Chapter 32

Admissions, Transfers, and Discharges

Objectives

• Define the key terms and key abbreviations in this chapter.

• Describe your role in admissions, transfers, discharges, and moving the person to a new room.

• Explain how you can help the person and family feel comfortable in the health care setting.

• Identify the rules for measuring weight and height.

• Explain the reasons for moving a person to a new room within the agency.

• Perform the procedures described in this chapter.

• Explain how to promote PRIDE in the person, the family, and yourself.

Key Terms

admission Official entry of a person into a health care setting

discharge Official departure of a person from a health care setting

transfer Moving the person to another health care setting; moving the person to a new room

Key Abbreviations

ft	Feet
ID	Identification
in	Inch; inches
lb	Pound

Admission is the official entry of a person into a health care setting. It causes anxiety and fear in patients, residents, and families. Worries and fears about serious health problems, treatments, surgeries, and pain are common.

Patients, residents, and families are in a new, strange setting. They may have concerns and fears about:

Moving to another room may cause similar concerns. So may transfer to another health care setting—hospital or nursing center. Discharge to a home setting is usually a happy time. However, the person may need home care.

Discharge and transfer are defined as follows.

• Discharge is the official departure of a person from a health care setting.

• Transfer is moving the person to another health care setting. In some agencies it also means moving the person to a new room within the agency.

Admission, transfer, and discharge are critical events. So is moving to a new room. The new room may be on another nursing unit. These events involve:

• Privacy and confidentiality

• Reporting and recording

• Understanding and communicating with the person

• Communicating with the health team

• Respect for the person and the person’s property

• Being kind, courteous, and respectful

See Focus on Long-Term Care and Home Care: Admissions, Transfers, and Discharges, p. 546.

See Teamwork and Time Management: Admissions, Transfers, and Discharges, p. 546.

See Delegation Guidelines: Admissions, Transfers, and Discharges, p. 546.

See Promoting Safety and Comfort: Admissions, Transfers, and Discharges, p. 546.

Focus on Long-Term Care and Home Care

Admissions, Transfers, and Discharges

Long-Term Care

The Omnibus Budget Reconciliation Act of 1987 (OBRA) and the Centers for Medicare & Medicaid Services (CMS) have standards for nursing center transfers and discharges. The person’s rights are protected. Reasons for the transfer or discharge are part of the person’s medical record. The person and family are informed in advance of the transfer or discharge plans. A procedure is followed if the person objects. An ombudsman protects the person’s interests.

Reasons for a transfer or discharge include:

• The measure is needed to meet the person’s welfare. The person’s welfare cannot be met in the center.

• The person’s health has improved. The person no longer needs the center’s services.

• The health or safety of others is in danger.

• The person has failed to pay to stay in the center.

• The center closes.

The person and family are told of the date and time of the transfer or discharge. They are given the name and location where the person will be going.

Teamwork and Time Management

Admissions, Transfers, and Discharges

Transfers, discharges, and changing rooms are easier if a co-worker helps you. When asking for help, politely tell your co-worker:

• The procedure you need help with

• When you plan to do the procedure

• What you need the person to do

• How much time it will take

Remember to thank the person for helping you.

Delegation Guidelines

Admissions, Transfers, and Discharges

To admit, transfer, or discharge a person, you need this information from the nurse. You also need this information when moving a person to a new room.

• If you need to admit, transfer, or discharge the person or move the person to a new room

• If moving to a new room, the person’s new room and bed number

• The transportation method to or from the agency—car, ambulance, or wheelchair van

• How the person will move about within the agency—walking, wheelchair, stretcher, or bed

• The person’s room and bed number

• What equipment and supplies are needed

• If the person stays dressed or needs to wear a patient gown or sleepwear

• If the person stays in bed or can be in a chair

• When to report observations

• What patient or resident concerns to report at once

Promoting Safety and Comfort

Admissions, Transfers, and Discharges

Safety

The person may develop pain or become distressed during admission, transfer, discharge, or when moving to a new room. If so, call for the nurse at once. Stay with the person. When the nurse arrives, assist as needed.

Follow agency policies for transporting persons requiring Transmission-Based Precautions. See Chapter 16.

Comfort

Admission, transfer, or discharge may be stressful for the person. So may moving to a new room. Some persons are happy. Others are sad and fearful. Some anxiety is normal. To provide mental comfort:

• Explain what you are doing and why.

• Do not rush the person.

• Be sensitive to the person’s needs and feelings.

Admissions

The admission process usually starts in the admitting office. In hospitals, it may start in the emergency room (ER). Admitting staff or a nurse obtains information for the admission record. This includes the person’s identifying information—full name, age, birth date, and so on.

The person is given an identification (ID) number and ID bracelet (Chapter 13). The person or legal representative signs admitting papers and a general consent for treatment.

The admitting office tells the nursing unit when to expect a new patient or resident. The person’s room and bed number are given. In some agencies, the person can walk to the room if able. Most persons require transport by wheelchair or stretcher.

See Focus on Long-Term Care and Home Care: Admissions.

Focus on Long-Term Care and Home Care

Admissions

Long-Term Care

Nursing centers’ admission coordinators ease the admission process. Often admission procedures are done 2 or 3 days before the person enters the center. Needed information is obtained from the person or family member.

The room assignment is made before the person arrives. Some residents arrive by ambulance or wheelchair van. The attendants take them to their rooms. Some arrive by car. Nurses or nursing assistants take them to their rooms. Often a family member is present.

A nurse or social worker explains the resident’s rights to the person and family. They also get a booklet explaining them.

The person’s photo is taken. The person may receive an ID bracelet. Photos or ID bracelets are used to identify the person (Chapter 13).

Persons with dementia and their families may need extra help during the admission process. Often confusion increases in a new setting. Fear, agitation, and wanting to leave are common. The family also is fearful. Many feel guilty about the need for nursing center care. The health team helps the person and family feel safe and welcome.

Admission is often a hard time for the person and family. They do not part until ready to do so. Remember, the center is now the person’s home.

Preparing the Room

You prepare the room before the person arrives. Figure 32-1 shows a room ready for a new resident.

FIGURE 32-1 The room is ready for a new resident.

See procedure: Preparing the Person’s Room.

Preparing the Person’s Room

Procedure

1. Follow Delegation Guidelines: Admissions, Transfers, and Discharges.

2. Practice hand hygiene.

3. Collect the following.

• Admission kit—wash basin, soap, toothpaste, toothbrush, water mug, and so on

• Bedpan and urinal (for a man)

• Admission form (Fig. 32-2, p. 548)

FIGURE 32-2 A sample admission form. (Courtesy Briggs Corp., Des Moines, Iowa.)

• Thermometer

• Stethoscope and blood pressure cuff

• Patient gown or pajamas (if needed)

• Towels and washcloth

• IV (intravenous) pole (if needed)

• Other items requested by the nurse

4. Place the following on the over-bed table.

• Thermometer

• Stethoscope and blood pressure cuff

• Admission form

5. Place the water mug on the bedside stand or over-bed table.

6. Place the following in the bedside stand.

• Admission kit

• Bedpan and urinal

• Patient gown or pajamas

• Towels and washcloth

7. If the person arrives by stretcher:

a Make a surgical bed (Chapter 21).

b Raise the bed for a transfer from a stretcher.

8. If the person is ambulatory or arrives by wheelchair:

a Leave the bed closed.

b Lower the bed to a safe and comfortable level as directed by the nurse.

9. Attach the call light to the bed linens.

10. Practice hand hygiene.

Admitting the Person

A nurse usually greets and escorts the person and family to the room. The nurse may ask you to do so if the person has no discomfort or distress.

Admission is your first chance to make a good impression. You must:

• Greet the person by name and title. Use the admission form to find out the person’s name.

• Introduce yourself by name and title to the person, family, and friends (Fig. 32-3).

FIGURE 32-3 The nursing assistant introduces herself to the person and family member.

• Make roommate introductions.

• Act in a professional manner.

• Treat the person with dignity and respect.

See Focus on Long-Term Care and Home Care: Admitting the Person.

Focus on Long-Term Care and Home Care

Admitting the Person

Long-Term Care

Physical and mental comfort is important. So is feeling safe and secure. Do not rush the admission procedures. Rather, treat the person and family as guests in your home. Offer a beverage. Visit with them. Tell them good things about the center.

Introduce residents in nearby rooms. Getting to know other residents provides comfort and support. Residents understand, better than anyone else, what a nursing center is like.

The center is the person’s home. Help make the room as home-like as possible. You may help the person unpack and put clothes away. The person may want to hang pictures or display photos. Show care and compassion. Help the person feel safe, comfortable, and secure.