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

2. Admission
Entering a health care agency 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
Collection of billing information by the admitting department of the health care agency

4. Admission Process (cont’d)
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
Initial medical orders for treatment

5. Question Is the following statement true or false?
The first step of admission is the collection of billing information by the admitting department of the health care agency.

6. Answer
False.
The first step of admission is the authorization from a physician that the person requires specialized care and treatment.

7. Admission Process (cont’d)
Medical authorization
The admitting department
Preliminary data collected
Addressograph plate

8. Admission Process (cont’d)
Initial nursing plan for care
Medical admission responsibilities

9. 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

10. Psychosocial Responses on Admission
Anxiety and fear
Decisional conflict
Situational low self-esteem
Powerlessness
Social isolation
Risk for ineffective therapeutic regimen management

11. Types of Admissions

12. The Discharge Process
Discharge is the termination of care from a health care agency
Discharge planning
Special considerations related to discharge planning

13. 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

14. (Refer to Skill 11-2 in the textbook.)
Discharge Process
(Refer to Skill 11-2 in the textbook.)

15. The Transfer Process
Transfer: discharging a client from one unit or agency; admitting him or her to another without going home in the interim
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

16. 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

17. Advantages of Transfer

18. Question Is the following statement true or false?
Transfer involves discharging a client from one unit or agency and allowing him to go home.

19. Answer
False.
Transfer involves discharging a client from one unit or agency and admitting him or her to another without going home in the interim.

20. Extended Care Facilities
Skilled nursing facilities
Intermediate care facilities
Basic care facilities

21. 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

22. 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

23. 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

24. Question
What is the appropriate action for the nurse to take with a client’s valuables?
a. Hand them over to the supervisor
b. Ask the client to keep them with himself or herself
c. Hand them over to the admitting department
d. Place them in the hospital’s safe temporarily

25. Answer d. Place them in the hospital’s safe temporarily
The nurse should place the client’s valuables in the hospital’s safe temporarily. Losing a client’s personal items can have serious legal implications for both the nurse and health care agency; therefore the nurse should not hand them over to the supervisor, ask the client to keep them himself, or hand them over to the admitting department.

26. 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

27. Community Services Where Referrals Are Made

28. Question Is the following statement true or false?
Skilled nursing facility provides 24-hour nursing care under the direction of a registered nurse.

29. Answer
True.
Skilled nursing facility provides 24-hour nursing care under the direction of a registered nurse.

30. 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

31. 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

32. Responsibilities Assumed by Home Health Nurses

33. Question Is the following statement true or false?
Home care nursing services help shorten the time spent recovering in the hospital.

34. Answer
True.
Home care nursing services help shorten the time spent recovering in the hospital.

35. General Gerontologic Considerations
Older adults may minimize their symptoms
Consider methods to facilitate/minimize alterations: planning a transfer to an institutional setting
Allow additional time when admitting, discharging, or transferring older adults
Pets are an integral social support system

36. General Gerontologic Considerations (cont’d)
Early discharge planning and appropriate community resources may return older adults to their own homes

37. General Gerontologic Considerations (cont’d)
Barriers to use of community-based services:
Lack of finances or reluctance to spend for service payment
Unwillingness to admit need; mistrust of service providers
Lack of time, energy, or ability to find appropriate services