Chapter 11 Admission, Discharge, Transfer, and Referrals

1. Chapter 11 Admission, Discharge, Transfer, and Referrals

2. Admission • Entering a hospital for nursing care and medical or surgical treatment

3. Admission Process • Admission involves: • Authorization from a physician that the person requires specialized care and treatment (table 11-1) • Completion of the hospital’s admission database 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

4. Nursing Admission Activities • Preparing the client’s room • Welcoming the client p. 170 • Orienting the client p. 170 • Safeguarding valuables and clothing • Helping the client wear hospital’s gown if indicated • Compiling the nursing data base

5. 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.

6. Types of Admissions

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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