Improving Long-Term Care Admissions Policy: A Voice of Change

Improving Long-Term Care Admissions Policy: A Voice of Change
Thirty minutes before evening shift change and you receive the call. A new admission is in route to your facility. The patient is reported to be of high acuity, requires intravenous antibiotics, and has a diagnosis of chronic pain. In some health care settings this would be considered a typical new patient admission. However, for rural long-term care facilities there is potential for considerable complications. In a setting where registered nurses are only required to be in the facility eight hours within a twenty-four hour time frame, significant complications can arise during admissions that require certain specialty care specific to the RN. Ineffective discharge planning between any health care settings can be detrimental to patient care.
To provide appropriate care, long-term care admissions must be well thought-out and explicit tasks fulfilled prior to the patient’s arrival. There should be a smooth transition between facilities to promote continuity of care (LaMantia, Scheunemann, Viera, Busby-Whitehead & Hanson, 2010). If discharge planning is inadequate, patient safety and health can be compromised. For example, scheduled drug regimens, such as antibiotics and controlled medications, must be available within a timely manner. Most long-term care facilities do not support an in-house pharmacy. In addition, many pharmacies require original hard scripts before filling controlled medications. If admitting orders are inadequate or cannot be carried out within the appropriate time span, the admitting facility may be unable to meet critical needs. I have experienced this first hand on more than one occasion. The most recent o...

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...ely reinforce quality-nursing practice. When nurses taking an active role in patient advocacy, we do what nursing does best, we care.

Reference
Kirsebom, M., Wadensten, B., & Hedstrom, M. (2013). Communication and Coordination during transition of older persons between Nursing Homes and Hospital Still in Need of Improvement. Journal of Advanced Nursing, 69, 886—895. DOI: 10.1111/j.1365-2648.2012.06077.x.v
LaMantia, M., Scheunemann, L., Viera, A., Busby-Whitehead, J., & Hanson, J. (2010). Interventions to Improve Transitional Care Between Nursing Homes and Hospitals: A Systematic Review. Journal of the American Geriatrics Society, 58(4), 777—82.
Tjia, J., Bonner, A., Briesacher, B., McGee, S., Terrill, E., & Miller, K. (2009). Medication discrepancies upon hospital to skilled nursing facility transitions. Journal of General Internal Medicine, 24(5), 630-635.