1. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 34 Admissions, Transfers, and Discharges

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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