Nursing Home Procedures on Transitions of Care

Objective: To identify nursing home standards through a nationwide survey of directors of nursing regarding transitions of care for residents transferred from acute care hospitals to skilled nursing facilities (SNFs). Methods: A national survey was distributed online and was completed by 241 directors of nursing of SNFs. The directors of nursing were asked about communication methods, transfer of records, and staff involvement with admissions from acute care hospitals. Results: The results of the survey demonstrated widespread use of an admission coordinator in the nursing home to direct admissions to the facility. Admission nurses consistently had the most responsibility for ascertaining the correct medication regimen on admission to the facility. Although there was a variation in types of records received from the hospitals, more than 80% received medication administration record or discharge/transfer sheet within 1 hour of a patient's arrival. Conclusion: The results of this survey demonstrate that although direct verbal communication is not the norm, communication via paper documentation of transfer information is highly common. There was a statistically significantly increased likelihood of the SNF receiving the discharge/transfer sheet and the last medication list when it was directly affiliated with the transferring hospital. These affiliations would increase as a result of proposed payment changes that would bundle Medicare Part A acute hospital payments with the SNF payment. (J Am Med Dir Assoc 2009; 10: 634-638)