Chapter 11 Admission, Discharge, Transfer, and Referrals

1. Chapter 11 Admission, Discharge, Transfer, and Referrals Bader EL Safadi BSN , MSc Fundamental of Nursing - A Feb,05,2012

2. Admission • Entering a health care agency for nursing care and medical or surgical treatment Bader EL Safadi BSN , MSc Fundamental of Nursing - A Feb,05,2012

3. Admission Process • 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 • 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 Bader EL Safadi BSN , MSc Fundamental of Nursing - A Feb,05,2012

4. Admission Process (cont’d) • Initial medical orders for treatment • Medical authorization • The admitting department • Preliminary data collected • Addressograph plate • Initial nursing plan for care • Medical admission responsibilities Bader EL Safadi BSN , MSc Fundamental of Nursing - A Feb,05,2012

5. 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 Bader EL Safadi BSN , MSc Fundamental of Nursing - A Feb,05,2012

6. Psychosocial Responses on Admission • Anxiety and fear • Decisional conflict • Situational low self-esteem • Powerlessness • Social isolation • Risk for ineffective therapeutic regimen management • Loneliness. • Decrease privacy. Bader EL Safadi BSN , MSc Fundamental of Nursing - A Feb,05,2012

7. Types of Admissions Bader EL Safadi BSN , MSc Fundamental of Nursing - A Feb,05,2012

8. The Discharge Process • Discharge is ”the termination of care from a health care agency“ • One discharge planning technique involves using the acronym METHOD as a guide • M =Medication • E = Environment • T = Treatment • H = Health teaching • O = Out patient referral • D = Diet Bader EL Safadi BSN , MSc Fundamental of Nursing - A Feb,05,2012

9. 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 Bader EL Safadi BSN , MSc Fundamental of Nursing - A Feb,05,2012

10. The Transfer Process • Transfer: “ discharging a client from one unit or agency and admitting him or her to another without going home” • 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 Bader EL Safadi BSN , MSc Fundamental of Nursing - A Feb,05,2012

11. 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 Bader EL Safadi BSN , MSc Fundamental of Nursing - A Feb,05,2012

12. 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 Bader EL Safadi BSN , MSc Fundamental of Nursing - A Feb,05,2012

13. 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 Bader EL Safadi BSN , MSc Fundamental of Nursing - A Feb,05,2012

14. 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 Bader EL Safadi BSN , MSc Fundamental of Nursing - A Feb,05,2012

15. 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 Bader EL Safadi BSN , MSc Fundamental of Nursing - A Feb,05,2012

16. 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 Bader EL Safadi BSN , MSc Fundamental of Nursing - A Feb,05,2012

17. 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 Bader EL Safadi BSN , MSc Fundamental of Nursing - A Feb,05,2012