Admissions process, is this how it is everywhere?

Greetings to all you wonderful nurses! Apologies in advance for the long post.

I'd like to know what you all do in the way of admitting a new psych pt onto your unit as it compares to my hospital.

I'm working 2nd shift (3-11pm). Frequently we have pt's that are admitted after 5, often we have multiple admits coming in shortly before or after shift change. Pt's come to us in a variety of ways from all over the area, as we are the only facility that take acute/crisis pt's except for the state hospital (and due to insurance and acuity, most people don't go to the state hospital). This includes counties an hour or more away.

Usually, a pt is seen in an ER (that can't WAIT to get rid of them), then they are transported to us. Sometimes they come via the police who call our mobile crisis unit, then are sent to us. Sometimes they are sent by a therapist, or just walk in the front door.

This impacts the amount and quality of info we have about any given pt; sometimes we get a good idea of what's going on with them, sometimes not. Sometimes they are frequent flyers so to speak, sometimes not.

The RN's are responsible for checking the initial committment certification to make sure it's filled out properly, and then for calling for a 2nd cert, and in some cases, a 3rd cert.

We "usually" get a "face sheet" from our admissions office, and if we're lucky, some labs from an ER, or an assessment from mobile crisis. Then we have a nrsng assessment to complete on the pt.

First is the physical search, where we, with a tech, go through clothes and do a body search, document any wounds and scars, etc. This can be an ordeal at times. We take vitals, ht and wt.

We get medication hx (last night a woman brought in a bag with over 30 pill bottles, all of which must be written by hand on a med reconciliation sheet which then serves as an order form). To get MD orders, we have to get as accurate a picture of the meds they are on as possible, but if the patient comes in actively psychotic, seeing people covered in blood and hearing voices commanding them to cut their wrists, it's pretty safe to assume that they aren't going to be the most reliable historian.

Then we have an assessment, about 10 pages long. We take a full medical hx (which is sometimes laughable, sometimes heartbreaking) and a psych hx, a suicide risk assessment, a psych assessment, and a physical assessment with additional in-depth assessments for wounds or pain.

Then we are supposed to verify meds (which is often impossible because pharmacies in outlying counties close at 5pm) and then call a (usually) cranky doctor to get orders to admit the pt. One of our on call docs is infamous for hanging up on you if you take too long to give report. Others are just plain disdainful if you have a difficult pt with multiple problems. I am truely perplexed as to why doc's treat nurses this way, like they are doing us a favor by doing their job. (That's a whole other issue I suppose.)

By this point, we've filled out by hand: med rec sheets including drug, route, dose, frequency, duration, last time taken (hahaha) with effectiveness and/or reactions, and maybe/hopefully verified the meds; the written assessment, a treatment team plan where we list each major problem in nsg dx form, a seperate nsg dx sheet for each problem (3 -5 usually), a med teaching form, a form for pneumococcal vacination, a nsg flow sheet, the KARDEX, and finally the MD order form used to call the doc.

Then, we have to find a secretary (often we have one secretary for 3 units, who is overwhelmed with work) to put all this in the system and then they hand write a MAR for standing orders and another MAR for PRN's. We then have to check the handwritten MARs against the orders. Until the pt is put in by the secretary, they are in pre-admission status.

For some reason, certain meds are only available on certain units, so we have to run to X unit for one group of meds and then Y unit for another group of meds.

You can guess that the pt is pretty much the same or worse than they were when they arrived by this point. And all they will get are meds (hopefully) and a bed until the following day when they are (hopefully) seen by everyone else (2 doc's, a therapist, and a case manager.)

According to management, all this should be accomplished in 45 minutes. Ummmm...... on an easy admit if everything goes smoothly, I can maybe get it done in a little over an hour. If I'm handwriting 30 meds, talking to a pharmacist, writing 4-7 care plans, with a pt who is psych acute with extensive medical problems, it can take hours.

With the push to HURRY, I tend to make more mistakes. Then there are 8-12 other pt's to worry about as well. One can only pray that none of the other pt's escalate or have a seizure, etc.

This is my first job, so I have nothing except my school clinical experience to compare it with. Is this normal???

Does anyone have any tips to help me speed up the process? Tips on how to talk to these docs? Reasons I shouldn't run screaming out the door? Thanks so much!!

-- daze