New Resident Admissions process

NurseLoveJoy88, ASN, RN · Mar 11, 2012

If I'm a day shift nurse and an admission comes in at 1300 I usually complete the initial assessment and that's it. There is nothing more the day shift nurse can do except that.

It usually helps if the admission packet ( braden scale, fall risk, nutritional assessment, skin sheets, inventory, and etc) is already put in the chart. That way the next nurse doesn't have to go on a scavenger hunt to find all of the forms that come with an admission. At my job we try to keep already made up admission packets on the unit.

So long story short: I would suggest the day shift nurse do the assessment, and make sure there is a chart with the paper work avail for the evening nurse.

CoffeeRTC, BSN, RN · Mar 13, 2012

I work 3-11 and we get 99% of the admits. Most shifts we have 3 nurse on and the charge nurse handle the admits. some shifts we can have 1-5 admits. A good amit takes a few hrs to do. This is what should happen or what we need.

Advanced notice of the admit (not hey look there is an ambulance here with an admit)

Orders or h and P faxed over from the hospital so we know what to expect

a chart ready (includes all papers needed)

The 7-3 charge is awesome and will start on some of the paper work..putting names on it and writing our standing type of orders on the order sheets. She also starts with some of the orders too and will make sure the room is ready and supplies are there (oxygen, tube feeding, pumps etc)

If they do come on 7-3, or by 2:30 pm..they normally get the wt, ht and vitals and unpack what they have and place a call to the family to let them know. If they come a bit earlier before change of shift they start on the orders and do a general assessment.

If we get a few admits and there is no extra nurse, we work together (me and the other nurse) and get what we can get done. Orders, nursing assessment, skin checks, dietary etc. The careplans will just have to wait or be passed on to the next shift since we still have a full assignment each and need to do meds, tx, orders etc on them.

RiverSunny · Mar 22, 2012

As for all of the assessments why not designate various ones to days, pms, and nocs so that they can be completed within the first 24 hours.

sbostonRN · Mar 22, 2012

Our admissions liason is very good about telling us how many admissions we're getting on a particular day. If the admission comes after 2:30, evening shift is responsible for the initial assessment. If they come before that, day shift gets it. However, if 4 admissions are on the schedule and the first one rolls in at 2:45, I will stay and help them.

Day shift is heavier for treatments at my facility (as well as discharges), and that is done purposely because evening shift is heavier for admissions. All daily skilled Medicare notes are done by days and evenings only has episodic notes. I think it's pretty well balanced. Each shift has their stressors but we work as a team so it's never unbearable for anyone.

peaches88 · Mar 23, 2012

Where I worked, if a new admit showed up 5 minutes before your shift ended, too bad, it was yours to do... all of it! It sucked. All paper charting too, so your hand hurt like hell after it was all done and if it didn't, then you probably forgot something, lol! We did, head to toe assessment, fall risk assessment, elopement risk assessment, physician order sheet, MARs, TARs, careplan, notify pharmacy, etc. Usually took around 2 hours. We only had one nurse on shift at a time, so there was no help, except sometimes the QA nurse would put in all the physicians orders. If you asked the DON or MDS coordinator for help, they probably would have just yelled at you. There are reasons that I left...

noc4senuf · Mar 23, 2012

from experience, most admits arrive on PM's because by the time the MD at the hospital decides to discharge, all transport vehicles are booked for earlier hours. My staff complete all assessments in 72 hours, it is broke up so the more important ones are done on admit.

buytheshoes11, MSN, RN · Mar 26, 2012

OP: the facility I am at pretty much does the same thing, except we never know the exact time an admit is coming. The nurse on the cart is given an approximate time but the admit can arrive anytime from 0800 - 2000. Sad, huh? Anyway, since our AM nurses have the big medication pass they very rarely do anything for the new admit, if he or she comes in on their shift, except say hello and maybe fax the medication list to the pharmacy. The PM shift does pretty much everything for the admit. The only good thing on a new admit day is if we have an extra/float nurse scheduled, because then he or she can do the computer part of the process (make the MAR/TAR, set up appointments in the computer, etc.). This helps so much but our facility rule is that the nurse on the med cart has to do the physical assessment which can take a ridiculously long time depending on the status of the patient. Maybe having a float nurse would be beneficial for your facility, even if that nurse came in for just several hours to help out!

qestout, ASN, RN · Mar 27, 2012

I like the idea of an admissions float nurse as a call-in. We're already scheduled for every minute of the shift on pm's. An admit is expected to be processed w/o allowing overtime? Huh?

I was hoping by posting this that I'd hear a sort of "pre-packaged" easy admit process, and how to spread it out over a couple of shifts with forms being preprinted. Having day shift just say, "hello, here is your bathroom" and then the pm shift gets the rest of it--not working!

qestout, ASN, RN · Mar 27, 2012

The day/pm shift med pass is not evenly divided. Can't tell you how many times I've scheduled meds for AM/noon that were changed! I know this is OT, and I'll prob start a new thread: who gives Synthroid at hs?

CapeCodMermaid, RN · Mar 31, 2012

I know a facility that changed its synthroid time to HS. It needs to be given on an empty stomach to maintain constant levels. But then there's the problem of the HS snack which seems to be a huge thing for our DPH this year.Most of our admissions come on the 3-11 shift. Other than the meds, the only thing that must be done right off is the 4 page assessment. We have up to 48 hours to do the rest of the assessments. We have EMARs and ETARs so the medication ordering process has been streamlined. There are 2 nurses plus a team leader who helps do the admissions. If there are more than 4, the nurse manager usually stays to help out. I usually end up entering meds and treatments on at least a few of the new admits.The day after we went live with EMR, we had 6 admits on the 3-11 shift. The SDC helped, I did a few, even the screener stayed to help. Nothing gets done without the TEAM approach.

buytheshoes11, MSN, RN · Apr 1, 2012

@ CapeCodMermaid: It would be a miracle if our DON or ADON would help out with admissions or anything on the floor. I know they are busy too, but they get upset with us when we cannot process four admits (like this past week) in one shift without overtime. From reading some of your posts you sound very reasonable and your facility sounds like a great place.