Admitting, Transfer,
Admitting, Transfer, and Discharge
1. Role of the Nurse in Care Coordination
Nurses coordinate care from admission to discharge and across different levels of care.
They identify ongoing health needs and anticipate physical, psychological, and social deficits that affect resuming normal activities.
Involvement of family and health education is crucial in planning care strategies.
2. Admission and Discharge Processes
Admission and discharge are simultaneous processes; discharge planning begins at admission.
Involvement of patients and families in planning is critical to understanding health implications and responsibilities for ongoing care.
3. Importance of Communication
Effective communication is essential to ensure safe and comprehensive care during admission, transfer, and discharge.
Poor communication can lead to misunderstandings, clinical errors, and poor patient outcomes.
4. Admitting Patients
Patients enter the system through various means: hospitals, clinics, or offices.
Reception staff (admission officers, secretaries) manage preliminary admissions, conducting interviews and reviewing information.
5. Nurse's Actions During Admission
Nurses conduct thorough assessments, review advance directives, and ensure diagnostics are completed.
Familiarity with continuity of care is essential, especially for patients previously receiving care at home or long-term facilities.
Patient allergies and medical history must be documented and addressed immediately.
6. Emergency Department Admissions
When patients are admitted through the ED, nurses share critical admission information with the nursing division.
Important patient information includes admitting physician, chief complaint, treatments received, and pertinent medical history.
7. Coordination of Admission Procedures
Nurses ensure coordination based on patients’ conditions; critically ill patients require immediate attention, while elective patients may have more time for orientation.
8. Admission Checklist
Medication reconciliation: verify home medications for duplications or interactions.
Update medication lists per provider's orders.
Meet planned schedules for visits and inform families.
Complete valuables documentation and ensure patient's comfort.
9. Special Considerations in Admissions
Teaching
Clarify that different nurses care for patients on each shift and explain the rationale for it.
Teaching should be integrated throughout the admission process.
Pediatric Considerations
Separation and loss of control can cause significant stress in children; parents' involvement in care routines is vital.
Understanding of normal behavior versus illness symptoms provided by parents aids coaches.
Gerontologic Considerations
Older adults might face functional declines; interdisciplinary care is essential.
Recognize factors that increase fall risks in elderly patients during hospitalization.
10. Transfer of Patients
Transfers are necessary for alternative therapy levels; continuity of nursing care is paramount during these transitions.
Effective communication and collaboration among the healthcare team are essential.
11. Transfer Procedures
Complete accurate documentation during transfers to ensure continuity of care and safety.
Communication between sending and receiving nurses is critical, including providing medical records and patient condition updates.
12. Special Considerations in Transfers
Teaching
Transfers can incite anxiety; clear and repeated instructions are necessary.
Pediatric Considerations
Involve parents and ensure comfort during transfer discussions; allow parental presence when appropriate.
Gerontologic Considerations
Stress management is important for elderly patients during transfers; clear orientation to new settings aids comfort.
13. Discharging Patients
Discharge planning ensures a smooth transition from care settings to home or other agencies.
The process requires comprehensive planning and involvement from all caregivers.
14. Joint Commission Recommendations for Discharge Planning
Address patient communication needs with considerations for language and impairments.
Engage patients and families in planning; adapt teaching materials based on health literacy levels.
15. Effective Discharge Planning
Successful discharge planning reduces readmissions and enhances patient satisfaction.
The process is typically structured into acute, transitional, and continuing care phases, addressing varying needs.
16. Barriers to Effective Discharge Planning
Communication is a major challenge; appointing a discharge coordinator or case manager can ease this burden.
Thorough assessment of patient needs and resource identification are critical before discharge.
17. Preparation for Discharge
Provide information about home modifications and community resources prior to discharge.
Conduct teaching on post-discharge care as early as possible in the hospitalization phase.
18. Procedure on the Day of Discharge
Allow patients to ask questions; ensure understanding of discharge instructions and treatments.
Handle logistical needs such as transportation and follow-up arrangements.
19. Special Considerations During Discharge
Teaching
Assess patient fatigue and pain before instruction begins to ensure clarity and understanding.
Pediatric Considerations
Family members should demonstrate skills before discharge to ensure confidence in managing care at home.
Gerontologic Considerations
Older adults typically require comprehensive information on community resources to manage their needs post-discharge.
Referrals to continuous care services assist in maintaining health and minimizing readmission.