Admission orders the day before?

[cockynurse80]

Is it acceptable to obtain orders/verification of admitting orders the day before admitting a LTC pt from one LTC facility to another?

I certainly understand that if this is done, the admitting RN should assess the pt and ensure and document that the orders are applicable to the pt at the time of admission and notify the doc. I see no reason why this part of the admission process could not begin the day before so that the facility is prepared and has all of the supplies/equipment needed....but I am not sure and this has become a rather interesting debate at my facility.

[tewdles, RN]

I am curious as to why the facility would object to this. Take a related example...in L&D units, there are anticipated admissions for scheduled CS or inductions perhaps. The background information and basic admission orders are in place in advance of the patient arriving. On the day and shift of the admission, the responsible nurse completes a comprehensive assessment and notifies the MD if additional orders are needed etc. This advance planning should allow your facility to properly plan for the arrival of that patient as you pointed out. It is difficult for me to imagine what the objection to this practice would be.

[CapeCodMermaid, RN]

Ah, Tewdles, you expect LTC and all its regulations to make sense! I welcome admitting orders as soon as possible. We often get patients from Boston who don't actually show up in the building till late in the day. We ask for a faxed copy of the orders as soon as they're done from the discharging hospital. The orders get written and verified here, the meds get ordered as well. If anything changes when the patient arrives, we change the orders accordingly. Usually the only things that might change are house specific treatment orders. Makes it easier on everyone and the staff nurses really appreciate the heads up.

[Dixiecup]

I've got burned on this more than once! A pt is supposed to come with IV meds so we go ahead and order all the medication and ancillary supplies, only to have the order dc'd when the pt gets there. Pharmacy won't take back IV medication and we have to eat the cost. Once, the pt ended up not even being admitted until two days later.

I no longer do any medication orders until the pt is physically in the building.

[nurseogden]

Other patients have orders sent the day before, why not LTC patients. Any changes in patient condition should be received with report on the day of arrival. Make it a practice to call sending facility for verbal report prior to arrival of patient of day of admission and there should not be any issues.

[fulzgold]

Has anyone ever had the hospital fill out your paperwork for an admission? I have often considered requiring this. We normally get orders faxed early on so we can get a head start on the paperwork and hope to only have to clarify order changes after the patient arrives. We don't order meds till the patient is in the building. Then they come in with the original orders, paperwork different than what was faxed, and the doctor has made med changes. So then you have 2 sets of admission orders, each one different from the other, and you still find yourself scouring both sets of orders looking for differences to clarify. Lots of things get missed this way. I hate it. Sometimes the MD will scribble a change at last minute in the margin on one of the papers that takes 4 nurses to decifer. I wondered if it wouldn't be easier to have a basic, reader friendly, Facility Admission Order. Fax the hospital this form and say fill it out. I would think they'd be happy to if they want to get rid of the patient.

[nurseogden]

[color=#5f497a]i have worked both in and outpatient settings. yes, the change in orders does wreak the occasional havoc with orders written prior to admission, especially in the inpatient setting. however, we live in a benefits outweigh the inconvienence world of medicine. for the most part, having orders ahead of time gives us ample time to be prepared for the needs of the patients. the changes received at the last minute are inconvenient, but it still seems that the patient is better served by orders sent ahead of time.

[color=#5f497a]our practice in the inpatient setting is to have necessary equipment available, but not to enter the orders into the system until actual arrival of the patient.

[color=#5f497a]on an outpatient basis, this is not usually a problem.

[color=#5f497a]have a great and wonderful nursing career.

:)

[CapeCodMermaid, RN]

Our local hospital won't even do the PASSAR which they are supposed to do or notify the court if we're getting a patient who has a guardian, so getting them to fill out the admission would never fly. My facility is in the middle of nowhere so at least the Boston hospitals who send us patients fax the admission orders over as soon as they put the patient in the ambulance. It really helps.