Chain of Survival and EMSC

Chain of Survival and EMSC

Chapter 23 Admitting, Transferring, and Discharging Patients Copyright 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved. Lesson 23.1 Admissions Theory 1)Differentiate between routine and emergency admissions. 2)Describe the role of the admitting department. 3)Identify the elements included in a patients orientation to the nursing unit. Clinical Practice 1)Orient a patient to the patient unit and the hospital. 2)Assist with the performance of an admission assessment.

Copyright 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved. Routine Admissions Scheduled in advance Physician and patient have agreed to the admission The patient has had a short time in which to make the arrangements Copyright 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved. Emergency Admissions

One for which there was no planning Occur when sudden illness, injury, or abrupt worsening of an existing condition requires immediate treatment Stressful for the patient, close family, and friends Copyright 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved. Admission Process

Admission criteria must be met for patients to be admitted to the hospital For routine admissions, these must be met in advance Criteria include the authorization for admission, which is usually handled by the physicians office Criteria also may include laboratory tests or x-rays Copyright 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Preadmission Procedures and Requirements Authorization for admission Most third-party payers require prior authorization for hospital admission All payment programs and plans have criteria that define the services covered Most plans do not cover procedures that are regarded as purely cosmetic Copyright 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Preadmission Procedures and Requirements (contd) Admitting department function Responsible for making sure that all admission criteria are met Collect the personal and insurance information and verify the authorization for admission May be responsible for making payment arrangements on insurance deductibles and copays

Copyright 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved. Preadmission Procedures and Requirements (contd) Laboratory work and x-ray examinations Usually performed before admission Includes laboratory tests, MRIs, bone scans, CT scans, and ECGs May include donation of own blood for patients

having surgery Depends on the reason for admission Copyright 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved. Day of Admission: Patient Orientation to Nursing Unit

Smile, make eye contact, address patient by last name Show the location of the call bell and demonstrate its use Show the location of the bathroom and use of the emergency call bell next to the toilet Show patient how to operate the television and telephone Allow time to answer any questions about the admission or scheduled procedures Explain visiting hours Fill the water pitcher if patient is not NPO Give a printed handout of information if possible Copyright 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved. Day of Admission: Care of Patient Belongings

Assist your patients to put belongings in the closet Encourage them to send home anything they dont need Valuables such as credit cards, money, or jewelry should be sent home Make a list of the medications, then send them home Notify the physician of any medications the patient is taking at home but that are not on admissions orders

List all over-the-counter and herbal preparations that the patient is taking Copyright 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved. Day of Admission: Admission Assessment In acute care facilities, the assessment must be performed by an RN Assessment performed according to guidelines listed in the nursing policy and

procedure manual Checklist may be allowed, but some form of narrative documentation is still required Copyright 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved. Day of Admission: Admission Assessment (contd)

Level of consciousness Vital signs Respiratory effort/difficulty Ability to communicate Vision and hearing abilities or difficulties Condition of skin Prosthetic devices Other health concerns Copyright 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved. Initiating the Medical Record

Charge nurse is responsible for checking to ensure that everything is accurately transcribed Admission orders usually need to be transcribed, and laboratory requests, consent forms, and dietary requests need to be sent The nurse verifying the admission orders must check and verify the accuracy of each form before signing off the orders Copyright 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved. Admission Orders

The individual transcribing the orders should make a check mark by each order as it is processed The nurse must read every laboratory slip, procedure request, and consent form, correcting as necessary A line is drawn along the left margin of the orders being verified, and then the nurse signs with the date and time immediately below the last order and the care providers signature Hospitals and other facilities have specific policies for noting allergies Copyright 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved. Reactions to Admission

Patients may experience anxiety over what will happen to them, concern over being away from home or work duties, financial concerns, fear of a possible diagnosis, fear of loss of privacy, or concerns about comfort and quality of care Feelings of loneliness or loss of identity may occur Copyright 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved. Plan of Care

Preparation of the written plan of care is part of the assessment Done by the nurse with input from all the members of the health care team The basis of the plan of care is the nursing process and nursing diagnosis Copyright 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved. Question 1 Tracy is admitting a new patient on her floor for a routine admission. A routine admission is best

described as an admission: with no prior planning. 2)for an injury. 3)that was scheduled in advance. 4)for a sudden illness. 1) Copyright 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved. Question 2 Jessica is taking care of an outpatient surgical patient who is 70 years old and retired. She states, I hope that my doctors office has gotten authorization for my surgery. Because Jessicas patient is 70 and retired, which health care plan does she most likely have? Managed care plan 2)Medicaid

3)Medicare 4)Self-pay 1) Copyright 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved. Lesson 23.2 Transfers and Discharges Theory 4)Discuss five types of information that must be included in the discharge form sent with a patient going to another facility. 5)Delineate the necessary information to include on a patients discharge instructions when the patient is going directly home. 6)Explain the procedure for pronouncing and recording a patients death.

Copyright 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved. Lesson 23.2 Transfers and Discharges Clinical Practice 3)Assist with the transfer of a patient to another unit. 4)Use correct communication techniques to ensure safe handoff to another nurse, department, or facility. 5)Interact with the social worker regarding the discharge needs of an assigned patient. 6)Demonstrate appropriate interaction with the family of a patient who has died. Copyright 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved. Transfers

When a patient is transferred, the physician should be notified immediately Transfer to another unit requires documentation of reason for transfer and patients condition at the time of transfer Report given by the nurse caring for the patient on the transferring unit to the nurse on the unit accepting the patient Copyright 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved. Transfers (contd)

Business office notified of the transfer; all patient belongings should be transferred with the patient Loss of belongings can occur during transfer Label all equipment brought to the hospital by the patient with tape and the patients name in large letters Check drawers for glasses, hearing aids, and dentures Copyright 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Discharging a Patient Begins at admission Discharge planner makes appropriate discharge arrangements for the patient When discharge orders are received: Assist as needed in notifying family or significant other

Collect patient belongings Prepare patient for the ride home or to a new facility Copyright 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved. Discharge to an Extended Care or Rehabilitation Facility Patients may not be well enough to go directly home at the time of discharge RN completes a detailed patient information

sheet for the receiving facility Any records to be transferred with the patient must be ready in an envelope before the transporting vehicle arrives Copyright 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved. Discharge Home Verify travel arrangements Prepare written discharge instructions; review with the patient and family members Copyright 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Home Health Care May include skilled nursing, such as wound care, diabetic care and teaching, and IV medication administration Physical, occupational, or speech therapy and respiratory care also often part of home care services, as well as personal care performed by a home health aide Copyright 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved. Discharge Against Medical Advice

Make sure the patient understands the risk of leaving against medical advice (AMA) Offer to have the patient talk with the physician or supervising nurse Have the patient sign the AMA form If the patient refuses to sign the form, it should be documented in the nurses notes Copyright 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved. Death of a Patient

Patient must be pronounced dead by a physician Document the following in the nurses notes: Time that life signs ceased, time death was pronounced, and name of person making the official pronouncement Autopsies are required in most states for certain conditions or may be requested by the family

Next of kin is required to sign permission for autopsy Copyright 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved. Death of a Patient (contd) Providing support for significant others Often the most important gift we can give the bereaved is just being there People need to grieve; it is an important step in

healing Offer to call priest, minister, rabbi, or spiritual advisor Allow the family and friends adequate time at the bedside to say their goodbyes Copyright 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved. Death of a Patient (contd) Autopsies Usually performed when the patient has died of

unknown causes, has died at the hands of another, or has not been seen within a specific period of time by a physician May also be performed when it is felt that information valuable to medical research may be obtained Copyright 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved. Organ Donation

Organ donation may be requested by the patient Handled by physician or specially trained nurse When handled sensitively, requests can be an opportunity for the family to allow something good to come out of a personal tragedy Health care workers must be culturally aware regarding organ donation Copyright 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved. Question 3 Discharge plans are developed by members of the health care team to organize the discharge for the patient. When does the discharge plan begin? On admission

2)Within 12 hours of admission 3)Within 24 hours of admission 4)The day before discharge 1) Copyright 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved. Question 4 Which of the following is not a consideration when ordering home health care? Reduced cost 2)Being in a familiar environment 3)Decreased exposure to potentially serious infection 4)Physicians convenience 1)

Copyright 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved. Question 5 When a patient wants to leave against medical advice (also known as AMA), it is important to: calm him by saying you understand and that if it were you, you might do the same thing. 2)explain that if he leaves early all of his bills will be paid for the time he was in the hospital only. 3)have him wait until he can speak to his physician. 4)let him leave, try to obtain an AMA form, and document it in the chart. 1) Copyright 2018, 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Recently Viewed Presentations

  • CUESB - Torre Jussana

    CUESB - Torre Jussana

    Quan? Què he de tenir en compte per presentar una sol·licitud? d el 29 novembre. al. 18. desembre. Què? Com? En . paper: alspunts de registre indicats a la convocatòria (on també hi consta l'horari).
  • Rural & Remote PRACTICE Manitoba

    Rural & Remote PRACTICE Manitoba

    Remote communities are particularly affected within the NRHA - rates are 7 x higher . 2007-2008 rate was 300/100,000 (from 10 communities in the NRHA) - astronomical by epidemiological standards. In Wpg the rate of pulmonary TB is higher than...
  • Vocabulary 5A + 5B Words Study PowerPoint

    Vocabulary 5A + 5B Words Study PowerPoint

    Vocabulary 5A + 5B WordsStudy PowerPoint. English 1 (Freshman Year) *This PowerPoint is Only used for Studying Purposes*
  • Marco de referencia - japsinaloa.org.mx

    Marco de referencia - japsinaloa.org.mx

    Abriéndonos al Cambio Los Derechos de los Niños, Niñas y Adolescentes en Sinaloa Taller teórico- vivencial Noviembre, 2010
  • FST Media Technology & Innovation  the Future of

    FST Media Technology & Innovation the Future of

    Continuous change for us Objective business-enabling strategies Key Priorities Business enabling strategies strategies Results of a CIO leadership survey conducted by IBM, Harvard & MIT - 2006 : CIOs felt transformative power of technology was not recognised by CEOs 2007...
  • Aspect of Narrative

    Aspect of Narrative

    Form. All Browning's poems are. DRAMATIC MONOLOGUES. All narrated by a diegetic monologist. The speaker tells his story to an . audience. Involves one speaker: the
  • Recapping: Ordering negative numbers. Arrange these sets of

    Recapping: Ordering negative numbers. Arrange these sets of

    Complete these number grids using addition and subtraction of negative numbers. mr-mathematics.com. 2. 8-12 - 4-11-24-15-4. Go Back. Negative Numbers. Learning Objective: Add and subtract with positive and negative numbers.
  • Menu System - FLL Tutorials

    Menu System - FLL Tutorials

    What happens in Consolidated judging? Sample* 20-min judging schedule:. 5 minute Project presentation. 2 minutes questions about the Project. 5 minute Robot Design judging. No game table will be in the room.