How to admit new patients in LTC facilities

realnursealso/LPN, LPN · Feb 17, 2011

Each facility will have their own paperwork and procedures. Kind of hard to generalize.

Simba&NalasMom, LPN · Feb 17, 2011

Details vary by facility/state, but here are the basics:

-Receive chart and/or paperwork from discharging facility (usually a hospital)...most of the time you'll get a chart with blank forms from medical records which includes the face sheet and your blank assessment forms and the CNA paperwork. Check to see if there is a signed form indicating code status; if not, discuss with resident (if A&O) or appropriate representative and fill out your state's form and obt. signature.

-Notify MD s/he has a new resident at your facility.

-Reconcile all meds: this should be done by two nurses for accuracy. Fax signed orders along with the face sheet to pharmacy as a STAT delivery. Again, facilities vary; hopefully your MARS will be pre-printed, but if not, you will have to write your own MARS and TARS. Place in appropriate books.

-Greet your resident, welcome him/her to facility, orient to roommate, mealtimes, call light, and shower days. Perform initial assessment: bring assessment form into room to be sure you don't miss anything. I always forget to check if their teeth or real or if they wear dentures. Most facilities also have an additional skin sheet to fill out. Be VERY thorough in your skin assessment; states love to ding nursing homes on unexplained bruises, etc (and with good reason). Also find out when resident last had pain meds, if applicable.

-Provide CNA with ADL sheets, personal inventory sheets, and a CNA care plan if facility uses one. If you haven't done it yourself, ask CNA for vitals.

-Place appropriate care plans in chart (they are most likely pre-printed fill-in-the-blank/date).

-Place resident on alert and on 24-hour report as a new admit and write admission note.

Of course all this has to be done between passing meds, doing treatments, dealing with COCs, etc. etc. etc.

Holy smokes after reading all this it's no wonder in my last job I worked 2 hours over every time I got an admit! :lol2:

Plagueis · Feb 17, 2011

I can also add the following assessment sheets that my old LTC used: Braden scale, pain, wander risk, and physical mobility. Also, we had to send the diet slip to the kitchen and weight the resident. Plus, sometimes there were consults for follow-up visits with specialists that required filling out a consult sheet to arrange an appointment and transportation.

lvnnars1 · Feb 17, 2011

"-Notify MD s/he has a new resident at your facility."

MD's should always be called for this, not faxed, right?, also how is a new admit assigned an MD, who usually does the assigning? do they usually have the same doctor from the hospital they came from? and also what are important things to tell the MD during this call? (Medications that the new admit is on, Diagnosis, Treatments?)

CoffeeRTC, BSN, RN · Feb 17, 2011

Sounds like you should ask for some training on this if you will need to be doing this.

As far as the MDs....not all docs from the hospital have privilages in your nursing home. If the residents does, then that makes it easy. If not, your admissions coordinator or who ever spoke with the family/ resident pre admit will go over this and ask them who they choose. Sometimes we do this on admit. Might depend on what hospital they go to, where they live etc.

When calling the doc, I might ask if they are familiar with this resident or if they wrote the DC orders in the hospital. If they know them....soooo much easier. If not, I will give them a brief Hx review,what brought them to the hosptial and why they are in LTC and then go over the meds, tx. Remember to check for labs and ask for them if you need orders (coumadins, abtx follow up, leves for some meds)

LPNnowRN · Feb 17, 2011

Details vary by facility/state, but here are the basics:
-Receive chart and/or paperwork from discharging facility (usually a hospital)...most of the time you'll get a chart with blank forms from medical records which includes the face sheet and your blank assessment forms and the CNA paperwork. Check to see if there is a signed form indicating code status; if not, discuss with resident (if A&O) or appropriate representative and fill out your state's form and obt. signature.
-Notify MD s/he has a new resident at your facility.
-Reconcile all meds: this should be done by two nurses for accuracy. Fax signed orders along with the face sheet to pharmacy as a STAT delivery. Again, facilities vary; hopefully your MARS will be pre-printed, but if not, you will have to write your own MARS and TARS. Place in appropriate books.
-Greet your resident, welcome him/her to facility, orient to roommate, mealtimes, call light, and shower days. Perform initial assessment: bring assessment form into room to be sure you don't miss anything. I always forget to check if their teeth or real or if they wear dentures. Most facilities also have an additional skin sheet to fill out. Be VERY thorough in your skin assessment; states love to ding nursing homes on unexplained bruises, etc (and with good reason). Also find out when resident last had pain meds, if applicable.
-Provide CNA with ADL sheets, personal inventory sheets, and a CNA care plan if facility uses one. If you haven't done it yourself, ask CNA for vitals.
-Place appropriate care plans in chart (they are most likely pre-printed fill-in-the-blank/date).
-Place resident on alert and on 24-hour report as a new admit and write admission note.
Of course all this has to be done between passing meds, doing treatments, dealing with COCs, etc. etc. etc.
Holy smokes after reading all this it's no wonder in my last job I worked 2 hours over every time I got an admit!

Just two hours? My first night as charge I had a discharge with diabetic teaching and a new admit on the weekend with no chart put together and I was seven hours over--oh, had never done either an admit or discharge nor seen one done, LOL!!!

Simba&NalasMom, LPN · Feb 17, 2011

Just two hours? My first night as charge I had a discharge with diabetic teaching and a new admit on the weekend with no chart put together and I was seven hours over--oh, had never done either an admit or discharge nor seen one done, LOL!!!

Awe you poor thing!! The last facility I escaped hired 3 new grads and they got ZERO orientation!! It's so sad. I really do love working in LTC but so hard these days to find a facility that doesn't work you to death and put you in mortal fear of losing your license. :mad:

Simba&NalasMom, LPN · Feb 17, 2011

Sounds like you should ask for some training on this if you will need to be doing this.
As far as the MDs....not all docs from the hospital have privilages in your nursing home. If the residents does, then that makes it easy. If not, your admissions coordinator or who ever spoke with the family/ resident pre admit will go over this and ask them who they choose. Sometimes we do this on admit. Might depend on what hospital they go to, where they live etc.
When calling the doc, I might ask if they are familiar with this resident or if they wrote the DC orders in the hospital. If they know them....soooo much easier. If not, I will give them a brief Hx review,what brought them to the hosptial and why they are in LTC and then go over the meds, tx. Remember to check for labs and ask for them if you need orders (coumadins, abtx follow up, leves for some meds)

LTR facilities where I live have a "House MD" (no not the hot English actor who plays Cranky Doc on Fox). The house MD serves as the PCP for the duration of the resident's stay unless otherwise specified: some residents already have a PCP they have been seeing and request they stay with their own docs. About 90% of residents, however, are assigned the facility MD.

Simba&NalasMom, LPN · Feb 17, 2011

"-Notify MD s/he has a new resident at your facility."
MD's should always be called for this, not faxed, right?, also how is a new admit assigned an MD, who usually does the assigning? do they usually have the same doctor from the hospital they came from? and also what are important things to tell the MD during this call? (Medications that the new admit is on, Diagnosis, Treatments?)

Calling is preferable, yes. I believe MDs are assigned by management, or perhaps the hospital discharge planner? As an LPN, that's something I've never done. Whenever I've done admits, the PCP and phone # is always listed on the face sheet. LTRs in my area have house docs who take most admits; some stay with their own PCPs who they were already seeing. It's nice to go over orders and ask if MD wants any labs drawn (for example if they come in on Coumadin, ask when the next INR should be...if diabetic, ask if s/he wants a hemo. A1C...if an infection, CBC etc.).

Thanks to other posters for covering the stuff I forgot!

lvnnars1 · Feb 20, 2011

what are important things to tell the MD during this call? (Medications that the new admit is on, Diagnosis, Treatments?)

Simba&NalasMom, LPN · Feb 20, 2011

what are important things to tell the MD during this call? (Medications that the new admit is on, Diagnosis, Treatments?)

Hmmm....with the admits I've done, usually the resident care manager (the RN case manager assigned to the case) discusses incoming orders, Dx, etc. with the MD, so I have rarely done that part of it. I would definitely advise of the primary admitting Dx; MD should ask pertinent questions. Offer to fax the most recent H&P and med list. If you work at a facility regularly, you will get to know the facility MD who will handle most of the cases and what his/her style is, when they come to visit, etc.