Creating an empty bed or discharging a patient

[mye614]

Seems like many of you got questions on the NCLEX-RN about creating an empty bed to give way to a patient being admitted. What are the criteria in deciding which patient is to discharge or to transfer in order to create an empty bed? If I could still remember, I think I too got some questions on this when I sat for the board the first time. Also how about when you have to place 2 patients in the same room, how do you decide on that? Say, you have a patient who's already in the room who's a one day post surgical patient, what type of 2nd patient can you have this patient be rooming in with? I am actullay sort of confused about this...If I can be guided, it'll be much appreciated.

[nurseMargo]

Seems like many of you got questions on the NCLEX-RN about creating an empty bed to give way to a patient being admitted. What are the criteria in deciding which patient is to discharge or to transfer in order to create an empty bed? If I could still remember, I think I too got some questions on this when I sat for the board the first time. Also how about when you have to place 2 patients in the same room, how do you decide on that? Say, you have a patient who's already in the room who's a one day post surgical patient, what type of 2nd patient can you have this patient be rooming in with? I am actullay sort of confused about this...If I can be guided, it'll be much appreciated.

You could place 2 pts that on droplet prec. in the same room. But i think they have to have same problem ( ex: meningitis).

Pt on airborne precautions goes into private room.

And that's pretty much the main idea.

As far as your first question , i didn't quite understand it.... You mean when do you know whether the pt needs to be discharged/transfered or kept in the hospital? If yes, then you wouldn't transfer or discharge an unstable pt.

[nursemaa]

Actually you would need a physician's order to discharge or transfer a patient, so it's not really a nursing decision. What you can do if you need to clear a bed is to contact physicians if you think a patient is ready to be discharged and see if they want to give you an order. If not, you can't really clear the bed.

[nurseMargo]

Actually you would need a physician's order to discharge or transfer a patient, so it's not really a nursing decision. What you can do if you need to clear a bed is to contact physicians if you think a patient is ready to be discharged and see if they want to give you an order. If not, you can't really clear the bed.

Well obviously you need an order. You say:".... if you think that pt is ready to be discharged..." So, she is asking: How will she know that pt needs to be discharged???

[mye614]

You could place 2 pts that on droplet prec. in the same room. But i think they have to have same problem ( ex: meningitis).

Pt on airborne precautions goes into private room.

And that's pretty much the main idea.

As far as your first question , i didn't quite understand it.... You mean when do you know whether the pt needs to be discharged/transfered or kept in the hospital? If yes, then you wouldn't transfer or discharge an unstable pt.

I guess I wasn't as clear. I know that you need to have a physicians order in order to transfer or discharge a patient. I guess what I was trying to ask is let's say you work in an emergency room or say in a hospital where the unit is already packed and you have to admit more patients who needs to be in a closed observation. Of course you will have to comunicate this with the physician but as a nurse how would you know which ones are ready to be discharge to give way to the new admit. I've actually come across some practice questions regarding this and I get stuck. I hope I made myself a little clearer......

[nursemaa]

Well obviously you need an order. You say:".... if you think that pt is ready to be discharged..." So, she is asking: How will she know that pt needs to be discharged???

Geez...sorry. :imbar I just wanted to point out that our role is to encourage physicians to discharge patients when we think they're ready rather to just decide to discharge....guess I misunderstood.

[nurseMargo]

Geez...sorry. :imbar I just wanted to point out that our role is to encourage physicians to discharge patients when we think they're ready rather to just decide to discharge....guess I misunderstood.

:rotfl:

[nursemaa]

Anyway....I'm not sure about ER, but in my case (orthopedics), we would basically consider a patient ready to discharge if they were ambulatory with minimal assistance, vital signs stable, bloodwork acceptable (specifically H&H), had adequate assistance and equipment arranged for at home, voiding OK, bowel movements OK, postop nausea & vomiting resolved, etc. Or a patient who needed rehab or extended care who had arrangements made and met the above criteria as much as possible for them.

So for these patients, we would call the doc and request a discharge order, letting him or her know that there were patients in the ER needing beds.

It's a tough question to answer, because it also depends on the patient's pre-hospital level of functioning, support systems at home, availability of rehab or extended care beds, patient's level of independence, and other factors.

What were the choices of answers?

[mye614]

Anyway....I'm not sure about ER, but in my case (orthopedics), we would basically consider a patient ready to discharge if they were ambulatory with minimal assistance, vital signs stable, bloodwork acceptable (specifically H&H), had adequate assistance and equipment arranged for at home, voiding OK, bowel movements OK, postop nausea & vomiting resolved, etc. Or a patient who needed rehab or extended care who had arrangements made and met the above criteria as much as possible for them.

So for these patients, we would call the doc and request a discharge order, letting him or her know that there were patients in the ER needing beds.

It's a tough question to answer, because it also depends on the patient's pre-hospital level of functioning, support systems at home, availability of rehab or extended care beds, patient's level of independence, and other factors.

What were the choices of answers?

On the answer choices, it basically tells you the patient's diagnosis and sometimes the lenght of their stay in the unit (ex. 1)acute or chronic asthma attack who was admitted 8 hours; 2) a one day post hernia surgical patient; 3) patient admitted 12 hours with severe vomiting and abdominal pain; 4) 3 day status post CABG;...this type of choices...I just made these up :) )..A lot of the scenario or case questions don't have any of these patient's current status (vitals, level of functioning, etc). so basically, I/we just have to use our critical thinking to decide which of these patients to send home to make available beds...And this is where I get stuck and confused..And sometimes too, for each answer choice there would be 2 or more different diagnosis associated with each patient...so it makes it more harder and confusing. :uhoh21:

[mye614]

Geez...sorry. :imbar I just wanted to point out that our role is to encourage physicians to discharge patients when we think they're ready rather to just decide to discharge....guess I misunderstood.

it's ok...sometimes it's hard for me to explain things...my native tongue is not english so a lot of times I struggle for the right words :wink2:

[suzanne4, RN]

Think of it another way, so that it makes sense to you.............

Of the four patients that you listed, which do you think would be able to be discharged, if any at all?

Right away you can take the first day post op from open heart sugery off of your list, there is no way that anyone would discharge them. Now think of the next.

If the physician did not want to discharge anyone, who has the power to override his decision? And, you will find times when there is no one that can be discharged. What would you expect to happen then?

[nursemomruns]

However, on the NCLEX, you will have to make a choice about which one to discharge. There aren't any "None of the above" options on the test.