inappropriate admissions....discuss

oramar · Feb 14, 2009

But thank goodness you are on the job because ambulatory people in the wrong kind of unit can really get hurt. For instance that dementia patient that died on the roof of a hospital in Pittsburgh just a short time ago.

MySimplePlan · Feb 14, 2009

...huh?

travel50 · Feb 14, 2009

So what are they going to do if they admit a batty resident to the regular hall, and suddenly realize, Oh, shoot, they need to be in a locked unit, and there is no empty bed in the locked unit???? They do need to get these admissions right in the first place. In my nursing home, 2 people always go to see a possible new admit. One is someone knowledgeable in finances (business office manager who knows everyone in the county anyway, the administrator, or the social worker), and one person who is from nursing...98% of the time that person is me, the DON. If I am out, one of the other nurses will go. But different people see different things, and can answer different questions, so we always send 2 people. Sorry you had such a bad day, but hopefully you feel better after venting. I certainly feel better having a laugh over your post and little faces.

CapeCodMermaid, RN · Feb 14, 2009

I've worked in many places and found that it depends of the philosophy of corporate management. Some places want all the beds filled no matter what which is NOT a good thing for the nurses who are stuck caring for inappropriate residents or for the DNS who is constantly doing reportables. I worked at one place where they had admissions meetings...ha! I was running the sub acute floor and was never even told when we were getting an admit! The day they admitted an alcoholic going through the DT's was the day I started inviting myself to the meetings.

Then I went to a place where they had admitted anyone behavioral or not and the place had gotten a horrible reputation. It took a while but we started admitted only people we could actually care for and the reputation turned around. The residents also got better care because the staff wasn't constantly battling with other residents. That place had a nurse screener but she got a bonus for every person admitted so it was less than ideal.

I'm in a different facility now and I as the DNS have the final say on admissions. We do not have a screener so we rely on the information the hospital sends us and I rely on years of experience with the hospital which likes to dump inappropriate people on us. I've had discharge planner threaten to call the DPH because I refused an admission. They think they can bully some people. Luckily, my ED backs me up 100% of the time and corporate listens when we tell them we couldn't handle a resident for whatever reason.

Tweety, BSN, RN · Feb 14, 2009

The nurses I see come to evaluate patients for transfer to their facility I've noticed never even meet the patient. They look at the chart and base their decision on the chart and whether or not they have the proper funding. Weird.

CapeCodMermaid, RN · Feb 14, 2009

I love the referrals that say "Pt. totally alert and oriented x 3. Do NOT contact the patient about this admission; contact the son/daughter". Always a story with that kind of thing.

ChristinaDCS · Feb 14, 2009

I am the DCS of an assisted living, and I do ALL of the admission stuff. From assessing for appropriateness to doing the actual orders. I will NOT admit anyone into my facility that I have not already visited with and spoken with the family. There should be a thorough nursing assessment before any admission. However, I am sure that isn't always the case with for-profit facilities.

ktwlpn, LPN · Feb 15, 2009

So what are they going to do if they admit a batty resident to the regular hall, and suddenly realize, Oh, shoot, they need to be in a locked unit, and there is no empty bed in the locked unit???? They do need to get these admissions right in the first place. In my nursing home, 2 people always go to see a possible new admit. One is someone knowledgeable in finances (business office manager who knows everyone in the county anyway, the administrator, or the social worker), and one person who is from nursing...98% of the time that person is me, the DON. If I am out, one of the other nurses will go. But different people see different things, and can answer different questions, so we always send 2 people. Sorry you had such a bad day, but hopefully you feel better after venting. I certainly feel better having a laugh over your post and little faces.

I do feel better after the vent-and I'm off for a few days so that helps:D. Everytime I find my self thinking about any aspect of that place I snap a rubber band I am wearing on my wrist.I don't want to think about it....NOT UNTIL THE NEXT TIME MY ALARM GOES OFF AT 5 AM.... :yeah: next week....

CoffeeRTC, BSN, RN · Feb 16, 2009

OMGosh...I tried the rubber band trick...my wrist was sooooo red and getting raw,LOL.

An empty bed means 0$$$ and our referal manger gets the boot. Seems like they only last a yr or so in our company.

Maybe if the place would admit more appropriate residents, spend more time talking with docs, staff decently, have decent house keeping and get a better rep in the community, we wouldn't have to accept certain types just to fill a bed, huh? I'll be honest, it hasn't been as bad with our newest referal/ admit guy..he has a bit of medical background and can at least read between the lines..it is when he isn't on duty and others step in. Wowsa...had a couple of pts that needed to be 302'd within a few hrs, a couple AMAs too.

CapeCodMermaid, RN · Feb 16, 2009

Is a 302 the same as a 'section'...sent out to the mental hospital?

CoffeeRTC, BSN, RN · Feb 17, 2009

Yes...and it isn't fun to do. Last time I had a youngish guy that was picking up chairs and throwing them toward the glass windows and doors and threatening to snap our necks. Our lovely SW told us we should just hold him down and give him a shot of something. How about that one....I told her she can come in and do that...but the police were on the way.

I have no problem dealing with the elderly alz with agitiation etc, but this guy was about 50ish...I only have 3 cnas and one other nurse on duty for 48 pts and of course I didn't even have any drugs to give him IM.