need help filling out LTC admission forms!

nurseprnRN, BSN, RN · Dec 30, 2012

As an LPN you are not responsible for the admission assessment of a resident; the RN does the nursing assessment that results in the RN developing the nursing plan of care. It is true that the RN can delegate the assessment, but if there are any components you aren't familiar with or cannot complete for whatever reason (including your personal or educational lack of experience in a given system assessment), the RN must do those.

I'm actually doing a case that involves this very issue-- the question is, who did the assessment before an admission, who wrote the plan of care based on what, and why didn't it get properly communicated to staff? Hint: The LPN did her best, but the RN blew it.

Grannyof6 · Dec 30, 2012

I think the physical assessment and care plans by the RN are done before arrival? I'm not sure. I'm so lost and buried trying to figure out what the form wants and then, when I look at their insurance info and other paper work, items sometimes aren't called the same things from one form to another, so I'm never sure if I've found the correct info and repeatedly have to ask another nurse, who are all very busy themselves. Its a nightmare. I'm ready to quit LTC nursing over this. No one wants (or has time) to help me, it seems. I can verify the orders, write the NNs, get the MARS written out, etc. But the insurance forms are horrible to figure out.

OnlybyHisgraceRN, ASN, RN · Dec 30, 2012

As an LPN you are not responsible for the admission assessment of a resident; the RN does the nursing assessment that results in the RN developing the nursing plan of care. It is true that the RN can delegate the assessment, but if there are any components you aren't familiar with or cannot complete for whatever reason (including your personal or educational lack of experience in a given system assessment), the RN must do those.

I'm actually doing a case that involves this very issue-- the question is, who did the assessment before an admission, who wrote the plan of care based on what, and why didn't it get properly communicated to staff? Hint: The LPN did her best, but the RN blew it.

I don't know if you've ever worked in LTC, if you have you will find that the LPN does do the initial assessment. I'm not debating whether it is right, wrong , or legal but it does happen. However, companies have gotten really creative. The form the LPN documents on will not be labeled as an assessment but more as a "data gathering" form. I worked in LTC previous to a hospital as a LPN and I did 95 percent of all new admissions by myself. Many LTC facilities have only one RN in the building, she does not do all the assessments.This is one of the reasons I left LTC, it was too risky to work for.

Lpn1226 · Dec 30, 2012

I work in LTC and admissions plain suck lol it is a ton of paper work and unfortunately the only way to figure it out is to do it and if u aren't there often that would be hard. Can the nurse manager or don make u cheat sheets? Go over some of the forms with you?

Grannyof6 · Dec 30, 2012

Joann12--

I would love to get a DON or someone to make a cheat sheet for me, but that'll be when pigs fly...lol. They'll just call the agency and tell them not to send me there anymore. I know the more I do admissions the easier they'll be but they sure eat up a lot of time. They've even given me 2 admissions on the same shift and no one will help, either with the paperwork nor with the med pass etc. I can only try to prioritize and do as much as I can. I have complained to the agency just in case they get a call from the DON, so they'll know what's going on.

these papers are important....you'd think they'd make sure they were done well even if that means taking the time to help someone.

BrandonLPN, LPN · Dec 30, 2012

I say the various states' BON's should just give up the ghost and officially allow LPNs to perform assessments. We all know LPNs do it already. I know it, you know it, they know it, so why all the pretense? Enough of the silly euphemisms like "data collecting". It's an assessment, call it what it is. When I'm the only licensed nurse on duty and I have a resident who is going downhill and I chart it and call the doctor, didn't I just perform an assessment? When I alter the care plan or implement standing orders based on my findings/judgement didn't I just perform an assessment. What on earth else would you call it??

Grannyof6 · Dec 31, 2012

i agree. I hope sometime in the future (probably after I retire) they'll let nurses unionize nationwide. Then maybe some of the staffing issues and paperwork etc will be addressed. The BON doesn't seem to be in touch with how the acuity has changed in LTCs since I first worked in it 20yrs ago and the need for increased staffing. frightening. I can't get over how much more stressful LTCs are now.

amoLucia · Dec 31, 2012

LTC admission paperwork is HORRENDOUS. We all agree. They may differ a bit from facility to facility but they're pretty much similar.

Might it help you if you picked up a sample admission packet? Maybe from a place that seems to have a comprehensive or extensive packet? That or just grab some forms that you've seen as you go along. Then you can just review when you get a chance. (Yeah, like we all have so much extra time!!!)

I do know that some places have an 'admission checklist' that some QA or manglement person goes around checking to see that all the checks have been checked by the checkers on the forms needing checks, etc etc etc. It could give you a reference point for many of the specialized forms like those for falls risk, wound/skin, behaviours.

On 11-7, I didn't get too many admissions, but I DID occasionally. My facilities advertised providing 24/7 so we were open to accept admissions (usually those coming from out of state) at any time. My job would have been terminated if I ever refused an admission r/t time!!!!!!!! I had to go thru the forms slowly also because I wasn't familiar.

So my advice to you would be just start at the first section and work your way thru. If something's not appplicable, you N/A it. If the pt is too lethargic, aphasic, non-English, etc, you just document what you can, and explain the other. It is a 24/7 operation and others can refine the paperwork. But you do need to hit the priorities. And let others know what still needs to be finished. My 11-7 admissions were bare bones completed.

And Brandon is right --- what's the difference between an LPN assesing a pt at admission or doing an assessment as part of regular care assignment 3 days later??? But that's another thread...

NotFlo · Dec 31, 2012

As an LPN you are not responsible for the admission assessment of a resident; the RN does the nursing assessment that results in the RN developing the nursing plan of care.

That's pretty funny. In seven years in several different facilities I've never once had an RN do an admission assessment of a new patient or begin the initial plan of care; both duties have always fallen to me, the LPN and nurse working on the floor that receives the patient.

The RN supervisor will write out and verify the orders with the MD, once in awhile will transcribe the orders onto the MARS and TARS but I have never had one even so much as set eyes on a new patient...they do their orders at the desk.

We have to start the plan of care upon admission, the unit managers do usually update and add to the plan of care. We have some unit managers that are RNs and some that are LPNs.

LTC/rehab admissions always seem to be terrible beasts. They suck and you end up writing the same information twenty times. The paperwork takes forever and a day to complete. It's amazing that on an average day I'm strapped, don't get breaks and leave late and don't have nearly enough time to complete everything, but if three admissions are coming somehow I'm supposed to fabricate another three or four hours into my day to do the admission assessments and paperwork. It's pretty insane.

TheCommuter, BSN, RN · Dec 31, 2012

Discussion has been moved to the LTC Forum for more responses.

Nascar nurse, ASN, RN · Jan 1, 2013

OP - it's nearly impossible to give you much advice because typically the required paperwork is different in all facilities. A couple of pointers that I always try to give new nurses are:

1. Make sure you've got all the pages of the transfer sheet. Our local hospital is infamous for sending page 1 of 4, page 2 of 4 and page 3 of 4. Of course things like ABT, coumadin or insulin is found of the page 4 of 4 that never made it to the facility.

2. At least scan the H&P from the hospital so you know why the resident was in the hospital to begin with. Amazes me when the nurse fails to document a surgical wound to the hip and when asked seems perplexed that the resident HAD hip surgery.

3. Critical thinking skills - If they have coumadin, make sure you have a PT/INR follow up order. If they have a wound, make sure there is a treatment order in place. If they are receiving insulin make sure they have accuchecks in place. Make sure there is something to address whatever it was that sent them to you to begin with (ABT for urosepsis, therapy orders, etc)

4. Get a code status ASAP. Nothing worse than a code within the first 24 hours and no one has bothered to ask what resident, family desire was!

5. Do a complete head to toe. This includes removing all dressings (unless there is an order to specifically not remove them). Measure and describe every area you see. This prevents any wounds being discovered later and then having to be included as an in-house wound rather than an admission wound.

6. Don't forget to fax orders to pharmacy as soon as you get them ready

7. Don't spend more time worrying about the task than the time it actually takes to get the task done. After hearing several of the nurses recently moan and groan that I just didn't understand how long the whole paper work task took I told them I would just do the next admission paperwork myself. Grabbed the transfer papers at the desk and stood and did the orders (yes, I had plenty of interruptions too). It is simply a matter of copying line by line, checking each line off as I go (so I don't inadvertently skip a line), taking a second look to make sure I got all those extras like I mentioned above included, faxing the pharmacy and moving on to the head to toe. It just didn't take as long as they kept trying to tell me it did. Some of them spend the first 20 minutes complaining about the length of time and I was nearly done in 20 minutes.

Hope some of this helps.