Chapter 20 Admission, Transfer, and Discharge
ADMISISON PROCESS
*Discharge planning starts at admission.
Establish the ability of client to participate in the admission assessment.
Begin establishing the therapeutic relationship with clients and families
during the admission process.
Promote professional communication between providers
Nurses use the nursing process as a guide to plan teaching and
interventions for clients during discharge
Use ISBAR to facilitate transfers and discharges
Procedure
Introduce yourself, your role and explain the roles of other care delivery
staff
If a semiprivate room introduce the roommate
Provide hospital attire and assist if necessary. Position the client
comfortable
Apply id bracelet and allergy band if needed
Provide brochures and information about *advanced directives. Document
the client’s advance directive status in the medical records, Place a copy in
the medical record if available.
Asses/ Collect data
Baseline data, biographical information, Clients reason for seeking health
care, Present illness, and symptoms.
Health history current illness and medications (prescriptions and over the
counter), prior illness, chronic disease, past surgeries, previous
hospitalizations, other relevant data.
Family history hypertension, cancer, heart disease, diabetes mellitus
Psychosocial assessment alcohol, tobacco, drug, and caffeine use, history
or mental illness, abuse/homelessness, home situation
Nutrition current diet, any chewing or swallowing problems, recent weight
gain/loss, use of nutritional or herbal supplements, dentures
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Chapter 20 Admission, Transfer, and Discharge
Spiritual health/ quality of life concerns religion, advance directives, living
will
Safety assessment history of falls, sensory deficit (vision/hearing), use of
assistive devices (walker, cane, wheelchair, crutches)
Discharge information family members in the home, transportation for
discharge, relevant phone numbers, medical equipment needs at home,
home health care needs at home.
Inventory personal items clothing, jewelry, money, assistive devices (eyeglass,
contacts, hearing aids, dentures), cellphones, religious articles. Discourage
keeping valuables at bedside. Document communication with client related to
items left in the room and valuables locked in the facilities safe.
Orientation Orient the client to the room and facility. Share information about:
call light operation, electrical bed operation, telephone services/tv control,
smoking policy, restroom locations, waiting areas, meal times, usual time for
providers visit, dinning services, visiting policies.
TRANSFER AND DISCHARGE PROCESS
Indications for transfers and discharge
Level of care changes (health status improved or no longer needs intensive
care)
Another setting is required to provide necessary care (transfer from
medical unit to surgical site)
The facility does not offer the type of care the client requires (after a stroke
care in a skilled facility)
The client no longer needs inpatient care and is ready to return home.
Discharge planning
*This should begin on admission for every patient
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Chapter 20 Admission, Transfer, and Discharge
Asses whether the client will be able to return to his previous residence, if
the residence needs specific equipment or adaptions, if the client needs or
has someone that can provide assistance at home.
Communicate health status and needs to community service providers.
The provider documents that the client may be discharged. If the client
wish to leave at any time, notify the doctor, and have the client sign the
forms if possible, and provide discharge panning.
Involve the client and family as much as possible in the discharge planning
Discharge education
The nurse discusses discharge instructions and must provide client a
printed copy. Verify understanding of the instructions by the client.
Standards for discharge education
Instructions regarding symptoms of potential complications and when to
contact emergency care or doctor. Give the phone number of the doctor,
names and phone numbers of the community resources.
Step by step instructions for performing continues treatment like dressing
changes.
Dietary restrictions and guidelines including those pertaining to medication
administration. Direction on how to take medications, interactions, and
why adherence is important.
Amount and frequency of therapies to perform to support continued
independence at home
Equipment
Items to transfer/discharge with the client
Personal belongings, valuables from the safe, assistive devices, medical
records or transfer form.
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Chapter 20 Admission, Transfer, and Discharge
PROCEDURE
Transferring /discharge a client
On the day/time of transfer conform the receiving facility is expecting the
client and has bed available
complete documentation
give verbal/ in person transfer
confirm the mode of transportation the klient will use
make sure the client is dresses appropriately
account for clients valuable
Receiving a transferred client
assess how the client tolerates the transfer
review transfer documentation
