Purpose for the Program
Let's face it, today the “buzz word” is budget—save time and money anyway you can. In a “feast or famine” unit, it can be unclear as to how that can be accomplished. Think outside the box! Is it possible to save time before a patient even gets admitted? By implementing a preadmission process, the answer is “yes.”
This process starts with the physician. The physician should inform the patient at her 35- to 36-week-of-gestation appointment that she will need to meet with the preadmission nurse. The patient is given the preadmission nurse's business card and is instructed to call and make an appointment. The proposed change for this implementation is to establish who is going to serve in the role of preadmission nurse. Consistency is key to ensure that all patients receive the same information.
Implementation, Outcomes, and Evaluation
The patient meets with the staff from registration to obtain a prenumbered patient account. This inactive account will sit dormant in the hospital census until the patient's full admission date of service. The patient is welcomed into a private office where a full up-to-date medical history is obtained from the prenatal record and the patient. All maternal/fetal risks and complication to date are obtained, current medication regimen is updated, and a family medical history is completed. Consents for obstetric care and newborn care are obtained, advanced directives are discussed, and pediatrician information is obtained.
After all consents have been discussed patient education begins (detailing what the patient should expect). After questions have been answered, the patient is offered a full tour of the unit, including the labor room, triage, and newborn nursery.
This process has been shown to increase focused bedside care at admission for nursing staff by almost 50%, which reduces the traditional admission time from 45 to 60 minutes to nearly 15 to 30 minutes! This added time also benefits the physicians because their patient care will not be delayed by waiting for nursing admission tasks (e.g., starting an intravenous line or monitoring) or completion of the patient chart before scheduled patient care (e.g., induction or cesarean delivery).
Implications for Nursing Practice
Overall, quality patient care starts before the patient is even admitted. The success of implementing a process that can show the patient we care about them and strive for excellence even before they are admitted is proven by an increase in patient satisfaction scores.