFFECTIVE WAY OF IDENTIFYING THE PATIENT MAY BYPASS IN EMERGENCY SITUATION AN ADDRESSOGRAPH CARD IS MADE CONSENT FORMS ARE SIGNED, EG. LIVING WILL, DIRECTIVES, WAIVERS INITIAL ORDERS OBTAINED VERBAL REPORT GIVEN TO FLOOR RN PATIENT IS ESCORTED

4. NURSING RESPONSIBILITES PREPARE ROOM IDENTIFY SELF ORIENT PATIENT GATHER INFO

5. PREPARE ROOM PROVIDE PERSONAL CARE ITEMS SUCTION OXYGEN IV POLE BED IN HIGH POSITION IF ARRIVING BY GUERNEY BED IN LOW POSITION IF ARRIVING BY W/C BLUE PADS IF NEC.

6. IDENTIFY SELF MAKES PT FEEL SECURE MAKES PT FEEL WELCOME ALLEVIATES ANXIETY/FEAR

7. ORIENT PATIENT LOCATION OF NURSE’S STATION CLOTHES STORAGE CALL LIGHT BED CONTROLS LIGHT SWITCHES TELEPHONE POLICY TV CONTROLS MEALTIMES SAFETY MEASURES SUCH AS BEDRAILS VISITING HOURS WHAT TESTS ARE SCHEDULED DIET ROOM BOUNDARIES SCHEDULED SURGERY TIME TIMES FOR DR VISITS

8. GATHER INFORMATION THE NURSE WILL GATHER INFO ABOUT: MEDICAL ORDERS TX’S LABS TESTS DIET ACTIVITY PHYSICAL ASSESSMENT WITHIN 24HRS.

9. TYPES OF ADMISSION INPATIENT OUTPATIENT

10. INPATIENT STAY LONGER THAN 24HRS PLANNED : NO IMMEDIATE THREAT PLANNED ELECTIVE SURGERY, TESTS PT IS PREPARED EMERGENCY : UNPLANNED STABILIZE IN EMERGENCY ROOM (CHEST PAIN, TRAUMA) DIRECT ADMISSION: UNPLANNED BYPASS EMERGENCY (VOMITING, DIARRHEA)

11. OUTPATIENT STAY LESS THAN 24 HRS OBSERVATIONAL: HEAD INJURY PREMATURE LABOR UNSTABLE VITAL SIGNS

12. VALUABLES WHEN DOCUMENTING VALUABLES, MAKE SURE TO USE WORDS LIKE: WHITE/YELLOW METAL NOT GOLD CLEAR STONE NOT DIAMONDS, RUBIES, ETC. HAVE A WITNESS HAVE NURSE & PT SIGN VALUABLES LIST DON’T FORGET DENTURES, GLASSES, ETC. WHEN TRANSFERRING PT, SIGN-OFF WITH NURSE KNOW YOUR FACILITY’S VALUABLES POLICY

13. PATIENT COMFORT PROVIDE PRIVACY. (SHUT DOOR & PULL CURTAIN.) ASSIST IF NEEDED TO REMOVE CLOTHING AND PUT GOWN ON. PROVIDE EXTRA BLANKETS IF REQUESTED. COLLECT INFO FOR DATABASE. PERFORM INITIAL ADMISSION ASSESSMENT IF APPROPRIATE. (SOME FACILITIES REQUIRE AN RN TO DO INITIAL ASSESSMENTS). OBTAIN PHYSICIAN ORDERS FOR TX’S, LABS, TESTS, MEDS, ACTIVITY, ETC. WITHIN 24HRS.

14. COMPONENTS OF A MEDICAL HISTORY IDENTIFYING DATA CHIEF COMPLAINT PERSONAL HX PAST HEALTH HX HX OF PRESENT ILLNESS FAMILY HX REVIEW OF BODY SYSTEMS CONCLUSION

15. WHAT TO WATCH FOR IN NEWLY ADMITTED PATIENTS ANXIETY LONELINESS DECREASED PRIVACY LOSS OF IDENTITY

16. ANXIETY APPEARANCE Exhibits Separation Anxiety. Sad. Worried. Restless. Reduced Appetite. Insomnia. HOW TO HELP Acknowledge feelings. Provide explanations and instructions before performing procedures. Inquire about stress due to children/pets/spouse at home. Reassure. Separation Anxiety can cause the elderly to be confused and disoriented.

17. LONELINESS Make frequent contact with your patient. Orient your client. Allow liberal visitation.

18. DECREASED PRIVACY Pull curtain and close door. Knock. Identify room boundaries, esp. if sharing room. Be careful of exposing patient. Patient feels uncomfortable because of unkempt appearance, so announce visitors.

19. LOSS OF IDENTITY Call patient by name they prefer. Allow patient to wear own gown. Display pictures. Give them some choices. (bathing, eating, etc.)

20. DISCHARGE TERMINATION OF CARE FROM A HEALTH CARE AGENCY METHOD (ACRONYM) M-MEDS E-ENVIRONMENT T-TREATMENT H-HEALTH TEACHING O-OUTPATIENT REFERRAL D-DIET AMA (Against Medical Advice) 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.

21. NURSES RESPONSIBILITY FOR DISCHARGING A PATIENT GATHER BELONGINGS/CHECK INVENTORY ARRANGE TRANSPORTATION INFORM PT OF CHECKOUT TIME TO AVOID BEING BILLED FOR AN EXTRA DAY ESCORT UNTIL PT SAFELY INSIDE VEHICLE WRITE DISCHARGE SUMMARY TERMINAL CLEANING. BED STRIPPED AND DISINFECTANT USED. BEDSIDE CABINET RESTOCKED/CLEANED.

22. TRANSFER DISCHARGING A PATIENT FROM ONE UNIT OR AGENCY AND ADMITTING THEM TO ANOTHER UNIT INFORMS PATIENT/FAMILY COMPLETE TRANSFER SUMMARY SPEAKS WITH NURSE ON TRANSFER UNIT TRANSPORTS PATIENT/BELONGINGS/SUPPLIES & CHART CHECKS ORDERS/MAKES NEW ADDRESSOGRAPH CARD W/NEW ROOM #

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. SETTING STANDARDS * REMEMBER* THE AMERICAN NURSE’S ASSOCIATION SETS THE STANDARD FOR PT CARE & DOCUMENTATION FOR RN’S LPN’S ARE GOVERNED BY JCAH DO NOT USE “SEEMS” OR “APPEARS” IN DOCUMENTATION. IMPLIES DOUBT AND LACK OF KNOWLEDGE. 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.