Planning for the unplanned: They ARE eventually going to leave!
Jacqueline Vance, RNC, CDONA/LTC
OK, in the title I'm not talking about your proverbial brother-in-law who is staying on the couch, or your college-graduated kids ... because we all know they're NEVER leave going to leave. I'm talking about your residents.
Let's be honest here, one day your resident is going to have to leave the facility. I mean, basically transitions will happen in two ways: the ones we plan for, and the ones we don't.
But guess what my friends? We can plan for the transitions we don't plan on! Hang with me. I know I'm confusing you. (I confuse myself a lot, but this will make sense in a minute.)
Oh, let me just say one thing. (OK, I lied … when do I ever say just one thing?) I REFUSE to call the process of a resident leaving any place of service to another place a “discharge.”
First of all, the word “discharge” itself is just disgusting. BLECH! Next, when you think about what we are doing, we are not “discharging” anyone anywhere. We are handing a person off to another level of service or another provider — even if the person is going home. (They all have a primary care practitioner, right?). So no more “discharge.” Let's just say transitioning, OK?
Let's look at this further. Pretty much every one of your residents is going to transition sooner or later. This will either be planned or unplanned. So why not get ready for it now, while you have time to prepare for it when it's not emergent and you have time to gather most of the information you need. (Wow, I'm starting to make sense!)
Think about this: What generic information does every resident need to accompany him or her? Perhaps the resident's name, the primary diagnosis for admission to your facility, medical history, allergies, copies of advance directives including AND/DNR status (Allow Natural Death/Do Not Resuscitate), and your facility's name and contact information (including phone number of facility and wing/unit).
You'll also want the attending practitioner name and contact number, any barriers to communication, cognitive issues that impair decision-making (and who should be contacted for decision-making if there is impairment), ability to feed self, special dietary needs (e.g., pureed foods, low-salt diet), prognosis and goals of care, and anything else the team feels is appropriate for a smooth transition.
Then all you need to do is add that last-minute information such as: reason for transfer (i.e., the acute change in condition or problem leading to the transfer), all current diagnoses, vital signs, any medical devices and/or lines (e.g., central line, dialysis site, oxygen, pacemaker), any wounds, current lab results and tests (and any with results pending), current accurate medication list, and anything else your team deems appropriate.
Almost ready to go!
But here are two last tips if transitioning to an emergency room. First, find out ahead of time if your emergency transport service needs a copy of any of this transition paperwork or you'll wind up with a call from the ER stating that they didn't get any transition information.
Next, separate the financial information (and label that administrative/payer information) from the clinical information (and label that Clinical Emergency Services staff). This is because many ERs have rules where the payer information can't be seen by the clinical staff and your transition information sits at a desk and doesn't make it back to the clinical staff. (I know, crazy right? But this little step could save some big headaches along the way.)
So, plan for the unplanned.
Oh, and tell that brother-in law and your kids that it's time for them to “transition.” You'll be happy to supply the paperwork!
Just keeping it real,
Jackie is written by Jacqueline Vance, RNC, CDONA/LTC, a 2012 APEX Award of Excellence winner for Blog Writing. Vance is a real life long-term care nurse. A nationally respected nurse educator and past national LTC Nurse Administrator of the Year, she also is an accomplished stand-up comedienne. She has not starred in her own national television series — yet. The opinions supplied here are her own and do not necessarily reflect those of her employer or her professional affiliates.