Admissions, Transfers, and Discharges Chapter 29 Admissions, Transfers, and Discharges

Admission, Transfer, and Discharge Admission is the official entry of a person into a health care setting. Patients, residents, and families are in a new, strange setting. They may have concerns and fears. Transfer is moving the person to another health care setting. In some agencies, transfers also mean moving the person to a new room within the agency. Discharge is the official departure of a person from a health care setting. Admission causes anxiety and fear in patients, residents, and families. Worries and fears about serious health problems, treatments, surgeries, and pain are common. Moving to another room may cause similar concerns, so may transfer to another health care setting (hospital or nursing center). Discharge to a home setting is usually a happy time. The person may need home care.

Admission, Transfer, and Discharge (cont’d) Admission, transfer, and discharge involve: Privacy and confidentiality Reporting and recording Understanding and communicating with the person Communicating with the health team Respect for the person and the person’s property Being kind, courteous, and respectful Admission, transfer, and discharge are critical events, so is moving the person to a new room. Sometimes the new room is on another nursing unit. Review the Focus on Long-Term Care and Home Care: Admissions, Transfers, and Discharges Box on p. 521 in the Textbook. Review the Teamwork and Time Management: Admissions, Transfers, and Discharges Box on p. 521 in the Textbook. Review the Delegation Guidelines: Admissions, Transfers, and Discharges Box on p. 521 in the Textbook. Review the Promoting Safety and Comfort: Admissions, Transfers, and Discharges Box on p. 521 in the Textbook.

Admissions The admission process usually starts in the admitting office. In hospitals, it may start in the emergency room (ER). Admitting staff or a nurse obtains identifying information. Full name Age and birth date Doctor’s name Medicare number Religion You prepare the room before the person arrives. The person is given an ID number and ID bracelet. Admitting papers and a general consent for treatment are signed by the person or legal representative. The admitting office tells the nursing unit when there is a new patient or resident. The person’s room and bed number are given. In some agencies, the person can walk to the room if able. Most persons require transport by wheelchair or stretcher. Review the Focus on Long-Term Care and Home Care: Admissions Box on p. 522 in the Textbook.

Admissions (cont’d) Admitting the person A nurse usually greets and escorts the person and family to the room. The nurse may ask you to do so if the person has no discomfort or distress. Admission is your first chance to make a good impression. You must: Greet the person by name and title. Introduce yourself by name and title. Make roommate introductions. Act in a professional manner. Treat the person with dignity and respect. Review the Focus on Long-Term Care and Home Care: Admitting the Person Box on p. 525 in the Textbook.

Admissions (cont’d) During the admission procedure, the nurse may ask you to: Collect some information for the admission form. Measure the person’s weight and height. Measure the person’s vital signs. Obtain a urine specimen (if needed). Complete a clothing and personal belongings list. Orient the person to the room, the nursing unit, and the agency.

Measuring Height and Weight 2.54cm = 1” 12” = 1 ft 2.2lb = 1 kg See pg. 529 in text Let’s Practice! Figure 29-06. Balance scale. The lower bar is divided into 50 lb values. The long lines on the upper bar are 1 lb values. The shorter lines are ¼, ½, and ¾ lb values. The lower and upper weights are moved until the balance pointer is in the middle. The values on the lower and upper bars are added for the weight. In this figure the lower bar is at 100 lb. The upper bar is at 34 lb. The weight is 134 lb (100 lb + 34 lb = 134 lb).

Admissions (cont’d) Weight and height are measured on admission. Then the person is weighed daily, weekly, or monthly to measure weight gain or loss. Scales used: standing, chair, wheelchair, bed, and lift Follow these guidelines. The person only wears a gown or pajamas. The person voids before being weighed. A dry incontinence product is worn (if applicable). Weigh the person at the same time of day. Use the same scale for daily, weekly, and monthly weights. Balance the scale at zero (0) before weighing the person. Follow the manufacturer’s instructions and agency procedures for the type of scale used. When weight and height are measured, no footwear is worn. Before breakfast is the best time to weigh the person. Review the Focus on Communication: Weight and Height Box on p. 527 in the Textbook. Review the Teamwork and Time Management: Weight and Height Box on p. 528 in the Textbook. Review the Delegation Guidelines: Weight and Height Box on p. 527 in the Textbook. Review the Promoting Safety and Comfort: Weight and Height Box on p. 528 in the Textbook.

Moving the Person to a New Room Reasons for moving to a new room include: A change in condition The person requests a room change Roommates do not get along Changes in care needs You assist with the move or perform the entire procedure. Support and reassure the person. Use good communication skills. Avoid answers such as, “It will be okay.” Use touch to provide comfort. Introduce the person to the staff and roommate. Wish the person well as you leave him or her. The doctor, nurse, or social worker explains the reasons for the move. The family and business office are told. The person is transported by wheelchair, stretcher, or the bed.

Transfers and Discharges Involve the person leaving the agency Are usually planned in advance by the health team The nurse tells you when to start the transfer or discharge procedure. The doctor must give the order before the person can leave. Tell the nurse at once if the person wants to leave the agency without the doctor’s permission. The nurse or social worker handles this matter. Discharge is a happy time if the person is going home. Some people need home care. Upon discharge, the health team: Teaches the person and family about diet, exercise, and drugs. Teaches about procedures and treatments. Arranges for home care, equipment, and therapies as needed. A doctor’s appointment is given. Use good communication skills when assisting with a transfer or discharge. Review Transferring or Discharging The Person on p. 532 in the Textbook. Review Focus on Pride: The Person, Family, and Yourself on pp. 532 and 533 in the Textbook.