I and my coworkers get a lot of questions/requests from LTC nurses that I don't understand why it's necessary or needed at that exact moment when it's going to be in the packet sent with the patient. Just a few questions...
Why do I get asked to fax the discharge papers when the patient will be there with the papers within a couple of hours?
Why do we get calls a day or two after admission asking for the admission diagnosis?
Is an end date for an antibiotic a separate documentation requirement or something? I almost got into a shouting match with a nurse who insisted on getting an end date for the abx when it was clear by the infectious disease doc's note (which I read to her) that this was an indefinite abx due to chronic implanted device-related infection.
Why do some want me to give all wound information in explicit detail, even if I've reassured the receiving nurse that all wound care orders will be sent in the packet?
Specializes in Internal Medicine, Geriatric Medicine.
And so do I! Next time, I'll take a look at the content of the packet of info we send. I think the unit secretaries have an automated field that they click in Epic when a patient is transferred to an LTC to print out info, but I don't know what info is grabbed and printed when that happens. I do know the packet is quite thick, as mtjoanna alluded to, but it may be cumbersome for an LTC bedside nurse to sift through. I'm not sure if there is an alternative, though...
I'd rather get too much information. I can sift through the medical stuff that might not be needed on a day to day basis and separate it out into it's own paperclip so the staff can read it when they have time or the inclination. But I think it's great that you're thinking about it and I appreciate it. I'm sure others will, too.
We need the discharge papers earlier than arrival so we can start entering orders. Many are asking for an antibiotic end date because most DO have an end date, which we need to enter with the order, but if it doesn't have an end date, as the example you say, then hopefully that's clear in the orders. Some may be asking about wound care orders because sometimes there is little or no info. on WC orders from the hospital.
At my work, we like the meds list to be faxed so our house doctor can review the meds and make any changes, if necessary. We then need to contact the off-site pharmacy, so our medications arrive in a timely fashion.
We have paperwork to prepare for the admission/re-admission, including charting discharge information we receive from the hospital. If the paperwork is started before the patient arrives, then that allows us more time to assess them/provide care when they arrive.
Based on hospital discharge packets, we can also send out referrals for physio, dietician, social worker, etc before the patient arrives. It really gives us extra time to prepare, to avoid an overload of work (and stress) when the patient arrives.
In addition, we require detailed wound information because we need to prepare to treat (ordering proper dressing supplies, ung, etc). We also have a wound specialist that works with my facility and the more information we provide, the better for the patient's care.
As for calling for a medical diagnosis 2 days later... I don't understand why that would happen. The dx should be known on admission day
Specializes in Critical Care, Med-Surg, Psych, Geri, LTC, Tele,.
One other reason the LTC nurse may have lots of questions is because the LTC facility has to determine whether the client is appropriate to return to the facility.
For example, if they are discharged with a foley and the facility doesn't provide foley care. This has nothing to do with the nurses being knowledgable enough to do it, it has to do with facility policies.
Other issues that can lead to a pt no longer being an appropriate placement include inability to ambulate, use of a wheel chair may or not be appropriate, etc. Some facilities do IV infusion ATB, some do not.
These types of issues often made for an acrimonious relationship between the LTC facility and the acute hospital.
I usually tried to play nicely with the other nurse, but I think that if a person doesn't know the other facilities requirements, it can seem redundant and like LTC facilities are being picky.
As previously said, many times its getting meds ordered so that they arrive in a timely fashion. Also, sometimes, there is more help available (management) to help put in the orders, so that the nurse who is receiving the care can complete care with other residents, and there is little disruption to care to those already at the ltc. And care can begin seamlessly on the new admission
Another thing that we need is an actual prescription for their controlled meds. The sooner we get this and the sooner we get the med list, the less of a delay.
We still do good old paper MAR/ TAR and orders (we get them printed monthly from the pharmacy). Since most of our admits happen on the 3-11 shift and the pharmacy quits taking new orders after 5pm, this gets tricky. That and the fact that the drs offices are closing around that time. If we can get the orders faxed to us early, review them with the MD and get them sent over to the pharmacy, we are more than likely able to get them on the PM delivery from pharmacy if we donnot have the med in our emergency box.
Thanks for all your posts. They really help me understand what is necessary to ensure continuity of care.
It is great that you asked these questions to understand why LTC facilities do what they do. As a result, you can help the nurses you work with to understand too. Or, you can point them to this thread.
Hi, I'm an MDS coordinator, and as an acute care nurse, you would have no reason to know what that is, but my job is to provide clinical information to CMS for reimbursement. We have several levels of care in nursing facilities, and when a person comes for skilled care, it is my job to reconcile the admission diagnosis with the hospital stay, as we are considered a continuation of the hospital stay. This is true even for residents who live all the time in our building, but have come to the hospital for acute illness and return to us at a "skilled" level for a short period of time. I also have to report to CMS changes in wounds (sometimes every 7 days) so if I have measurements on discharge from the hospital, and no one in our facility measures the wound til the next day, I can tell if there has been a significant change. In my role, in addition to an admission assessment, I am responsible for the total plan of care, and the more information in that packet, the less invasive I have to be to my co-workers fighting for the chart. Also in the event of some skilled admissions, there is a "look-back" period that extends back into the hospital stay for surgery, ventilators, oxygen, IV meds, transfusions, Bi-Paps, you name it, that CMS expects us to address on admission. Functional assessments from PT/OT and ST or swallow studies are pure GOLD. Since we are usually an extension of the hospital stay, it is common sense that we need all the records from the stay. Hospitals are famous for forgetting to mention that the sitter was still in place on discharge (not really "legal" for us to accept) or leaving out the nursing documentation that the patient has a large, involved family who mostly don't speak English (we need more time to arrange translators,) and other social information that is critical to make the patient confident that we know what we are doing. ALSO, the industry standard for answering call lights is very different than the hospital setting, and people are rarely ever prepared for that. Hope this helps a little.
I'm not upset. I'm trying to understand why I get asked certain questions. If you don't want to answer, don't answer, but don't assume I have negative views. I'm trying to understand reasoning.
Nurse to nurse in the acute care setting, we don't go over wounds in explicit detail because they are all documented already, including wound care. We don't give end dates for abx because they aren't known or change when the culture comes in. Discharge papers have orders, and unless there is an order I didn't get to during my shift, we don't go over every order.
That's because there is a huge difference between the two. I work in ICU full time and in a LTC center PRN. Two completely different ballgames.
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IsabelK
174 Posts
I'd rather get too much information. I can sift through the medical stuff that might not be needed on a day to day basis and separate it out into it's own paperclip so the staff can read it when they have time or the inclination. But I think it's great that you're thinking about it and I appreciate it. I'm sure others will, too.