admission transfer and discharge

CHAPTER 20 Admission, Transfer, and Discharge

KEY TERMS

  • Admission process (ad-MI-shun PRAH-sess)
  • Discharge instruction form (DISS-charj in-STRUK-shun FORM)
  • Discharge planning (DISS-charj PLAN-ing)
  • Discharge process (DISS-charj PRAH-sess)
  • Leaving AMA (Leaving Against Medical Advice)
  • Medication reconciliation (med-i-KAY-shun REE-kon-si-lee-AY-shun)
  • Separation anxiety (SEP-uh-RAY-shun ang-ZYE-uh-tee)
  • Terminal cleaning (TER-mi-nuhl KLEE-ning)
  • Transfer summary form (TRANS-fer SUM-uh-ree FORM)

CHAPTER CONCEPTS

  • Caring
  • Clinical Judgment
  • Collaboration
  • Health-Care Systems
  • Leadership and Management
  • Professionalism

LEARNING OUTCOMES

  • Define terms associated with admission, transfer, and discharge.
  • Identify four common patient reactions to admission.
  • Describe therapeutic nursing interventions for common reactions to admission.
  • Explain the importance of making patients feel welcome during the admission process.
  • Relate specific ways to enhance communication in a culturally diverse patient population.
  • Discuss components of the admitting procedure, including the admission orientation checklist and personal belongings inventory.
  • Outline nursing responsibilities during the discharge process.
  • Describe the discharge process, including the discharge summary.
  • Discuss the significance of medication reconciliation during discharge.
  • Compare patient transfer to another facility with transfer within the same facility.
  • Identify appropriate documentation for admission, transfer, and discharge scenarios.
  • Discuss safety information pertinent to these processes.

CRITICAL THINKING CONNECTION

Clinical Assignment
  • Case Study: 67-year-old male who fell and shattered his femur, unable to bear weight for 8 weeks, facing discharge due to insurance issues.
Critical Thinking Questions:
  1. When does discharge teaching for the patient begin?
  2. How would you coordinate care for the patient given that his wife cannot assist?
  3. Describe your advocacy for the patient.

ADMISSION

  • Nursing Responsibility: Make admission less stressful, establish rapport.
  • Direct Admit: Patient admitted from physician’s office to hospital, facilitated by communication between physician and hospitalist.
  • Initial Interaction:
    • Approach with a smile, avoid showing stress, and maintain positive body language to establish good first impression.
    • Speak kindly, introduce yourself, include credentials, and use the patient's surname.
Reactions to Admission
  • Common Patient Reactions during Admission:
    • Fear of the Unknown: Questions about diagnosis, tests, procedures, potential pain, duration of stay.
    • Anxiety: Concerns involve child care, job impacts, and financial burdens.
    • Loss of Control: Due to unfamiliar environment and imposed routines.
    • Loss of Identity: Patients feel like a number rather than individuals.
Interventions for Managing Reactions
  • Explain upcoming actions to reduce anxiety.
  • Always use layman's terms; avoid medical jargon.
  • Involve family for children or older adults to alleviate separation anxiety.
Importance of Communication
  • Cultural Considerations: Acknowledge and respect cultural beliefs to alleviate anxiety and build trust.
    • Address patients in formal terms unless advised otherwise.
    • Use interpreters when language barriers exist; avoid slang and ensure mutual understanding.
  • Admitting Procedures Include:
    • Creating patient chart with demographic data: name, SSN, age, contact details, etc.
    • Applying identification wristbands for safety.

NURSING RESPONSIBILITIES DURING ADMISSION

  • Introduction and orientation to room and hospital routines are essential for patient comfort.
  • Complete a personal belongings inventory and safeguard valuables.
  • Perform an assessment including objective and subjective data.
    • Example data includes medical history, allergies, and current medications.

DISCHARGE

  • Begins during admission; multi-step process focused on safety and continuity of care.
  • Key Steps in the Discharge Process Include:
    • Ensuring healthcare provider orders are up-to-date in EHR.
    • Medication reconciliation: Confirm correct dosages and avoid duplication.
    • Provide discharge instructions, including medications, dietary restrictions, follow-ups, and patient's condition.
    • Assist patient in gathering personal belongings.
    • Notify housekeeping for terminal cleaning post-discharge.
Discharge Teaching
  • Essential for continuity of care, involving education on diagnosis, medication usage, activities, and dietary restrictions.
  • May need to recommend community resources or further home care services.
Leaving AMA
  • If a patient wishes to leave against medical advice, document the situation and inform the attending physician.

PATIENT TRANSFER

  • Transferring Patients Within Facility:
    • Requires physician’s order, medication reconciliation, and preparation of transfer summary form.
  • Transfer to Another Facility:
    • More complex, involving coordination for transportation, completion of required documents such as discharge summary and keeping the receiving facility informed.
Summary of Key Points
  • First impressions during admission can impact the patient's experience.
  • Common reactions to hospital admission include fear, anxiety, and feelings of loss.
  • Discharge planning is essential for effective patient care continuity.
  • Medication reconciliation is vital for patient safety during discharge to avoid omissions and interactions.
  • Understanding and managing patient transfers involves several critical steps, ensuring a thorough transfer of patient information.