Admissions in Rehab/LTC

[RNjuice, ADN, RN]

In the past year, I've worked in two radically different Long Term Care / Rehab settings. One thing the two facilities share in common, however, is that admissions tend to come in right before shift change, and the responsibility of who is to perform the various assessments becomes diluted / is otherwise unclear. Furthermore, I have found it to be challenging to find the time to fit in a timely, thorough admissions assessment in the midst of providing the necessary care for the patients already present.

Does anyone have advice, suggestions, or perhaps something that has worked in your facility that ensures that neither new admissions nor existing patients are neglected when a new admission arrives?

[NewRN'16, ADN, RN]

Here is how I've tackled admissions. I knew they were coming, so I had made sure the room was ready (did pt need O2? - a concentrator and NC ready to go. Was the pt a trach? All trach equipment in place. Was the patient on continuous feed or needed IV ABX? Pole ready in the room.

When pt arrived, get STAT vitals and assessment. Not charting just obtain the info for you (if the pt is A&O enough to answer questions) Don't ever let the patient just sit there after being dropped off by transport, too many times acute care any us off unstable patients whom we had to promptly send back as we couldn't care for them in our facility.

Quick assessment and vitals shouldn't take you more than 15 mins. If it's 9 pm , return to passing meds/completing tx and tasks you have. Continue checking on the new admit as much as possible, as they often are disoriented since it's a new room, new bed, new call light system etc, and maybe they're in pain.

Now you're back to "completing the paperwork". Start with entering the pt in the system, then calling the MD and verify the med req. Be ready to have all your ducks in a row before calling the on call, just as I'm a regular SBAR. Please read the pt H&P before calling! Too many times I have seen colleguex fumbling with paperwork when asked questions because they weren't ready and wasting a huge amount time on that. After you cleared the med req, proceed with your admission (make a new chart , enter allergies, meds, assessments , etc). STAY organized! Don't leave papers laying all over the desk. Of you start making the chart right away you will know where everything is. ).

I have had situations where I had 30 pts and 2 admission which all came after 9 pm. It's doable. You may have to stay an hour or 2 longer but really of you stay organized and are prepared I'm advance you will be OK.

Best of lack and hugs!! I hope this helps!!

[NewRN'16, ADN, RN]

Ah, I completely forgot what you asked who is actually responsible for the admission , at the shift change? I would say the nurse who received the patient , who has report on them, who has already assessed them. You can delegate to oncoming nurse certain things , such as labs, help you with wound care you couldn't complete, f/u with MD to verify meds if MD hasn't called.back yet, etc. But as far as I'm concerned I've always fully took care of my admissions. You don't know what kind of emergencies next shift may have, a change in conditions or a code can make it impossible for them to help.

[RNjuice, ADN, RN]

Thanks so much for your detailed response!

You make a great point about how a quick assessment can be done without taking away too much time from med pass / tx for existing patients. I also respect and appreciate the fact that you take full responsibility for the patients you admit, as in my brief time working in this setting, I have on several occasions been left to perform the initial assessment on new admissions from the previous shift as 1st shift tends to try and leave ASAP. It's not unusual for me, as you've stated, to stay an hour or more after to complete paperwork in these cases.

As I've thought about it since posing the question, it's important to ensure that the patient is stable and establish an objective baseline for them as soon as they arrive. As a newly practicing nurse with little experience that graduated years ago, I'm having to reshape my thought processes and return to thinking like a nurse. Also having to redevelop my assessment skills to be as efficient and useful as possible.

Continuing to work at it!

[Golden_RN, MSN]

There is so. much. paperwork. in LTC admissions that there really has to be a culture of teamwork and realizing that it is a 24 hour business. If a new resident is admitted during the last 30 minutes of your shift, you will not be able to get it all done. One idea is a "cheat sheet" check list for new admissions - was just a worksheet where you could indicate which tasks you completed for the new admission (fall risk, braden, admission assessment, care plans, confirm orders etc.), then pass it along to the next shift for completion. At least the first shift can show that what they started and the next shift knows exactly what still needs to be done.

[NewRN'16, ADN, RN]

On 5/29/2020 at 12:40 PM, RNjuice said:

Thanks so much for your detailed response!

You make a great point about how a quick assessment can be done without taking away too much time from med pass / tx for existing patients. I also respect and appreciate the fact that you take full responsibility for the patients you admit, as in my brief time working in this setting, I have on several occasions been left to perform the initial assessment on new admissions from the previous shift as 1st shift tends to try and leave ASAP. It's not unusual for me, as you've stated, to stay an hour or more after to complete paperwork in these cases.

As I've thought about it since posing the question, it's important to ensure that the patient is stable and establish an objective baseline for them as soon as they arrive. As a newly practicing nurse with little experience that graduated years ago, I'm having to reshape my thought processes and return to thinking like a nurse. Also having to redevelop my assessment skills to be as efficient and useful as possible.

Continuing to work at it!

Try to do as much as you can OK your shift, because even though theoretically nursing is a 24/7 job, you really can't be sure what the next shift will or will not complete.

I am new to nursing as well, only 4 years experience here, but I hope my advice helps.

I usually complete my assessments because I want to leave my patient safe (for example in case of pt deteriorating, the next shift will have all meds in the system, will know their HX and allergies. Will. Have access to all the information at the touch of a mouse.

I wish LTC and SNFs would have a charge nurse doing the admissions, but most don't. So it is up to us nurses to make sure our patients are safe.

I think you are doing great , and as you go you will learn that many many things will be left undone from the previous shift.

[Rachelle Garrett]

Can you share the steps how to complete an admission with epic from pulling down the orders from ER , to complete my Epic charting admission , thank you all so much

I have work in about 4 hours I’m lost how you complete an admission with epic charting