Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 34 Admissions, Transfers, and Discharges
Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Admission is the official entry of a person into a nursing center. New residents and families may have concerns and fears. Transfer, moving the person to another health care setting, such as another nursing unit, or to another agency, causes similar concerns. Discharge, the official departure of a person from a nursing center, is usually a happy time. OBRA has standards for transfers and discharges. The person’s rights must be protected. Slide 2
Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Admitting, transferring, and discharging residents involve: Privacy and confidentiality Reporting and recording Understanding and communicating with the person Communicating with the health team Respecting the person and the person’s property Being kind, courteous, and respectful Slide 3
Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Admissions During admission: Identifying information is obtained from the person or family. The room assignment is made. A nurse or social worker explains the resident’s rights to the person and family. The person or legal representative signs admitting papers and a general consent for treatment. The person’s photo is taken. The person receives an ID bracelet. Residents arrive by ambulance, wheelchair van, or car. Slide 4
Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Admission is a hard time for the person and family. Persons with dementia and their families may need extra help. Often confusion increases in a new setting. Fear, agitation, and wanting to leave are common. The family also is fearful and may feel guilty. You prepare the room before the person arrives. A nurse usually greets and escorts the person to the room. Slide 5
Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Admission is your first chance to make a good impression. 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. To help meet safety and security needs: Do not rush into admission procedures. Treat the person and family as guests in your home. Introduce the roommate and residents in nearby rooms. Help make the room as home-like as possible. Show caring and compassion. Slide 6
Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. During the admission procedure you will: Collect some information for the admission form. Measure the person’s weight and height. Measure the person’s vital signs. Complete a clothing and personal belongings list. Orient the person to the room, the nursing unit, and the center. Weight and height are measured on admission to the center. Then the person is weighed daily, weekly, or monthly. Standing, chair, bed, and lift scales are used. Slide 7
Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. When measuring weight and height: The person wears only a gown or pajamas. The person voids before being weighed. 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. Slide 8
Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Transfers Reasons for transfers include: The person’s condition changes. The person requests a room change. Roommates do not get along. The person’s care needs change. The doctor, nurse, or social worker explains the reasons for the transfer. You assist with the transfer or perform the entire procedure. Support and reassure the person. Use good communication skills. Slide 9
Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Transfers and Discharges OBRA and the CMS have standards for transfers and discharges: Protect the patient’s rights. Reasons for the move are part of the medical record. The person and family are informed in advance. A procedure is followed if the person objects. Also, an ombudsman protects the person’s interests. Slide 10
Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. OBRA and the CMS reasons for transfers and discharges: The move is necessary to meet the person’s welfare. The person’s health has improved so that the center’s services are no longer needed. The health and safety of other people in the nursing center are in danger. The person has failed to pay for his or her stay in the nursing center. The nursing center closes. Slide 11
Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Discharges Discharge is the official departure of the person from the center. The health team: Plans the discharge Teaches the person and family about diet, exercise, and drugs Teaches the person and family about procedures and treatments Arranges for home care, equipment, and therapies as needed Makes a doctor’s appointment Slide 12
Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Use good communication skills when assisting with a discharge. Wish the person and family well as they leave the center. A person may want to leave the center without the doctor’s permission. Tell the nurse at once if the person expresses the wish or intent to leave. Slide 13
Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Quality of Life To help the person and family: Be courteous, caring, efficient, and competent. Be sensitive to fears and concerns. Handle the person’s property and valuables carefully and with respect. Protect them from loss or damage. Treat the person and family like you want your loved ones treated. Visit new residents often. Explain all procedures and what the various sounds mean. Always protect the person’s rights and promote quality of life. Slide 14