what needs to be done for a new admission

[SleeepyRN]

I apilogize for such a no brainer question. I am in the process of applying for new jobs again. I have been a nurse for a year now, however, 6 months of that was spent in a pediatrician's office (where my mom, RN/office manager works.) She let me take over the nurse duties so that I can gain nursing experience while looking for my first nursing job. I spent 2 more months in a SNF. During that time, I learned TONS, everyday. I never did get the "dreaded" admission though.

So what all is entailed in am admission. I basically know head to toe assessment, skin check, and calling the M.D. to reconcile the medication orders. And of course documenting. What other admission responsibilities are entailed? And since admissions can ofted interrupt, say, med pass, can the duties of admitting someone be split up so you can get back to med pass, and THEN return to the new resident to return your admission? I'm obviously confused on the whole process. Thanks for reading!

[ricksy]

I recently had some difficulty as a new nurse with an admission. I hope the question regarding "can the duties be split up" be answered. Thanks for the post.

[MarggoRita]

Yes the duties can be split up, do take vitals and assess for any immediate concerns/safety issues, notify appropriate staff of diet order and if on thickened, and of any swallow or fall risks. The rest of the physical assessment can be held off for a while.

[AngelRN27]

Agreed ^ Make sure you do your initial assessment right away to be sure the patient is safe, vitals are okay, and that all pertinent things are in place as applicable, such as O2, IV Fluids, etc. If patient has DM I always get a sugar as well. After that, if I'm in the middle of med pass, I'll finish everyone else up, draw up meds I know must be given on my shift for the admission, and document later. Also, I *always* look over the patient history for anything important that could be an immediate "threat" (i.e. allergies, seizure disorder, hx of acute CVA, DM). If available, I always try to take a peek at labs too and make sure nothing is too out of whack that may need immediate intervention.

[RN&mom]

I work LTC/SNF, the resident needs a head to toe assessment within 2 hours but I like it to be done immediately if possible. Diet slip filled out ASAP & sent to dietary. All info, face sheet, h&p, discharge summary, faxed to doctor. Face sheet, med list and any copies of prescriptions faxed to pharmacy. All this I have done within an hour of an admission arriving but you have to remember, you knew this person was coming so I hurry earlier in the day to prepare and have time. There's more to an admission but those are the basics that must be done ASAP at my facility... Admissions really are not that bad in my opinion.

[CapeCodMermaid, RN]

OK so put yourself in the new admission's place. Most likely they were at home 4 or 5 days ago minding their own business when either they got sick or had some sort of trauma. They get whisked off to the hospital in an ambulance by people young enough to be their grandchildren then left in the ER till someone decides to see them. After a few days of little sleep and lots of new medications and possibly anesthesia, they once again get shoved in an ambulance and brought to the scary nursing home that they've heard bad things about.

So....they get put into a bed and in a minute or two more strange people come in and demand they take off their clothes so their skin check can be done. Instead of swooping in with your blood pressure cuffs and your stethescopes why don't you walk in and introduce yourself before you do anything else. "HI. My name is CCMermaid and I'll be your nurse today. I know you're tired but we have lots of questions we need to ask you and lots of forms to fill out. Are you in any pain? Do you mind if I take your vital signs?"

The world will not stop revolving on its axis if you don't yank their clothes off to see their butt. If they look like they're still very ill, do the vitals but leave the skin check until bed time when they will be getting undressed any way.

[systoly]

it really depends on the admission

their skill level, what time of day, what type of equipment is needed

sometimes you know ahead of time and have orders before pt arrives

it happened to me once or twice, but don't count on it

yes duties can be split up, i don't think i've ever done one all by myself

i like the above approach, but sorry, i do look for skin probs right away,

we inherit a lot in ltc

one of my pet peeves: please explain the call system and have it within reach,

even if they seem unable to use it

let everyone (dietary, therapy, etc.) know they're here

if at all possible go over the med list with pt. or family

invariably there'll be changes from what they were on at the other facility or their home

get a large cup of coffee and dive

[SleeepyRN]

I just re read my post. Sorry for all the typos. That happens a lot on my phone.

[SleeepyRN]

Great answers! CapeCod, thanks for putting it into the percpective of the resident. All this info is a good basis to start from. From here, I can get specifics from the facilitie's policies and procedures.

[RN&mom]

At my facility me must do skin check within 2hrs of arrival. If done correctly its not a rushed thing it's a get to know you kind of thing and we as well inherit lots of wounds which is why it must be done...

[terraqueous]

I always add a neuro check to my admission assessments. You need to know what their baseline is when they arrive and lots of times with elderly folks, one pupil may be larger than the other due to medical history, surgery, cataract. This can be pretty worrisome if first noted at the time of a fall.