Admission, Transfer, Discharge- Chapter 11

Why is first contact with nurses and health care workers important?

- Anxiety and fears can be lessened and a positive attitude regarding the care to be received can be initiated.

Guidelines for admission?

- Begins in the admissions department - Patient can sign several forms - Routines show appropriate concern for the patient can ease anxiety and promote cooperation and positive response to treatments

How should a room be when a new admission comes in?

- Clean - Tidy - Appropriate temperature - Personal care items in place - Any other special equipment should be placed ready when patient arrives.

What are cultural considerations regarding the older adult?

- Depression may be as a result of separation anxiety and they enter the hospital. Maybe become very quiet and depressed due to not being able to return home. -Experience disorientation stress caused by hospital admission - Sleeplessness and loss of appetite - Memory may be affected

What ensures continuity of care during transfers?

- Documenting the patients condition before and during transfer and adequate communication among nursing staff

What is the preparation for transferring a patient?

- Explain transfer to patient and family; discuss the patients condition and plan of care with the staff of the receiving unit or facility; transportation arrangements

What common reaction to hospitalization can the nurse expect?

- Fear of the unknown - loss of identity -depression -Disorientation -Separation anxiety - Loneliness

What is the most important aspects of the admission procedure?

- Greeting the patient the name and making the patient feel welcome - Helps deal with identity loss - Nurse should be courteous, interested in, and receptive of the new patient

How can the nurse reduce the severity of common reactions?

- Have a warm caring attitude and be courteous - Show empathy - Treat patients with respect - Maintain their dignity - Involve them in a plan of care - Adjust hospital routine to meet their desires

What are cultural considerations regarding the Appalachians ( eastern and southern states?)

- Includes the patients religious beliefs on admission to the health care system

What is the admitting procedure on the patient care unit?

- Introduce roommate if one is present - Check ID band and verify the information - Assess immediate needs such as pain, shortness of breath, or severe anxiety - Jewelry, money and medications should be given to the family to take home - If family is not present, valuables must be in the hospital safe. * some facilities require all medications brought in by the patient be sent to the pharmacy to be identified; they are then returned to the patient upon dismissal

What are risk factors should be identified in older adults?

- Multi-system disease processes - Major surgical processes - chronic or terminal disease

What people does discharge planning involve?

- Multidisciplinary action with participation by all members of the health care team - the patient and patients family

What information does the admitting department need the it comes to admission?

- Name, address, phone number - Age, birthday, social security - Next of kin - Insurance company, policy number - Place of employment - Physicians name - reason for admission

When transferring a patient, what must the nurse obtain?

- Obtain a set of vital signs, assessment and give report to the person accepting the patient

What are cultural considerations for the hospitalized patient?

- Secure an interpreter when needed - Respect the patient as an individual - Avoid treating these patients differently that other patients - "special" treatment may be interpreted as patronizing - Do not assume they are angry, aggressive or hostile if they speak loudly or are more emotional than other patients. - Use titles such as Mr. and Mrs. - Never try to use ethnic dialects with patients - Avoid trying to impress patients by saying you have friends of the same racial background - Be attentive to the patients nonverbal communication to help clarify confusing verbal communication - Ask for clarification if you do not understand what the patient is saying

Once the patient is established in the room, what should the nurse do?

- Take health history - Perform the initial assessment by the RN, data collection may be delegated to the LVN

What is the process of discharge planning when talking to family/ patient?

- Teach the patient and family about the patient's illness and its effects on his or her lifestyle - Provide instructions for home care - Communicate dietary or activity instructions - Explain the purpose, adverse effects, and scheduling of medication treatment and instruct how to take their medications - it can include arranging transportation - Follow up care might be necessary - Coordinate outpatient or come care services

What is a telephone admission?

- The day before admission , a clerk from the admitting office calls the patient at home and gathers all the information needed to begin records - instructions may be given regarding the time of arrival, items to bring to the hospital, and things that should not be Brought

What is HIPPA

- The health insurance portability and accountability act - Addressed the privacy of all information received from the patient

What is essential to known when transferring a patient?

- The patient is a human being that deserves dignity, courtesy and respect

When admitting a patient what should be done to help with fear of the unknown?

- The patient should be given an orientation to the unit, surroundings and the room - Promotes safety and gives some control over the environment

What are cultural considerations regarding Haitians- Americans?

- They believe leaves have mystical and healing powers - The nurse gives more authority over doctor - Families tend to make decisions as a unit - Associate wheelchairs with being sick

Upon admitting a patient, what may the patient be asked to do?

- To put on pajamas or a hospital gown. Nurse might need to help patient change clothes - Clothing should be inventoried along with other personal items the patient uses - Jewelry and money kept in the room must be recorded

What is another approach to discharge planning?

- Transitional care/ specialists. Transitional specialists begin discharge planning and usually makes a home visit before the patient is discharged - Following discharge to the home, this specialist is available to patient and family - It has proved to be cost-effective and improves the quality of care.

What hospital routine should be explained upon admission?

- When meals are served - When family and friends may visit - When laboratory or diagnostic imaging evaluations are scheduled - when physician makes rounds - Policy use of side rails

What does the admission ID band include?

- patients name -age -admitting number - physicians name - room number

What is the admissions first initial action ?

- when patient is Brough to his room. - Introduces themselves to roommate - Explain hospital procedures and policies relevant to their stay. - Involve patient in the plan of care - To help reduce stress of hospital admission by showing how the bedside equipment works

Why is ID band necessary?

-if Patient becomes disoriented - If patient becomes sleepy or drowsy - To prevent medication errors - To identify patients as residents of the facility - Entry of the client into patient care - Patient feels loss of identity - Provides safe means of identification - To address patient appropriately

What is the patient self-determination act of 1991?

Addresses the patients right to refuse or accept medical treatment

What is AMA?

Against medical advice This is when a patient leaves a health care facility without a physicians order for discharge - Notify physician immediately - if the physician fails to convince the patient to remain in the facility, the physician will ask the patient to sign AMA form that releases the hospital of liability from legal responsibility - The risk of leaving must be explained to the patients - Do not retain the patients; this violates his or her rights

What do social services assist for ?

Assist with meeting with financial aid and to meed medical expenses - Assist in the community resources and counceling - Secure an interpreter

When is ID band checked?

Before giving medications and treatments

Separation anxiety and loneliness are what parts of maslows pyramid ?

Belongingness and love

What does effective discharge require?

Careful planning and continuing assessment of the patients needs during hospitalization

What is essential for effective discharge planning?

Communication

What is admission?

Entry of a patient into the health care facility

What is a discharge summary?

Includes patients learning needs, how well they were met, the patient teaching completed, short- and long- term goals of care, referrals made, and coordinate care plan to be implemented after discharge

Who sets the standards for discharge ?

JCAHO The joint commission on Accreditation of Healthcare Organizations They are in charge of discharge instructions such as - medications - rehabilitation techniques - referral to community agencies - Medical equipment used

What is the first assessment upon admission to the care unit is assessed for?

Pain

What is the admission process in the ER?

People brought to the ER are admitted directly to a patient care room or a special care unit (ICU, burn unit or coronary care unit) - Family member goes to the admitting office to provide the necessary information.

What is the medication reconciliation form in discharge planning?

Provides information as to which medications the MD wants the patient to take until the post hospital check up in his/her office

The loss of identity reflects what part of Maslows Pyramid?

Seld-esteem

What is discharge planning?

Systematic process of planning for patient care after discharge from the hospital

What is the transferring of a patient?

The changing condition of a patient, whether improved or more critical, may require transfer either to another health care institution, such as a nursing home or rehabilitation hospital.

What are cultural considerations regarding Japanese people?

They believe contact with blood, skin diseases, and corpses cause illness.

What do efficient admission routines do for the patients?

They ease anxiety promote cooperation Give positive response to treatment

What is the purpose of DC planning?

To ensure continuity of care - Thorough documentation before, during, and after a transfer ensures that the patients condition is being monitored and maintains the continuity of care.

what is intra-agency?

Transferring a patient from one area or unit within a hospital or facility to another area within the hospital ex) medical floor to ICU

What is inter- agency?

Transferring a patient from one facility to another facility

what does - inter mean?

Transferring a patient from one facility to another facility

What does Intra mean?

Unit/ same facility to unit/ same facility

What are cultural considerations regarding the Orthodox Jewish?

Use of electronic devices avoided during Sabbath, sundown Friday to sundown Saturday

What is a form that hospitals give after discharge?

Written instructions and teaching documentation for the patient to sign and acknowledge understanding of the instructions - The instructions serve as a guide for the patient to use at home

What are referrals for health care services

a patient may require the services of various disciplines within the hospital - The nurse needs to recognize the patients needs - Referrals should be made as soon as possible after the patients need is identified - physicians order is usually required

What are examples of referrals for the health care services

dietitian physical therapist speech therapists interpreter social worker clinical nurse specialist occupational therapist

What are some common Patient reactions to hospitalization?

experience fear, loss of identity, disorientation, depression, separation anxiety, and loneliness - Patient is usually very concerned about health problems or potential health problems and the potential outcome of treatment

When does discharge planning begin?

should begin shortly after admission

What is essential the nurse assures that the patient understands upon discharge?

the discharge instructions - Assists the patient to pack belongings and dressing to conserve patient energy and strength