New Resident Admissions process

[qestout]

I'd like to get ideas on how other LTC RN's and facilities process admits. If I could find out how other facilities handle theirs, I could make suggestions.

The way it's done where I work: Most admits are scheduled to arrive at 1300. Day shift only has time to greet them before 1400 report to next shift. PM shift person is expected to do the whole thing, plus regular shift duties, med pass, treatments, Medicares--and the days/administrators all go home. This is too much extra paperwork to be added onto the workload of the nurse that gets the admit to their section.

A partial list of things that need doing: Full body, neuros, etc, Fall risk, B&B, vaccines, TB, care plan, pharmacy notification, doctor's orders, MAR, treatment, care cards, orientation to facility and on and on.

Just looking for ideas :)

[nursegirl62]

speaking from the being an previously experienceddon..

there is probably nothing more crucial than a well done through and accuratelydocumented admission assessment.

so having that in mind while i was don ichanged many of our admission policies. first admissions must arrive by11:00am. only exceptions were i've i gave them directly to the hospitaldischarge planner. i had one hospital who would thought they would try and pushme...by sending the admission at 4pm...i sent the ambo with the admission backto the hospital and never had another problem. dons need to advocate timelyadmissions!

next the various admission details were divided between charge, floor, mds ,social services, activities and myself. then everything reviewed by the eveningshift charge nurse. i once again reviewed everything the next morning.(if wedid a friday admission, i always came in saturday morning) i cannot stress enough how important it is tohave a successful admission! you can have a 100% occupancy rate, but if it’snot done well then it’s just rubbish! …..and it all comes back to haunt thefacility! if anything needed to be delegated to the nurse doing medicationrounds only did i do the delegating. i’m highly protective of staff and foundthat when medication/treatment nurses were given additional obligations theneverything is in jeopardy….thus adding to errors and possible regulatorysanctions, and survey problems on top of the ones for poorly or incompleteadmissions.

[CapeCodMermaid, RN]

If I sent an admission back to the hospital simply because I didn't like the time they arrived, we wouldn't get any more referrals from that hospital and I'd probably be without a job.

I don't know where you live and work, but in Massachusetts, it is expected that SNFs take admissions 24/7....those that don't won't be open much longer.

[nursegirl62]

it wasnt that "i" didnt like it. it fell well without outside our policy for addmssion times. when push comes to shove....families and patients want qualityin care. snfs are not acute care and should not beconsidered to do 24/7 admissions. i know i was extreme but over time gainedif not respect atleast a understanding of addmission policy with discharge planners ( whom btw are usually not nurses ) they are just trying to sell you apatient....i wonder if this attitude will change when next year those very samehospitals will start getting penalized for readmissions of those patients theboot out the door and not allow the snf do timely, proper assessments whichoften allows for catching those very things that cause hospital readmission.

washington state, and i doubt if it is muchdifferent here rural snf.

are you the don in your facility?

[CapeCodMermaid, RN]

I am, indeed the DON. I have worked in rural facilities and inner city facilities. I have shifted and flexed my staffing to accomodate later admissions. We very rarely get an admission, especially an ortho patient before 4 pm and more likely after 6pm. Nursing is a 24/7 business and we are always ready and willing to take admissions. We always have at least one RN in the building, can stat any meds we don't have in the huge first dose kit, have backup IV pumps. Perhaps it's just different in Massachusetts. Competition is fierce and we want to be the facility of choice for all the surgeons, case managers, AND patients....oh, wait....we already are!

[nursegirl62]

Maybe that is the difference competetion might not be as fierce ,might actually be the other way many SNFs here have waiting lists for addmissions....sounds like you have things well and ready to do 24/7 addmissions in a rural LTC we dont. I could turn a blind eye to poor addmission process or but opted to implement policy and practice to faciliate safe admissions for this facility. Each facility needs to do what is correct to achieve the desired outcome. Well done CapeCodMermaid!

[CapeCodMermaid, RN]

Thanks. Do you have a post acute unit? We tend to get our long term residents admitted before noon, but the short term ones are the ones who come any time.PS. I have a waiting list for my long term beds and run a 97-98% occupancy on my short term unit.

[noc4senuf]

I agree with CCM. I have been a DON for 10 years and never heard of anyone doing anything but 24/7 admits. As long as you have your processes in place, it should run smoothly. Counting my longterm and TCU beds, I run about 99% capacity.