Admission, Transfer, Discharge, & Delegation Basics
On admission to unit or transfer the patient must be assessed by a Registered Professional Nurse.
Admission and transfer of patients to unit is based on acuity (how “sick” is the patient).
Nursing Units cluster patient types (oncology, ortho, telemetry) and by acuity (med-surg, telemetry and
critical care)
Long term care have different levels of resources – independent, assisted living, skilled care,
maintenance care
When patient has admission into a healthcare encounter - Discharge Planning begins with admission –
(unless admission is in long term care which now becomes their new community home)
DMETHOD
Discharge planning process should be initialed asap after patient’s admitted
D = Diagnosis – focus on prevention (primary health promotion - prevention), causes and early
identification (secondary health promotion – screen) of signs (objective/measurable) and symptoms
(subjective).
M = Medication Continuity (make sure med reconciliation is conducted on new admissions to assure no
maintenance medications are missing).
Emphasize proper taking of medication with 5 R’s. During medication in healthcare setting,
assure patient teaching occurs with each dose. Make sure teaching is documented in the
patient’s medical chart. (some meds like insulin special education sessions such as with Diabetic
Educators will be set up to assure patient is safe for self-administration)
Emphasize what to recognize for side effects, adverse effects and what to if develops
E = Environment: Prevent Injury
Modify (home) living environment to promote safety, for example decrease risk of falls by
removing scatter rugs, have handrails installed on steps, bath tub area
T = treatment = rehabilitation (tertiary health promotion)
Emphasize need to continue any rehab plans, follow up
Encourage family emotional and physical supports
H = health promotion prevention (exercise programs tailored to patient needs) and lifestyle
modifications (i.e. smoking cessation) Teachable moments: Need to know KSAs
O = output follow-up – when, with who, how will they get there
D = diet any special needs now or maintenance (resources for)
Delegation Basics N330
A. Vocabulary
a. Delegation – the process for a nurse to direct another person to
perform nursing tasks and activities.
b. Supervision – the provision of guidance and direction, oversight,
evaluation and follow up by the licensed nurse for accomplishment
of a nursing task delegated to the nursing assistive personnel.
c. Scope of Practice for RNs, LPN, LVN and UAP
i. In 2016, 25 states adopted a standardized and multi-state
licensure which bottom line means the registered nurse needs
to know the regulations that are allowed to perform in various
settings.
B. Delegation
a. Requires nursing judgement decision that are always Outcome(s)
Focused
b. Includes Prioritization (includes evaluation) by the RN - Prioritization
includes deciding which needs or problems require immediate action
and which ones tolerate a delay in action until a later time because they
are not urgent.
c. Knowing the purpose of care, current clinical picture, and the picture of
the outcome or result is necessary to plan priorities.
i. Is it life threatening or potentially life threatening, if the task is
not done?
ii. Would another patient be endangered if this task is done now
or the task is left for later?
iii. Is this task or process essential to the medical or nursing plan
of care?
C. Establishing Priorities
a. Maslow Physiological integrity (essential for survival) and Safety
and Security are top priorities
b. ABC plus V and L (Rosalina Alfaro-Lefevre, 2017)
i. First priority Airway, breathing, circulation, vital signs and lab
values.
ii. Second level mental status changes, untreated medical issues,
acute pain, acute elimination problems, imminent risk
iii. Third level is health problems other than those at the first two
levels, such as more long term issues in health education, rest
and coping.
D. Rules of Delegation
a. Right Circumstances – context (situation) of decision making and
patient condition
b. Right Task – the nurse delegating needs to determine the right task
can be safety delegated for this patient, given the patient’s condition,
and the preferred outcome. This provided the person is competent
(had education and evaluation to determine competency) to perform
the task.
c. Right Person
i. Licensure, Certification, and Role Description
ii. There are more than 100 descriptions of assistive personnel
found across the U.S.
iii. The RN must know the role description of co-workers as well
as own.
d. Right Direction and Communication
i. relay proper instructions Four C’s of Communication; Clear (no
ambiguity), Concise (right amount of information), Correct
(aligned to rules, regulations, or job descriptions, Compete (no
room for doubt).
e. Right Supervision and Evaluation
i. RN is accountable for nursing judgement decision and for
ongoing supervision of any care that is delegated or assigned.