Probari perspective - The 5 Elements of an Admission Review

Let’s face it - nursing home operators and clinicians are often set up for failure when it comes to safely and effectively transferring a resident into facilities.  If reports are called at all, they can be brief and missing key details.  Discharge packets are either too small (without the needed information) or too big (so much info you don’t know where to start).  The nurse is given an impossible decision between finding the necessary resident information or taking care of the patient.

Many providers that we have worked with have started doing routine admission audits either on the day of admission or in the days following.  Since this is something we do quite often, we wanted to share the 5 big areas that every admission audit must have.

1. Medication Reconciliation - There is an amazing phenomenon that takes place when a patient goes to and from a hospital…they lose and gain medications.  Sometimes new meds are not entered as orders, but mentioned in narrative notes.  Other times old medications that the resident hasn’t been on in years suddenly get reactivated.  And then there is the case when the doses get tangled up in transition.  The bottom line is that things must be compared from the hospital record and the nursing home.
   
   PRObari Tip - Line up the DC instructions next to the admitting med list and compare. Look for dosages, frequencies and duplicates.
   
   
   

2. Treatments and Therapies - We see a lot of different treatments and therapy orders that are hiding in notes or not in the places that are most obvious. However, these are critical areas that often have unique monitoring and care orders associated with them, so identifying them from the start and educating your staff on what to do with that information is important.
   
   PRObari Tip - Make sure every wound, line, and device has an order associated with it.
   
   
   

3. Equipment - This can sound obvious, but we often see unique equipment coming to the facility that the staff may not be trained on. Sometimes we do not see evidence that the equipment is getting used in the first days of care, or it’s unclear if it’s working properly. Staff need to understand what the equipment is for, how to use it and when to know it’s not working properly.
   
   PRObari Tip - When you identify an unfamiliar piece of equipment with a resident, make sure the orders and the instructions are nearby for the nurse to reference quickly. Also - inservices are great!
   
   
   

4. Follow up appointments - Our team is always scanning for upcoming appointments that the residents might have. Just like meds, these can slip through the cracks and never get scheduled. If they are scheduled to be seen while the resident is at the facility, setting these up early to arrange for transportation will greatly help. If they are scheduled for their appointment after they discharge, this then can be communicated to the family so they are aware.
   
   PRObari Tip - We find appointments often in the dictations from the hospital physicians, and not always in the discharge instructions. If you have access to the medical records, it’s worth your time to dig for a few minutes.
   
   
   

5. Advance Care Planning - Advance Directives and goals of care planning are important to the Probari team, because residents and families should have a chance to weigh in on the kind of care they receive. Many times we see that Palliative Care teams or others at the hospital took time to have these types of conversations with the resident and family, but these orders were never updated and the facility is often unaware.  A scenario we never want to see is unwanted care delivered or not delivered due to improperly communicated goals of care.
   
   PRObari Tip - Scan the hospital records for any provider notes that pertain to goals of care.  If so and the orders haven’t been changed, the conversation can be revisited with the resident and Advance Directives updated  Also, If appropriate, ask the family if they discussed advance directives or palliative care in the hospital.

If you have any follow up questions or would like more information on how Probari can help bridge the gap at admission for your care team, please contact us by clicking here.