Chapter 11: Admission, Discharge,

Transfer, and Referrals

Carolyne Richardson-Phillips, RN, MS

PNU 145
Fall 2015
Pages 168 – 185
 Learning Outcomes:
By the end of this session, the PN Student will be able to:
1.List the major steps involved in the admission process
2.Identify common psychosocial responses when clients are admitted to
a health care agency
3.List the steps involved in the discharge process
4.Discuss the use of transfers
5.Explain the difference between transferring and referring clients
6.Describe levels of care that nursing homes provide
7.Discuss the purpose of the MDS
8.Identify two contributing factors to the increased demand for home
health care
 Admission
• Involves
• Authorization from healthcare professional - the person requires
specialized care and treatment
• Collection of billing information by admitting department of the
health care facility
• Completion of agency’s admission data base by nursing personnel
• Documentation of the client’s medical history and findings from
physical examination: advanced directives; family history;
psychosocial history; history of mental illness; spiritual health;
safety assessment; discharge information
• Development of an initial nursing care plan
• Initial medical orders for treatment
• Medical authorization & responsibilities
• Admitting Department or Unit
• Types
• Inpatient
• Outpatient
 Nursing Admission Activities
• Preparing client’s room
• Obtaining medical equipment
• Welcoming client
• Orientating client: helping a person become familiar with a new
environment to facilitate comfort and adaptation; meal times; call
light; bed & television control; visiting hours; restrooms
• Safeguarding valuables and clothing: have family members take
home valuable items if possible; follow agency policies
• Helping client undress
• Compiling nursing assessments/written information:
• Initiating Nursing Plan of Care
• Notifying physician & obtaining orders
 Psychosocial Responses on Admission
• Client
• Anxiety and fear
• Decisional conflict
• Situational low self-esteem
• Powerlessness
• Social Isolation – Loneliness
• Decreased Privacy Loss of Identity
 The Discharge Process
• Discharge Planning-Begins at admission or shortly after
• Process that improves client outcomes by:
• Predetermined post-discharge needs in a timely manner
• Coordinating the use of appropriate community resources to
provide continuum of care
• Involves a multidisciplinary team
 Some Steps in Discharge Process
• Discharge planning
• Obtaining a written medical order
• Completing discharge instructions (Meds, appointments,
treatments, therapy & more)
• Notifying the business office
• Discharging the client
• Gathering belongings, arranging transportation, escorting the
client
• Writing a discharge summary
• Requesting that the room be cleaned
• Notifying admitting that the client has left
 The Transfer Process
• Transfer: discharging a client from one unit or agency
• Transfers occur when
• Facilitate more specialized care
• Reduce health care costs
• Provide less intensive nursing care
• Steps Involved
• Informing client & family
• Completing a transfer summary
• Speaking with a nurse on the transfer unit to coordinate the
transfer
• Transporting the client and belongings, medications, nursing
supplies, and written information to the other unit
 Extended Care Facilities
• Skilled nursing facilities: usually 24 hr nursing care
• Intermediate care facilities: do not need 24 hr nursing care
• Basic care facilities: provides extended custodial care
• Determining the Level of Care: determined at or prior to admission
– Each client is assess using a standard form developed by the
Health Care Financing Association called a Minimum Date Set
for Nursing Home Resident Assessment and Care Screening
 Determining the Level of Care for Skilled Facilities
• Minimum Data Set (MDS)
• Standard form developed by the Health Care Financing
Association
• How some facilities are paid-there is a set amount for each level
of care
• MDS is repeated every 3 months or whenever a client’s condition
changes
• Problems identified on the MDS are then reflected in the nursing
care plan
• Assessment: cognitive patterns, communication & hearing
patterns, vision patterns, physical functioning and structural
problems, continence patterns in the last 14 days, psychosocial
well-being, mood & behavior patterns, activity pursuit patterns,
disease diagnosis, health conditions, oral & nutritional status, oral
and dental status, skin condition, medication use, special
treatments and procedures
 Selecting A Nursing Home
• Nurses teaches the client or family the following:
• Find out the level of care that the facility is licensed to provide
• Review inspection reports on each facility
• Asks for recommendation
• Visit the nursing home
• Note appearance of residents and the staff response
• Observe for cleanliness & odor
• Request brochures on services
• Clarify charges & billing procedures
• Analyze the overall impression of the facility
 The Referral Process
• A referral: process of sending someone to another person or agency
for special services
• Referrals generally are made to private practitioners or
community agencies
- Counsel of aging
- Hospice
- VNA
- Home health services
- Respite care
- Meals on Wheels
- Rehabilitation
 Home Health Care
• Provided in the home by an employee of a home health agency
• Has increased due to limitations imposed by Medicare and
insurance companies on the number of hospital and nursing home
days for which they are reimbursed
• Home care nursing services
• Help shorten time & recovery in hospital
• Prevent admissions to extended care facilities
• Reduce readmissions to acute care facilities
• Responsibilities of home health nurses
 Reference

• ATI Nursing Education (2013). Chapter 9: Admissions,

Transfers & Discharges. Fundamentals of Nursing (8th Ed)
• Timby, B., K. (2013) (10th ed.) Fundamental Nursing Skills
and Concepts. Philadelphia, PA: Lippincott, Williams, &
Wilkins.