1. Admission, Transfer, and Discharge
Chapter 45:
Admission, Transfer, and Discharge

2. Admission Admission to the healthcare facility
Activities surrounding a client’s arrival at the facility for the purpose of receiving healthcare
One admission
Each continuous period of time a client spends in a facility is considered one admission
Admitting department
Proper identification of each client is vital
Admission process
-major purpose is to determine how the client feels about admission*

3. The Admitting Department
Examples of some information entered into health record
Name
Address
1. age
Sex
2. marital status
Next of kin
3. health insurance

4. ID band Contains: 1. clients full name and/or alias
ID or medical record number
2. birth date
Date of admission
Providers name

5. The Client’s Arrival on the Nursing Unit
Assist in changing to hospital gown or robe.
*some units like chemical dependency, psych or long term care the client wears street clothes
Inspect for skin integrity.
Assist the client into bed.
Orient the client to the facility.
Care for the client’s personal belongings.
Check for client identification, allergies, fall precautions, seizure precautions, resuscitation status
Prevent dehumanization.
Assess for anxiety/apprehension.

6. Client Identification Checklist
Proper ID bands with correct information
Allergies
Fall precautions
Seizure precautions
Resuscitation status
Care plan board or communication board

7. Caring for Client Valuables and Personal Items
Encourage clients to keep only essential items in hospital
Competent clients may keep personal items at the bedside
Valuables should not be brought to the facility; if they are they should be kept in the facility vault
In memory care or mental health unit, facility does assume some responsibility for client belongings
Careful listing and description of client property is even more important

8. Measures to Prevent Dehumanization
Dehumanization-depriving a person of personality, privacy and other human qualities*
Develop rapport and trust with the client before delving into personal matters or embarrassing procedures.
Ask the client for input in their care and allow client to maintain personal dignity.
Handle questions and procedures with utmost tact and respect for the individual.
Think of client as person whose needs for physical and emotion support are greater because of illness.
Emphasize client strengths rather than weaknesses.

9. Assessing Client Anxiety Level
Calm: Not anxious
**+1 anxiety: Increasing uneasiness and apprehension
+2 anxiety : Increasing uneasiness, apprehension, dread
+3 anxiety : Increasing apprehension, dread, paranoia
Panic: Symptoms may include a feeling of choking, difficulty breathing, inability to sit still, chest tightness or pain, trembling, sweating, increased pulse rate and blood pressure, or headache

10. Nursing Interventions to Alleviate Client Anxiety and Fear
Assessment of level of discomfort
**Clear explanations and clear answers to questions
This alleviates fear and anxiety unfamiliar settings
Offering the client an opportunity to express feelings
Providing more helpful coping mechanisms
Allowing the client to make decisions relating to his or her care

11. Assessment, Reporting, and Documentation
Weight
Admission weight also establishes a baseline for further observations or calculations of medication doses or anesthesia*
Height
Vital signs
Pulse oximetry
Collecting specimens
Radiology and laboratory examinations

12. Admission assessment for children
Provide child a tour of facility
Be knowledgeable about developmental stages
*check with child to determine how much they understand
Determine how much self car the child can perform

13. Reporting the Admission
The Joint Commission
An RN performs formal admission assessments and formulates nursing diagnoses
LV/LPN
Client orientation and admission procedures
Client’s vital signs, weight, and client-reported symptoms

14. Need for Transfer to Another Unit
Assignment to a certain unit is temporary
A change in client acuity necessitates placing the client in another department
The client’s condition requires transfer to the ICU or specialized care
Postpartum area
Postsurgical unit
Psychiatric unit

15. Preparation for the Transfer
Explain the need for transfer to the client and family.
Assemble client’s personal belongings and medications and take these to the new unit.
Transfer the client’s information to the computer in the new location.
Determine how the client will be moved. Provide for client safety.
**Review the health record (MAR and flow sheets) and check for completeness.
Record the transfer in a transfer note. Make sure the receiving unit is ready.

16. Transporting the Client
Keep the client safe during the move.
Introduce the client to the staff at the new nurses’ station.
Give a report to the staff on the new unit, make sure the transfer is completed in the computer.
Take the client to the room and assist the client into bed.
When returning to the nursing unit, notify all necessary departments of the transfer.
Request assistance from security personnel if necessary.
Observe procedures for isolation as required.

17. The Client’s Discharge and Nursing Actions involved
**Plans begin at admission.
Involves the total nursing care team, client, and family.
Nursing students and LVs/LPNs assist with teaching the client and family before discharge.
Client and family should verbalize information and perform return demonstrations of procedures.
Carefully document all discharge teaching.

18. Discharge Prep (in practice 45-1)
*allow the client and family to practice while you watch to be sure they know how to do the procedure
1. outline dietary restrictions
Demonstrate the operation of equipment
2. describe medication administration such as how/when to take meds and undesirable side effects. Give the client/family written guidelines
3. identify situations and possible adverse signs and symptoms that require the client to be seen by the PCP
4. communicate the date, time and location of the next scheduled exam if knows.

19. Educating the Client Explain the safe change of dressings.
Describe the amount of rest and suggested exercises.
Detail dietary restrictions.
Show how to perform personal care.
Demonstrate the operation of equipment.
Emphasize the importance of self-care and building the client’s independence and self-esteem.

20. Educating the Client (cont.)
Describe medication administration.
Identify situations that require the client to be seen by the primary care provider.
Write down the phone number of the hospital unit.
Communicate the date, time, and location of the next scheduled examination, if known.
Discuss with the physician the need for a public health nursing referral.
Make sure the client has all personal property.

21. Against Medical Advice (AMA)
AMA: Client leaves the facility without permission.
*Report to the team leader.
*The client is asked to sign a dated release form.
A licensed nurse witnesses the client’s signature.
The primary provider documents the AMA discharge.
Client refusal to sign must be noted on the form.
The form is signed by at least two witnesses.

22. AWOL AWOL (absent without leave)
The client walks off the unit to go home or to leave the facility without being discharged
The client usually needs to be readmitted on return
This is considered a new admission for the client
Long-term facilities usually identify vulnerable clients who are likely to leave without permission
WanderGuard or other special transmitter alert
Important for safety if the client is confused or otherwise vulnerable

23. The HIPAA Legislation
Health Insurance Portability and Accountability Act (HIPAA)
Guidelines must be followed to protect client privacy
Client or responsible person signs a document confirming that agencies policies were discussed
Protect the client’s privacy
Confirm
Advance directives or living will
Donor status

24. Communication Among Healthcare Team Members
Primary healthcare providers’ orders
Verbal orders
*student nurse or secretary should never take verbal orders!!! ONLY LICENSED NURSES!!!
Telephone communication
Emergency calls
*pink alert

25. Computer use 1. always log off when completing documentation
2. keep the screen protected
3. make sure no unauthorized person can access client information