Procedures for Admissions

[maestrotee]

I currently work on the Medicare unit in a LTCF. We stay super busy with admissions/discharges, families, doctors, etc. Our admissions paperwork is a nightmare! I'm sure everywhere it's the same story, so, instead of whining about the problem, I would like to contribute to the solution. Here's the problems we are having right now ...

When an admission comes in to our facility, it is the belief of the majority of floor staff that it is the hall nurse's responsibility to complete each paper and process, regardless of the time of admission. For instance, if we get a resident at 9 pm, then it is the second shift's responsibility to complete everything in the packet ... making for a clock-out time of about 2 am. As a result, we have learned what mandatory tasks need to be completed immediately, then ask the following shifts to make an effort to pitch in. For example, the orders need to be entered, verified with another nurse, physician notified of arrival, MAR/TAR created, VS's, head to toe including skin check, 7-page assessment, height and weight, diet slip to dietary, initial nurse's note, 2 immediate care plans, POS faxed to pharmacy and, usually, verification that medications are on the way. That's just the beginning of the process, however. After those first steps, if the hour is getting late, it does not seem unreasonable to delegate the rest of the process to oncoming shifts, such as side-rail assessments, CNA kardex, bowel and bladder retraining assessment, and on and on. I must be the only one who feels this way, because if I leave any of this stuff undone, it will still be sitting on the counter waiting for me on my next day on ... even if I am off for several days.

It seems like there should be a more team oriented approach to this process. I would like to hear from some of you out there as to how it happens at your facility. Is it all up to one person, or is there a system in place, and, if so, please let me know what is working for you. I am working on a proposal, kind of a checklist, listed in priority based on regulations and facility policy. Ideally, it would include 'mandatory minimums' of responsibility. Such as, the admitting nurse is responsible for this, this, and this. The next nurse coming on is responsible for this, this, and that, and so on. Anyway, I would appreciate your feedback. Thanks in advance!

[AprilRNhere]

When I was a CNA in LTC I can't think of a time when we EVER accepted an admission that late. I think they set up appropriate times for them to come in. Good luck though in resolving your problems.

[icyounurse, BSN, RN]

I like your idea about the checklist, and yes you are right admission processes can be a universal nursing problem. Some facilities are better than others. I would love to see a checklist with minimal requirements. It would be alot simpler for the nurse taking over to see what needs to be done simply and in black and white. Alot of times coming on the next shift right after an admit it can be hard to figure out what needs to be done.

[loriangel14, RN]

Where i work the charting is all computerised so you just fill out all the screens for admissions and when you get to the end you know you are done.We don't usually accept admissions on any shift but days and whoever has the time does the admission. Sometimes 2 people will each grab a computer and do it together. it is faster with two.

[BookwormRN]

I work Med/surg and of course, this can be an issue. However, nursing is a 24/7 job!!!

If I get an admit at 2200, I will get the pt settled, check orders for anything STAT or NOW, and go from there. I let the next shift know what I haven't accomplished and they will take over.

Let's face it-I still have other pts to care for, meds to give, chems to check, etc.....

[Quickbeam, BSN, RN]

I absolutely agree that the "haha, he got here on your shift" approach is stupid and counterproductive. It is 24/7. Everywhere I've worked, we've done what we could and left the rest for the next shift. Just don't save critical phone calls for nights, that's all I ever asked. People get really annoyed to be called at midnight when they could have been called at 8 PM.

I think you have a management problem. This is a top-down attitude and it can be changed.

[maestrotee]

Thanks for the replies. Sounds like I certainly have my work cut out for me if I intend to be an agent for change in this area. Your comments are very helpful. Keep 'em coming! :)

[RNKPCE]

I work acute care but we face similar problems. As has been said previously nursing is as 24/7 job. You can't always wrap your patient up and put a bow on them to present to the on coming shift. The checklist is a good way to let the oncoming shift know what still needs to be done. I can't believe they would put off doing parts of the admission and save it for you even if you are off several days, how much sense does that make, especially in the legal sense.

You are right on and if management doesn't support you I don't know what to tell you. You do get paid OT if you stay late to finish admission work I hope. Also if I were a manager I wouldn't want to be paying OT to have the off going nurse finish the work that the oncoming nurse can do.

[CoffeeRTC, BSN, RN]

You wont be able to change this concept unless you have your DON on board. We have a check list but it doesn't indicate the "must have done first". That would be a nice way to make sure that it gets done and says "hey, we all have to do this admit"

In our place...11-7 just about refuses to do any part of an admission.

Yes...we do have admits that late at night too.

Get the DON on board and just have him or her remind all shifts that nursing is 24/7.