Chapter 23 - Fundamentals of nursing textbook notes PDF

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Fundamentals of nursing textbook notes...

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Chapter 23: admitting, transferring, and discharging patients •

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Routine admissions o Scheduled in advanced o Patients arrive a few hours before their procedure and discharged same day Emergency admissions o No prior planning o Sudden Admission process o Preadmission procedures and requirements ▪ Routine admissions take place day of ▪ Come in a day or two before admission to complete administrative paperwork ▪ Insurance companies and health care mandate specific criteria be met Authorization for admission o Third party payers require prior authorization for hospital admission o Variety of third-party payers including private or employer provided coverage through major insurance companies, managed care plans, HMO o Government plans include Medicaid o Primary care providers authorize Admitting department function o Responsible for making sure that all admission criteria are met o Collect personal and insurance info and verify authorization for admission o Deductibles and co pays Laboratory work and x ray examination o Lab work and examination related to the planned course of treatment Day of admission o Arrive 1 or 2 hours before Patient orientation to the nursing unit o Never assume that a patient wishes to be called by his or her first name o Orient patient to the unit o Patient must also be given many opportunities to have questions answered and procedures explained o Care of patient belongings ▪ It is important to notify the primary care provider f any medications the patient has been taking at home that they are not included in the present orders Initial nursing assessment o Documented by RN o Vital signs, medications, o Lpn complete written assessment and beginning care plan Initiating the medical record o Patient will have electronic medical record o Charge nurse transcribes orders and prepares the medical record o Admission orders are often long and complex

Nurse must read every laboratory slip, procedure request and consent form, correcting as necessary Patient transfer to another hospital unit o Primary care provider must be notified and approved o Notify patients family o Guidelines on documentation but transfer must be recorded in the nursing notes by both nurse transferring and nurse receiving o ISBARR should be used while giving report o Loss of patient belongings is most likely to happen during a transfer from one unit to another o All equipment brought to the hospital by the patient should be clearly labeled, usually with a wide piece of tape on which the patients name Is written in large letters Discharging the patient o Discharge planning begins at admission, particularly when the diagnosis indicates the patient will need rehabilitation or long-term assistance o Discharge planner uses this information, along with info gathered from the patient family and primary care provider to make appropriate discharge arrangements o Actual discharge orders written by primary care provider Discharge to an extended care or rehabilitation facility o Must complete detailed sheet Discharge home o Written discharge instructions Home health care o Receive home health care following discharge Discharge against medical advice o Patient insists on leaving hospital against primary care providers advice o They need to sign a leaving against medical advice form Death of a patient o Providing support for significant others o Autopsies ▪ Examination of remains by a pathologist to determine cause of death ▪ Autopsy is performed when death is sudden or unexpected ▪ Coroner city or county medical officer responsible for investigating unexplained death Organ donation o o

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