1. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Admission, Discharge, Transfer, and Referrals

2. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Entering a health care agency for nursing care and medical or surgical treatment Admission

3. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 Admission Process

4. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 Admission Process (cont’d)

5. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False. The first step of admission is the authorization from a physician that the person requires specialized care and treatment.

7. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Admission Process (cont’d) Medical authorization The admitting department –Preliminary data collected –Addressograph plate

8. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Admission Process (cont’d) Initial nursing plan for care Medical admission responsibilities

9. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Psychosocial Responses on Admission Anxiety and fear Decisional conflict Situational low self-esteem Powerlessness Social isolation Risk for ineffective therapeutic regimen management

11. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Types of Admissions

12. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins The Discharge Process Discharge is the termination of care from a health care agency Discharge planning Special considerations related to discharge planning

13. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Discharge Process (Refer to Skill 11-2 in the textbook.)

15. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Advantages of Transfer

18. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Extended Care Facilities Skilled nursing facilities Intermediate care facilities Basic care facilities

21. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Community Services Where Referrals Are Made

28. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? Skilled nursing facility provides 24-hour nursing care under the direction of a registered nurse.

29. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer True. Skilled nursing facility provides 24-hour nursing care under the direction of a registered nurse.

30. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Responsibilities Assumed by Home Health Nurses

33. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? Home care nursing services help shorten the time spent recovering in the hospital.

34. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer True. Home care nursing services help shorten the time spent recovering in the hospital.

35. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins General Gerontologic Considerations (cont’d) Early discharge planning and appropriate community resources may return older adults to their own homes

37. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins 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