01.09 Admissions, Discharges, and Transfers

Overview

  1. Patient Disposition
    1. Admissions
    2. Discharges
    3. Transfers

Nursing Points

General

  1. Admissions
    1. Inpatient vs Outpatient
    2. Keys for Admission Process
      1. Identify Patient
      2. Introduce Self
      3. Vital Signs
      4. Assessment
      5. Patient Orientation
    3. Admission Must Haves
      1. Health History
      2. Medications
      3. Plan of Care
      4. Discharge Planning
        1. Continual throughout hospitalization
      5. Education Evaluation
      6. Provider Orders
        1. If none available, results in delay of care
  2. Discharges
    1. Discharge Planning
      1. Starts on admission
    2. Is discharge appropriate?
      1. Can patient take in nutrition?
      2. Can patient void?
      3. Can patient ambulate or have method of mobilization?
      4. Assistance/PT/OT planned?
      5. Home Health Care planned?
    3. Completion of Care
    4. Follow-up Scheduled
    5. Medication Plan
    6. Understanding of Education
    7. Discharge Summary
    8. Other Scenarios
      1. Leaving AMA
      2. Left Without Being Seen (LWBS)
  3. Transfers
    1. Reason for transfer
      1. Is the transfer appropriate?
        1. Medically stable
      2. Higher level of care
      3. Patient/family request
    2. Unit or Facility of Transfer
    3. Method of Transport (MOT)
    4. Report

Nursing Concepts

  1. Patient Centered Care
  2. Prioritization
  3. Health Promotion

Patient Education

  1. Explore the education history and level of the patient
    1. Provide education for the patient regarding admission, discharge and/or transport
    2. Understand the patient’s level of literacy and adjust education methods as needed

Reference Links

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Video Transcript

In this lesson, we’ll discuss admission, discharges and transfers

Alright, so when we first think of the admission process, we need to take a look at if the patient is going to be inpatient or outpatient. That helps set us up for our plan of care. It helps us think about education, planning in terms of treatment and also helps in discharge planning, which I’ll talk about more in depth in a few minutes.

Also, when we admit patient, there are some key things that you need to do each time. You’ll need to introduce yourself, identify the patient, get a set of vital signs, assess your patient and orient your patient to their room. By introducing yourself early, you get to help ease your patient’s anxiety and also you get some insight into what’s going on with your patient.

Now that we looked at things you actually do for your patient when they are admitted, let’s look at some concepts and planning for your new patient.
The things we are going to talk about here are RN driven. You can delegate other tasks like vital signs, but for this part of the admission, it’s all on you as the nurse.

You’ll get a history assessment similar to the health promotion assessment, so be sure to check out that lesson. You’ll also ask you patient about any medications they’re on and also what allergies they have. You’ll also develop a plan of care and evaluate your patient for education purposes (so think barriers to education). Check out the patient education lesson for more info on patient education. You’ll also make sure your patient has a provider order for admission. Sometimes there are standing orders and then sometimes your provider will have to put in special ones. Just check with them and your unit for the particulars.

And then you’ll begin discharge planning. The big deal with discharge planning on admission is that it helps identify necessary resources that the patient would need once they get home.
So when we think about discharge, the first question we should ask is “is this discharge appropriate?” Is the patient eating? Are they voiding? Can they ambulate? Do they have care at home?

Is all of their treatment complete in the hospital? Do they have follow up appointments scheduled? Also, we need to find out if they have the appropriate medications and will have access to them. Do they understand all of the education that you’ve provided to them?

Once you’ve made sure that all of these things fit the bill for that particular patient, you’ll often present your patient with something called a “discharge summary” which is basically a written set of instructions for their care, medication and follow up.

Now that we’ve gotten through the bulk of discharge, there are a couple of situations that where a patient wants to leave.

The first is AMA, or against medical advice. This means that the patient knowingly understands that they’ve been advised to continue with medical treatment and are refusing it and are leaving.

The other is LWBS or leaving without being seen. This is more common in emergency rooms. It’s still considered a discharge, but basically, they show up to the ER and are placed in a room, and decide to leave before being seen by a provider. Commonly, your patient will wait in the waiting room and then leave.

Transfers are similar to discharge, in that you need to advocate for your patient and make sure that the transfer is appropriate. An inappropriate transfer would be the instability of a patient. However, some instances require it, like transfers to higher level of care. Or if a patient is not stable and they’re being transferred to a lower level of care. Just things to think about.

Transfers can be to another unit. They can be transferred to the ICU for example, for a higher level of care.

Sometimes a patient needs to be transferred to another facility, like a skilled nursing facility or long term care facility , or they can be transferred to another facility by family request or if the patient needs a higher level of care.

Another thing you’ll need is called an method of transport. This is essentially a way for the patient to be transported to the new facility. This is often an ambulance or other transport service.

The one final important piece to transfers is that you’ll give report. There’s a whole lesson on giving report and the ins and outs of that, so be sure to check that out.

So our responsibility within transfers is to make sure it’s an appropriate transfer, make sure the patient has a method of transport and also to give report to the nurse receiving the patient.
Let’s recap.

Admissions, they’re lengthy processes, but remember your discharge plan begins here. Work to get a solid history and help establish your patient for their stay.

With discharges, make sure you start planning quickly. Make sure your patient is ready for discharge and educate them! When a patient doesn’t know what they’re supposed to do or when to follow up, it can lead to a readmission to the hospital.

When transferring your patient, know where they’re going or where they should go. If you know your patient, you can make that transition smooth for them.

Always make sure that your patient is where they’re supposed to be. Do they need to be admitted? Are they ready to be discharged? Is the transfer to a different unit going to help or harm the patient? Ask yourself those questions when you’re transferring them.

Admissions, discharges and transfers on the surface don’t seem like they’re important, but they are. Knowing the where and why of where they’re supposed to be will help them have good outcomes. Be sure to check out the resources attached to this lesson. Now, go out and be your best selves today. And as always, happy nursing.

Read more

  • Question 1 of 7

Upon admission to the hospital, a nurse asks a client about allergies. Which statement by the nurse best describes how the nurse would assess for a latex allergy in the client?

  • Question 2 of 7

A nurse is assessing a client who is being admitted to the hospital from home for knee surgery. Which part of the assessment would be included with an admission assessment but not with a routine focused assessment?

  • Question 3 of 7

A client with a history of aggression requires medical management to control his behavior. The nurse performs an intake assessment of this client upon admission to the hospital. Which information should be included as part of the initial assessment?

  • Question 4 of 7

A patient with pancreatic cancer will be using total parenteral nutrition at home. The nurse is providing discharge teaching for the patient about how to use TPN after he leaves the hospital. The nurse should teach the patient which of the following information?

  • Question 5 of 7

A client is being admitted to the hospital for a surgical procedure. During the admission process, the nurse teaches the family about how to call for the rapid response team. Which information given by the nurse provides the most accurate explanation of when to use the rapid response team?

  • Question 6 of 7

A patient is preparing to go home from the hospital and the physician has ordered that his PICC line be discontinued before discharge. The nurse gathers supplies to prepare to remove the PICC. Which of the following considerations should the nurse keep in mind when removing a PICC line? Select all that apply.

  • Question 7 of 7

A nurse is assisting with admitting a patient to the hospital from home. The nurse participates in the medication reconciliation process to check the patient’s home medications during admission. Which of the following steps is NOT part of the process for medication reconciliation?

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