TRANSFER AND DISCHARGE

HELE R. NOIME R. GUCE R.N. MSN

 TRANSFER

 A patient may be transferred within the unit.

 The Physician or nurse may request a change of room
because of deterioration in the patient condition.
 Efforts are made to accommodate the request on
vacancy basis.
 Nurse are responsible to document in the record that
the change has been made and the reason. Inform the
admitting dep’t and the information desk of the room
and bed change.
 TRANSFER

 Make sure that all forms and list correctly note the
patient new location.

 When patient is transferred to another unit or facility,

nurse are responsible for carrying out certain
procedures that will make the transition as smooth
and nonstressful as possible for the patient and the
receiving staff.
 PROCEDURES

 Obtaining the order of transfer

 Notifying appropriate person
 Interacting with the patient, including reenforcing any
health teaching.
 Caring for the patient’s personal property.
 Completing and duplicating records, assessment data and
care plan
 Arranging transportation
 Giving report.
OBTAINING ORDER FOR TRANSFER

 A physician usually writes the order of transferring a patient

within the hospital or to another facility
 If there is some nursing reason for transfer such as inability
to provide a room or equipment for special patient need,
notify the physician, who will then write the order.
 In an emergency the transfer is made and the physician
writes the order later.
 A physician order must be obtained for transferring a
patient.
NOTIFYING APPROPRIATE PERSONS

 You are responsible to notify all persons involved in

the transfer.
 These includes the nursing supervisor, admitting
department, the patient’s family, and the unit of
facility that is receiving the patient.
 The discharge planner may already have made these
contact.
INTERACTING WITH THE PATIENT

 Patient has the right to know the transfer plans.

 Transferring frail, sick, older people without their knowledge
takes away their right to decision making about their own
health care.
 Transfer from a familiar long term care setting to the hospital
and from an acute care setting to long term care may each be
upsetting.
 If you note any signs of anxiety about the transfer spend time
with the patient and the family, allowing them to talk about
their concerns.
 CARING THE PROPERTY

 Make sure that all personal property is checked and

accompanies the patient being transferred when
appropriate.
 The resident of a long term facility may be returning
to that facility to reside after an acute hospitalization.
COMPLETING OR DUPLICATING RECORDS,
ASSESSMENT, AND CARE PLAN

 If the patient is being transferred within the facility, gather

all assessment forms and care plan, bedside equipment, and
plastic identification card. Review the assessment and care
plan for completeness and accuracy.
 It is essential to update the data and care plan just before
the patient leaves. This provides the receiving staff with the
current assessment and identification of any unresolved
patient problems.
 Remember that these documents are confidential and
should be given only to authorized persons.
ARRANGING TRANSPORTATION

 When the patient is being transferred from the

hospital to a nursing home or another facility, the
discharge planner often makes arrangements for an
ambulance.
 When critical care is needed, the nurse may take
arrangements, particularly when the patient needs
special equipment, such as oxygen or maintenance of
intravenous therapy, or specialized personnel or
critical care nurse
 GIVING REPORT

 When the patient is going to the other unit of the same

facility, call a new unit and go with the patient so that
you can give the nursing staff a verbal reports and
answer any questions.
 When the patient is transferred to another facility,
duplicate the records and make a telephone call to the
receiving staff, giving them comprehensive report
regarding the patient.
 Record may also be faxed.
 Occasionally, patient becomes disgruntled or
impatient and demands to leave the facility without
the physician order for discharge.
 An AMA form is completed and signed by the patient
before leaving, releasing the facility of any
responsibility
Planning for Continuity of care

 You are responsible that plans are made for continuing of care
as needed.
 You as a nurse often identify an ongoing patient need that
could be addressed by a community agency.
 Making referrals to agencies that provide a variety of home
services is becoming a vital extension of home care.
 Encourage patients to call the unit or the physician if they have
any concern
 When post discharge call is made it should be documented for
legal purposes.
 DISCHARGE

 When you are planning for a patient’s discharge your

responsibilities are the following:
 Obtaining order for discharge
 Planning for continuity of care
 Providing patient teaching
 Performing final assessment
 Caring for personal property
 Performing business functions
 Documentation
Obtaining Order for discharge

 An order is needed to be discharge.

 No business documents or final paper are started until
the precise time of discharge is determined.
 If you have been told verbally that a patient is to be
discharged but the order is not yet written, you may
sometimes complete such tasks as ordering take home
medications and making patient assessment before
the actual discharge order is written so that the
patient’s departure is not delayed.