- BPC - Foundations Chapters 23 Admitting, Transferring, & Discharging Patients

PowerPoint Question Discharge plans are developed by members of the health care team to organize the discharge for the patient. When does the discharge plan begin? A.) On admission B.) Within 12 hours of admission C.) Within 24 hours of admission D.) The day before discharge

(A) On admission

End of Chapter Question What information should be included in a discharge summary? (Select all that apply) A.) Patient's present condition. B.) Activity restrictions. C.) Medications administered in the hospital. D.) Topics covered in discharge patient education. E.) Diet to be followed.

(A) Patient's present condition. (B) Activity restrictions. (E) Diet to be followed. A discharge summary must contain information about the patient's current condition, a list of discharge medications (not necessarily those administered in the hospital), the diet to be followed, and activity restrictions. The discharge form will note topics covered in discharge teaching; this information is not put into the discharge summary.

End of Chapter Question If a patient brings credit cards, cell phone, and jewelry to the hospital, you can provide for their security by: (Select all that apply) A.) Sending items home with the family. B.) Storing items in the bedside drawer. C.) Placing the contents in a valuables envelope to be stored in a safe. D.) Making a list of all the items on a "belongings list" and placing it in the medical record. E.) Hiding valuables in the closet.

(A) Sending items home with the family. (C) Placing the contents in a valuables envelope to be stored in a safe. Items sent home with the family or a friend will be secure; items gathered, recorded, and placed in an envelope with the patient's name and identifying information and placed in a safe in the business office will be secure. A list is made of the items and their disposition and documented in the medical record, but that does not guarantee the items' security.

End of Chapter Question An autopsy may be required when: (Select all that apply) A.) A patient dies after a 4-day hospitalization. B.) A patient dies at the hands of another. C.) A patient dies without being under a primary care provider's care outside the hospital. D.) The cause of death is unknown. E.) The patient dies because of an accident.

(B) A patient dies at the hands of another. (C) A patient dies without being under a primary care provider's care outside the hospital. (D) The cause of death is unknown. (E) The patient dies because of an accident. An autopsy is usually required if the patient has not been under the care of a primary care provider for some time; if the cause of death is unknown; or if murder is a possibility.

End of Chapter Question When instructing a patient scheduled for same-day surgery, you tell him to: (Select all that apply) A.) Bring his medication with him. B.) Bring only essential items to the hospital. C.) Have someone available to take him home after the procedure. D.) Report to the same-day surgery unit 1 to 2 hours before scheduled procedure. E.) Bring a robe and slippers and any overnight supplies such as a denture care kit.

(B) Bring only essential items to the hospital. (C) Have someone available to take him home after the procedure. (D) Report to the same-day surgery unit 1 to 2 hours before scheduled procedure. Same-day surgery patients should only bring essential items with them to the hospital because they will not be in a regular patient room and belongings may get lost. The patient is to report to the hospital 1 to 2 hours before the scheduled surgery in order to be prepared for surgery. Because the patient will have anesthesia and pain medication, someone must drive him home.

End of Chapter Question If a patient wants to leave AMA, the nurse: A.) Detains him until the primary care provider can speak with him. B.) Explains that insurance may not pay his bill if he leaves. C.) Immediately calls the supervisor to speak to the patient. D.) States that security people will prevent his leaving.

(B) Explains that insurance may not pay his bill if he leaves. The nurse explains that if he leaves without a discharge order, the insurance company may not pay his bill. The nurse should speak with the patient and find out why he is insisting on leaving before calling in anyone else. The primary care provider should be notified and may or may not speak with the patient before he leaves.

End of Chapter Question When transferring a patient to another facility, copies of pertinent medical records: A.) Are the responsibility of the family to deliver. B.) Must be faxed to the facility or must accompany the patient. C.) Are mailed at the time of transfer. D. Must be delivered by hospital messenger because they are confidential.

(B) Must be faxed to the facility or must accompany the patient. Pertinent medical records are either faxed to the receiving facility when a patient is transferred or are placed in an envelope and sent with the patient.

End of Chapter Question In an acute care facility the person responsible for the initial nursing assessment is: A.) The admission staff. B.) The RN. C.) The RN or LVN. D.) The primary care provider.

(B) The RN. Within the hospital, an acute care facility, the RN is the person who must complete the admission assessment. The LVN/LPN may assist by collecting certain data for the RN such as vital signs and height and weight.

End of Chapter Question Orders are verified and signed off by: A.) The unit secretary. B.) The licensed nurse. C.) The physician. D.) The nursing supervisor.

(B) The licensed nurse. Orders are transcribed by the charge nurse or unit secretary but are verified and signed off on by the RN or LVN.

PowerPoint Question Jessica is taking care of an outpatient surgical patient who is 70 years old and retired. She states, "I hope that my doctor's office has gotten authorization for my surgery." Because Jessica's patient is 70 and retired, which health care plan does she most likely have? A.) Managed care plan B.) Medicaid C.) Medicare D.) Self-pay

(C) Medicare

PowerPoint Question Tracy is admitting a new patient on her floor for a routine admission. A routine admission is best described as an admission: A.) With no prior planning B.) For an injury C.) That was scheduled in advance D.) For a sudden illness

(C) That was scheduled in advance

PowerPoint Question Which of the following is not a consideration when ordering home health care? A.) Reduced cost B.) Being in a familiar environment C.) Decreased exposure to potentially serious infection. D.) Physician's convenience

(D) Physician's convenience

Emergency Admission

Admission for which there is no prior planning.

Routine Admissions

Admission that is scheduled in advance.

Open-Book Quiz When is an autopsy usually performed? (See page 405 in your textbook.)

An autopsy is usually performed when a death is sudden or unexpected, the result of injury or suspicious circumstances (such as suspected homicide), or had not been seen within a specific period by a physician.

Open-Book Quiz Summarize the elements of patient transfer. (See page 402 in your textbook.)

Before a patient is transferred, the patient's primary care provider must be notified and approve the transfer. If the patient's condition suddenly deteriorates, he may be moved immediately per established hospital protocols, but in general, transfers from one nursing area to another require a specific order by the attending physician. The admissions office, or in some facilities the business office, must be notified of any transfers. It is also important that the patient's family or significant other be notified, preferably before the actual transfer. In emergencies, notification should be made as soon as possible. Each facility has specific guidelines on documentation, but the transfer must always be recorded in the nursing notes by both the nurse transferring the patient and the nurse receiving the patient. The care plan must be reviewed and revised and a full report given to the receiving nurse when the patient arrives on the new unit.

Medicare

Health care provided through the Social Security Administration primarily for the retired older adult.

PowerPoint Question When a patient wants to leave against medical advice (also known as AMA), it is important to: A.) Calm him by saying you understand and that if it were you, you might do the same thing. B.) Explain that if he leaves early all of his bills will be paid for the time he was in the hospital only. C.) Have him wait until he can speak to his physician. D.) Let him leave, try to obtain an AMA form, and document it in the chart.

D.) Let him leave, try to obtain an AMA form, and document it in the chart.

Autopsy

Examination of the body organs and tissues to determine cause of death.

Managed Care Plan

Health care plan in which all medical care is managed by the insuring group.

Open-Book Quiz If a patient insists on leaving the hospital against the advice of the primary care provider, what procedures should you follow? (See page 404 in your textbook.)

If the patient insists on leaving the hospital against the primary care provider's advice, it is the responsibility of the health care team to help patients understand how the decision to leave the hospital may affect their health. Listen to what the patient has to say, answer questions, and offer to ask the primary care provider's or supervising nurse to talk with the patient. If the patient ultimately decides to leave, notify the primary care provider immediately. If the primary care provider thinks it is inappropriate for a discharge order to be written, the patient is asked to sign a form stating that he is leaving against medical advice (AMA). When patients choose to leave AMA, they must be informed of additional potential consequences. These include that they will not receive prescriptions for medications or treatment, and that if insurance carriers refuse to pay the hospital bill, they would become liable for monies owed. Document that you relayed this information in the medical record.

Medical Social Worker (MSW)

Individual who provides counseling and information regarding long-term planning, financial assistance, or available community services.

Open-Book Quiz When discharging a patient to an extended care or rehabilitation facility, what information is detailed on the patient information sheet? (See page 403 in your textbook.)

Information recorded includes: - Primary and secondary diagnoses - Current orders - Medications (including over-the-counter medications, dietary supplements, and any herbals the patient takes), noting dosage, route, frequency, and time of last dose given. - Care provider names and phone numbers - A brief synopsis of the hospital stay.

Open-Book Quiz What department is responsible for making sure that all admission criteria are met? (See page 399 in your textbook.)

The admitting department is responsible for making sure that all admission criteria are met. However, for an emergency admission, this process may become the responsibility of the emergency room clerical staff.

Open-Book Quiz Describe ways in which you can provide support for significant others after a patient's death. (See page 404 in your textbook.)

Often the most important gift we can give the bereaved is just being there. Simply sit and listen while they talk of their loss and the fears about the changes it will bring. Offer to call their priest, minister, rabbi, or spiritual advisor. You can also offer to make telephone calls or arrangements for someone to come and take the significant others home if this seems appropriate. Allow the family and friends adequate time at the bedside to say their good-byes.

Do-Not-Resuscitate (DNR)

Order written by a physician or other authorized provider when the patient has indicated a desire to be allowed to die if breathing ceases or the heart stops.

Coroner

Person with legal authority to determine cause of death.

Co-Pay

The amount an insurance carrier requires that patient to pay for care.

Discharge Planner

Registered nurse or social worker who implements and organizes the plan for patient discharge.

Open-Book Quiz Differentiate between a routine admission and an emergency admission. (See pages 398-399 in your textbook.)

Routine admissions are those that are scheduled in advance. The primary care provider and patient have agreed to the admission as the most appropriate way to address the medical need, and the patient has had at least a short time in which to make plans and arrangements for this interruption in the usual routine. Emergency admissions are those for which there was no prior planning. It occurs when sudden illness, injury, or abrupt worsening of an existing condition requires immediate admission for treatment.

Deductible

The amount an insurance carrier requires the patient to pay for care before beginning to pay expenses.

Medicaid

State medical care coverage for individuals and families with reduced or poverty-level income.

Health Maintance Organization (HMO)

Type of group practice that enrolls patients for a set fee per month and provides a limited network of doctors, hospitals, and other health care providers from which to choose.

Open-Book Quiz Explain how you would orient a patient to the nursing unit. (See page 400 in your textbook.)

You should smile, make eye contact, and call the patient by name. A good example of the initial contact would be, "Hello, Mr. Jones. My name is Sandra Smith. I'm an LPN/LVN and I'll be one of your nurses today." It is important that the patient be given the names of all caregivers and their specific roles. Never assume that a patient wishes to be called by his or her first name. Address patients in the manner that is most comfortable for them.