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Thread: Hello! I have an Admission Process Question

  1. #1
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    Hello! I have an Admission Process Question

    Hello all,
    I am an RN, BSN, EdM with 31 years of experience from front line med-surg nursing to leadership
    I am currently an admission RN for a large hospice organization.

    MY quesiton is: What is your admission process (details needed please).
    *Process from start to finish
    *How many forms are involved in process
    *Number of admissions per RN in one day
    *How long is your day
    *Salaried or hourly
    *Is there a separate admission RN or do case managers do own admissions?
    *How complex are your patients? Do they come home on IVs, TF drips, TPN, Morphine drips...
    *Do you see patients in hospitals and SNFs?

    My team and I find the process rewarding yet time consuming. It is fine and we feel we have a good system, however, leadership is telling us that Nationally, hospice organizations are doing 2 admits per RN per day. It can take 5 to 6 hours for a simple admission and upwards of 10 to 12 hours for a more complex case.

    We are working 12 to 16 hours days (salaried) when we have 2 admissions. The travel time between patients can be upwards of 1 to 3 hours between patients, depending on summer traffic.

    Our leadership team is currently meeting to determine how to accomplish two per day. I sent a lengthy email with step by step process and needed background data entry support to show them how we could do 2 per day and the response was not what I expected. In fact, the took away the completion of our clinical data entry tool as they think that is what takes us so long. I am not sure they get that the tool is a critical piece to help us determine eligibility and have data to do our computer work when we leave the patient's home.

    Which leads me to another question: Do you complete your computer work, make all your phone calls to MD, med supply company, pharmacy etc from the patient's home? We do some calls from the home, and leave and complete the computer work and other calls (Profiling meds with Hospice Pharmacia) as it can take 30 min to profile meds if they have a long list, and the computer alone takes approx 3 hours.

    I would be happy to share our process in detail if anyone would like to see what we are doing as you may have recommendations to streamline?
    All I know is 2 admissions per day is not feasable in an 8 to 10 hour day at this point and leadership disagrees. There is no cookie cutter admission as things come up, families need emotional support and education and some times, patients are in destress (resp, pain etc) when we arrive.

  2. #2
    Super Moderator cougarnurse's Avatar
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    Does the admission process have to be just in regards to Hospice, or can it be another line of nursing?

    Just wondering before I answer any further.

  3. #3
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    Not sure if my first response went through. I will reply again just in case.

    This is related to Hospice only. Unless, you can think of a similar type of situation. Our organization separates Hospice Admission Nurses and Case Managers. Some organizations have their Case Manager do admissions and case management.

    Admission nurses go to patient's home, SNF or hospital, assess pt for eligibility, consult w Med Director for approval, then review consent forms, educate, reconcile meds with MD and review orders, profile meds with Hospice Pharmacia, order DME and then complete computer documentation - Build Care plan, flow sheet, vitals, enter orders, enter Level of care, team, dx, allergies, Code status, HCP, wound assessment form and then do a series of clinical assessment screens.

    There is more to the admission process of course, with complex cases....patients with drains, IVs, Pumps, wounds, extreme emotonal distress, depression, fear, SOB, Anxiety, pain...etc.

    Thanks for any info you can provide.
    Last edited by cougarnurse; 09-15-2013 at 11:21 PM.

  4. #4
    Super Moderator cougarnurse's Avatar
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    OK.....was wondering about pre-scheduled procedures at hospitals, LTC, etc.

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