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 occurrence was a patient being discharged from a local hospital. The patient arrived at the facility during late afternoon with limited documentation and illegible physician orders. The patient had a diagnosis of terminal cancer and chronic pain. This situation left the staff unable to meet his immediate needs. Unsuccessful attempts in reaching the admitting physician to obtain narcotic hard copies and verification of additional orders resulted in the patient returning back to the hospital due to a pain crisis. This is an example of how poor collaboration and medication discrepancies can be detrimental to patients.
Further research into my experience has revealed similar scenarios being played out across long-term care facilities nation wide (Kirsebom, Wadensten & Hedstrom, 2013). Premature discharging from hospitals has resulted in medication discrepancies, incomplete discharge orders, and inappropriate medical treatments. Recent studies show that three out four skilled nursing facility admissions experience medication discrepancies from the discharging institute (Tjia, Bonner, Briesacher, McGee, Terrill & Miller, 2009).
The majority population of long-term health facilities is comprised of geriatric patients...