Admissions, Transfers, and Discharges

Objectives

• Define all key terms & abbreviations related to admissions, transfers, discharges, and room changes.

• Clarify the nursing assistant’s role in each event.

• Emphasize techniques to help persons and families feel safe, welcomed, and informed.

• List and apply rules for accurate weight & height measurement.

• Explain rationales for intra-agency room moves.

• Perform all related procedures safely, legally, and efficiently.

• Demonstrate PRIDE (Personal & professional responsibility, Rights & respect, Independence & social interaction, Delegation & teamwork, Ethics & laws) toward person, family, and self.

Key Terms & Abbreviations

• Admission – Official entry into a health-care setting.

• Discharge – Official departure from a health-care setting.

• Transfer – Movement to another setting OR to a new room within the same agency.

• CMS – Centers for Medicare & Medicaid Services.

• ft / in / lb – Foot, inch, pound.

• ID – Identification.

Psychological & Emotional Considerations

• Common fears on entry:

  • Location/navigation anxiety: “Where do I go? Where’s the bathroom?”

  • Clinical worries: correct care, procedures, pain, abuse.

  • Social losses: separation from home, friends, possessions; meeting strangers.

  • Sensory overload: new sights, sounds, alarms.

• Similar apprehensions arise during room moves or transfers; discharge can mix joy (going home) with worry (need for home care).

Regulatory & Rights Framework (Long-Term Care Focus)

• CMS sets strict standards protecting resident rights during transfers/discharges.

• An ombudsman may advocate when rights are threatened.

• Valid LTC reasons for transfer/discharge:

  • Services no longer meet resident’s welfare or safety.

  • Condition improved so center is unnecessary.

  • Non-payment or facility closure.

• Person & family receive written notice of date, time, destination.

Teamwork & Time Management

• Cohesive staff actions ease every move:

  • Specify procedure, timing, exact help needed, and duration when requesting assistance.

  • Express gratitude to co-workers.

• Return shared equipment (standing, chair, wheelchair, lift scales) promptly to central storage.

Delegation Guidelines (What the Nurse Must Clarify)

• Whether you will admit, transfer, discharge, or relocate the person.

• New room/bed numbers and transportation modes (ambulance, wheelchair van, walking, stretcher, bed).

• Mobility status once on the unit (walk, wheelchair, stay in bed).

• Clothing requirements (street clothes, gown, sleepwear) and activity level (bed vs. chair).

• Equipment & supplies to prepare.

• Specific observations to report and their timing.

• Immediate concerns that warrant instant reporting.

Safety & Comfort Principles

• Monitor for pain/distress; summon nurse immediately, stay with person, assist as directed.

• Comply with Transmission-Based Precaution transport policies.

• Mental comfort strategies:

  • Step-by-step explanations; avoid rushing.

  • Sensitivity to emotions; therapeutic touch; avoid empty reassurances.

Admission Process Overview

• Often initiated in admitting office or ER.

  • Collect identifying data, generate ID number/bracelet, obtain general consent.

• Nursing unit is alerted to room assignment and ETA.

• Transport typically via wheelchair/stretcher; ambulatory persons may walk if safe.

• LTC variation: paperwork starts 2–3 days earlier; rights explained verbally & in writing; photo or bracelet for ID.

  • Dementia residents may show heightened confusion/agitation—extra reassurance and family support required.

Preparing the Room (Procedure Highlights)

• Follow delegation info & perform hand hygiene.

• Assemble supplies:

  • Admission kit (wash basin, soap, oral-care items, water mug, etc.).

  • Bedpan & urinal (male), thermometer, BP cuff, stethoscope, pulse oximeter.

  • Gown/sleepwear, towels, washcloths, IV pole if needed.

  • Nursing assistant admission checklist (Fig. 36-2 example).

• Organize:

  • Place assessment tools on over-bed table; mug on stand/table.

  • Store kit, bedpan, linens in bedside stand.

  • Arrange bed height: surgical bed & raised height if arriving by stretcher; low & closed for ambulatory arrival.

  • Attach call light to linens; position IV pole; final safety & hand hygiene.

Admitting the Person (Step-by-Step)

• Greet by preferred name; introduce self; present as competent & respectful.

• Introduce roommate; ensure privacy (family may stay or wait in lounge).

• Keep cloths on if condition allows; otherwise assist into gown.

• Comfort positioning (bed/chair) per nurse.

• Assist nurse with assessment:

  • Measure VS, pulse ox, weight, height; obtain urine if ordered.

  • Complete checklist (pain rating, belongings, comfort measures, water, items within reach).

• Orientation tour:

  • Names of care team (posted on board), bedside stand contents, over-bed table use, call lights (room & bathroom), bed/TV/light controls, phone & internet, charging outlets, location of nurses’ station, chapel, dining, lounges, etc.

  • Meal/snack times, visiting hours.

• Label & secure personal property; compile belongings list; help store items.

• Denture cup labeling; water mug filling if NPO not in effect.

• End with comfort, safe bed level/rails, room safety check, hand hygiene, and thorough report/charting.

Weight & Height: Importance & General Rules

• Baseline on admission; thereafter per schedule (daily/weekly/monthly) to track fluid balance, nutritional status, medication dosing.

• Use appropriate scale: standing, chair, wheelchair, bed, or lift.

• Universal guidelines:

  • Follow manufacturer instructions.

  • Prevent falls (locking wheels, stable platforms, gait belts if needed).

  • Gown/sleepwear only; no footwear unless state exam requires.

  • Void before weighing; dry incontinence product.

  • Same time each day (preferably before breakfast).

  • Same scale for serial weights.

  • Zero balance before measurement (digital read $0$; balance bars at $0$).

Mathematical Conversions & Reading Devices

• Lower balance-bar increments = $50 \text{ lb}$; upper bar long lines = $1 \text{ lb}$; short = $\frac14, \frac12, \frac34 \text{ lb}$.

• Example reading (Fig. 36-6): lower bar $100 \text{ lb}$ + upper bar $34 \text{ lb} = 134 \text{ lb}$.

• Conversion factors: $2.2 \text{ lb} = 1 \text{ kg}$.

  • Kilograms to pounds: $\text{kg} \times 2.2 = \text{lb} \Rightarrow 100 \text{ kg} \times 2.2 = 220 \text{ lb}$.

  • Pounds to kilograms: $\text{lb} \div 2.2 = \text{kg} \Rightarrow 32 \text{ lb} \div 2.2 = 14.5 \text{ kg}$.

• Wheelchair scale: $\text{Weight}_{\text{person}} = (\text{person + chair}) - (\text{chair alone})$ e.g. $200 \text{ lb} - 35 \text{ lb} = 165 \text{ lb}$.

• Height rod: upper section numbers descend; lower ascend; read at movable edge to nearest $\tfrac12$ inch.

• Inch→ft & in conversion: $64 \text{ in} \div 12 = 5 \text{ ft} \text{ remainder }4 \text{ in} \Rightarrow 5 \text{ ft } 4 \text{ in}$.

Procedure: Measuring Weight & Height (Standing Scale)

• Pre-steps: verify order, ask person to void, hand hygiene, bring scale, ID with 2 identifiers, privacy.

• Place paper towel, elevate height rod, zero weights.

• Assist person (robe/footwear off unless test rule), stand centered, arms at side.

• Adjust lower then upper weights until pointer centers; note weight.

• Have person stand tall; lower height rod gently to head; read & record height to nearest $\tfrac12$ inch.

• Assist off scale, replace robe/footwear, reset equipment, comfort & safety, discard towels, return scale, chart values.

Procedure: Measuring Height in Bed

• Two-person task; supplies: tape measure, ruler.

• Position supine if allowed; coworker anchors tape at heel; extend beyond head.

• Lay ruler flat across crown intersecting tape; read where ruler’s lower edge meets tape.

• Record; restore comfort & safety; document.

]Moving a Person to a New Room

• Triggers: condition change, request, roommate conflict, altered care needs.

• Communication: physician/nurse/social worker explain rationale to person/family.

• Nursing assistant role:

  • Gather belongings/equipment on utility cart.

  • Transfer via wheelchair/stretcher/bed; cover with bath blanket.

  • Provide emotional support: avoid clichés, use touch, introduce to new staff/roommate, express good wishes.

  • Report to receiving nurse: tolerance, observations, pending nurse-to-nurse report.

  • Document time, helpers, method, destination, person’s response.

  • Strip & remake vacated bed per policy.

Transfers & Discharges (Agency ↔ Home/Another Facility)

• Planned ahead; education on diet, exercise, meds, follow-up, equipment; home care arranged.

• Nurse directs timing; usually wheelchair; stretcher for ambulance.

• Discharge procedure highlights:

  • Assist dressing, packing; ensure nothing left behind.

  • Reconcile belongings list; person signs.

  • Nurse provides prescriptions, written & verbal instructions, valuables, final assessment.

  • Wheelchair departure: escort to exit, brakes on, assist into vehicle, load belongings.

  • Ambulance: wait with rails up & call light; raise bed for stretcher transfer.

  • Document time, transport mode, companions, destination, observations.

Promoting PRIDE

• Personal & Professional Responsibility: courteous, efficient, competent; safeguard belongings.

• Rights & Respect: accurate visitor info; honor who the person wants to see; report requests.

• Independence & Social Interaction: visit newcomers, introduce peers, encourage activities; monitor for isolation.

• Delegation & Teamwork: manage family waiting needs (refreshments, directions) when privacy required.

• Ethics & Laws: discharge teaching is the nurse’s duty—redirect questions appropriately.

Practical / Real-World Connections

• Accurate weight critical for drug dosing (e.g., anticoagulants, chemo), fluid balance (CHF, renal), nutritional assessments.

• Height informs BMI, equipment sizing, rehab goals.

• Proper orientation reduces falls, call-bell anxiety, and hospital readmissions.

  
  \\Respectful handling of property prevents lost-item claims & maintains trust.

Example Scenarios & Problem-Solving Tips

• If new room not ready and person anxious:

  • Offer seat, blanket, conversation; explain delay honestly.

  • Provide refreshments if allowed; distraction (TV, reading).

  • Pre-load cart with items, review paperwork so final move is swift once room prepared.

Ethical, Philosophical, & Safety Implications

• Admission is entry into a vulnerable state; kindness upholds dignity and autonomy.

• Transfers can feel like abandonment; thorough communication preserves trust.

• Discharge without correct education risks rehospitalization—staying within scope protects patient safety and legal standing.

\