Week 6 Notes Doc PDF

Clients Safety, Ergonomic Principles, Moving and Positioning Patients, Admissions Transfers and Discharge Client Safety The Joint Commission, the organization responsible for evaluating & accrediting healthcare organizations & programs in the U.S. Factors contributing to an unsafe p...

Clients Safety, Ergonomic Principles, Moving and Positioning Patients, Admissions Transfers and Discharge Client Safety The Joint Commission, the organization responsible for evaluating & accrediting healthcare organizations & programs in the U.S. Factors contributing to an unsafe patient environment: - Age & Ability to understand (make sure pt can comprehend based off their age and learning style) - Impaired mobility (bed bound pt, lack of balance, etc) - Communication (must be able to effectively talk w pt) - Pain & Discomfort (can cause agitation and restlessness; we MUST promote comfort and believe what patient says about their pain) - Delayed Assistance (answering call lights and bed alarms promptly and listening to what pt says they need) - Equipment (make sure it is in service and working; know how to use properly) Fall Assessment Rating Scales- forms that when filled out, give a numerical rating for each patient's risk for falls. The higher the number the greater the patient risk (0-10) Preventing Falls - Individualize care plan in relation to fall-risk assesment - Place call light within reach, respond to light in timely manner - Watch out for Fall-risk alert wristbands - Safe environment (adequate lighting, low positions bed, clean/decluttered floor, items within pt reach - Place fall-risk patients near nursing station - Do frequent hourly rounds - Use assistive ambulation devises, keep near by - Sedated or unconscious pt keep bedside rails up Restraint Alternatives  - Vests, Jackets, or bands with connected straps that are tied to the bed, chair, or wheelchair to keep the patient in one place. - Monitors (chair monitors, bed monitor, or position alarm) a pressure sensitive device that generate an alarm sound at the nurse station when the patient’s weight is no longer sensed. - Soft Devices- include bolsters that can be placed in the bed on either side of the patient to prevent them from slipping between or through the side rails. Restraints - Also known as,” protective devices” “safety reminder devices” “Posey's” - Avoid restraints at all costs, should be a last resort (least restrictive methods FIRST) - Must have a healthcare provider order for restraints - Order should include date, time order initiated, type of restraint, location of restraint, alternative methods used first, reason restraint is to be placed, the specific period it is to remain in place, and signature of the ordering healthcare provider Guidelines for Restraints - Check on patient every 30 minutes. Making sure to check the skin for redness or chafing under the restraint & the extremities for warmth & Color. - Remove the restraint every 2 hours, while restraint is off o Offer fluids to the patient o Assist with toileting as needed o Change patient position if they are in bed o Assess the extremities for edema, capillary refill time, sensation, & function. o Assess skin over pressure points o Assist the patient to ambulate if that is appropriate o Stay with the patient the entire time the restraint is off - Document all actions on the appropriate flow sheet Actions to take if a patient has fallen - Check the patient for obvious injuries. Look for bleeding, check level of consciousness, assess for signs of hip fracture, observe for deformities at any joint, and assess for paralysis or weakness on one side of the body. - Call for help - Take the patient vital signs - If the patient is not conscious, has unstable vital signs, or is not breathing, or is without a pulse, call a CODE BLUE immediately  - Assist the conscious patient to bed with the help of others following facility policy. - Notify healthcare provider. Explain what occurred and give the patients current condition, be prepared to take orders for X-ray and other test. - Document the incident according to facility policy. An incident report must be completed. Charting should include details of finding the patient, vital signs, assistance to bed, notifying healthcare providers. If there is a fire in your area (R.A.C.E) Rescue- remove patient from immediate danger to a safer area of the hospital. Alarm- sound the fire alarm according to facility policy. This may involve dialing an extension or pulling a fire alarm box. Confine- Confine the fire to one room or area. Close the doors according to hospital policy. Fire doors automatically close to help confine the fire to one wing of the hospital. Extinguish- you should only attempt to extinguish a small fire with a fire extinguisher. To extinguish a small fire, obtain the nearest fire extinguisher and follow P.A.S.S Pull the pin found between the handles Aim the nozzle of the fire extinguisher at the base of the flames Squeeze the handles together to release the contents Sweep the nozzle back and forth at the base of the flames to extinguish the fire Types of hazards to nursing staff - Physical hazards: o injuries to back and joints. o repetitive motion injuries such as carpal tunnel syndrome, o exposure to lasers, which can injure the eye if you do not use PPE o Exposure to radiation - Chemical hazard: o exposure to cytotoxic medications and treatments such as those used in chemotherapy o exposure to other chemical including cleaning fluids. - Biological hazards o Include blood and bodily fluids contaminated with HIV or hepatitis virus  o Exposure to influenza virus o Exposure to epidemics and pandemics Minimizing Physical Hazards - Body Mechanics o Involves using the joints & leverage of the body to your advantage o Working with what your body is designed to do rather than working against it. - Follow these guidelines o Plan your work carefully. Think through how to do it safely! o Elevate your work to a comfortable level (raising head of bed ) o Keep your feet shoulder width apart, one foot slightly ahead of the other o Avoid twisting. Turn your whole body or pivot on one foot. o Bend your knees when lifting heavy objects o When carrying an object, hold it close to your body with your elbows bent o When possible, push, pull, or slide heavy objects rather than lifting them. o Get help when you need to move or lift a patient. - Adequate rest Ch 16 Moving and Positioning Patients Effects of immobility Complications include - Blood clots - Pneumonia - Bone demineralization - Kidney stones - Constipation - Pressure injuries - Urinary retention - Depression - Contractions Effects on Immobility on the Musculoskeletal System -Muscle Atrophy: muscles decrease in size, tone, and strength as a result of disuse. -Contractures: shortening and tightening of the muscles because of disuse  -Osteoporosis: a condition that occurs because of loss of bone minerals; it leads to an increased risk of skeletal fractures Sarcopenia: loss of lean muscle mass To prevent Musculoskeletal Complications -Maintain proper body alignment, which means to keep the head, trunk, and hips positioned in a straight line - Correct body alignment should be maintained while the patient is in supine position - Use range of motion (ROM) exercises - Perform ROM exercises every 8 hours to maintain muscle strength and flexibility in addition to joint flexibility. -Ensure that you support the weight of the extremity at the joints during passive ROM exercises Correctly apply any supportive or therapeutic devices for maintaining proper body alignment, such as a trochanter roll or foot-drop splint, and follow the orders for their use exactly. A trochanter roll is a rolled towel or cylindrical device placed snugly against the lateral aspect of the patient’s thigh to prevent the leg from rotating outward. Some facilities use footdrop boots, a splintlike padded device that supports the foot in proper plantar flexion and suspends the heel over a small pocket of air, thereby reducing the risk of pressure injuries and footdrop. Assist patients out of bed and with ambulation as soon as orders permit to limit the demineralization of bones. Active VS Passive Range-of-motion exercises - Active ROM exercises are performed by the patient without physical nursing assistance. The nurse may remind or encourage the patient to perform the exercises, but the patient Is able to move all extremities independently. - Passive ROM exercises are done with the nurse performing the exercising of the patients joints while providing proper support to the patient’s extremity. Passive exercises are indicated when a patient is too weak to move his or her own extremities or when one or more extremities are paralyzed. Effects of immobility on the cardiovascular system - Bedrest results in 50% reduction of blood flow to the legs and contributes to venous stasis, pooling of blood in the veins of the lower legs. - When the patient is lying down rather than sitting or standing, the heart must work harder to pump blood throughout the body. - When a patient is confined to a bed, they may develop a blood clot, which may then dislodge and travel through the veins. - (DVT)Deep vein thrombosis: A clot that develops in the deep veins of the legs. These types of clots can impair circulation in the limb.  - Embolus: a traveling blood clot. The clot breaks away from the vein wall in the leg and travels through the bloodstream. o Once the embolus becomes lodged so that it blocks blood flow to a portion of a vital organ, oxygen and nutrients are prevented from reaching the tissue, resulting in the death of the affected cells. ▪ (PE)Pulmonary Embolus: occurs in the lungs. ▪ (MI)Myocardial infarction: Occurs in the heart or known as heart attack. ▪ (CVA) Cerebrovascular accident: occurs in the brain or known as stroke. o An embolism to any of these 3 vital organs may result in death. - Orthostatic hypotension: a decrease in blood pressure that occurs when a patient changes from a reclining or flat position to an upright position, such as sitting or standing. o If the blood pressure falls too far, patient may experience syncope(fainting). If patient exhibits any of these signs upon standing, assist them to a sitting or reclining position. Preventative measures for cardiovascular complications o Encourage movement of the extremities. If the patient is unable, you will perform passive ROM exercises. o Apply ordered devices to prevent pooling in the legs. ▪ Antiembolism stockings: closed-fitting elastic stockings that usually cover the whole leg. ▪ Sequential compression devices (SCD): air filled sleeves that are wrapped around the patient’s lower legs and connected to a pump that inflates and deflates each area of the sleeve in a sequence designed to move blood in the legs toward the heart. o Change the patients position from horizontal to vertical. Elevate the head of the bed as much as possible or allow the patient to sit in a chair if permissible. o Remain with the patient the first few times they get out of bed. Effects of immobility on the respiratory system - When the patient is unable to move about and take deep breaths, the result is a decrease in lung expansion and respiratory muscle weakness. - Pulmonary Emboli (blood clots in lungs) are respiratory conditions that can occur in immobilized patients. - Atelectasis (collapsed lung due to pt’s lungs inability to fully expand)  - -Can thicken the mucus secretions in the lungs, making it difficult for the client to expel the mucus when coughing Preventative measures for respiratory complications (Turning, deep breathing, and coughing) o Turn the patient from side to side at least every 2 hours to permit lung expansion. o Elevate the head of the bed 45 degrees or more to promote lung expansion. o Encourage cough and deep breathing exercises every hour while the patient is awake. o Encourage patient to use an incentive spirometer, taking 10 deep breaths every hour to expand the lungs to reach a preset level of inspiratory volume. Effects of immobility on the Gastrointestinal System - Decreased appetite - Lack of peristalsis (natural movement of the intestines) - Constipation---> can lead to fecal impaction if chronic - Flatulence (gas in the stomach) - Distention (bloating) - Indigestion Preventative Measures - Assist the patient to get up in a chair or ambulate at least 3-4 times daily. - Reposition patient at least every 2 hours. - Encourage ROM exercises or provide passive ROM to all joints at least once every 8 hours. - Place the patient in a sitting position to defecate on the bedpan, allowing gravity to assist. - Help the patient select well-balanced, nutritious meals from the menu. - Encourage the patient to choose foods with fiber to help prevent constipation. - Encourage fluid intake of 8oz or more every 2 hours. - Instruct patient to avoid drinking through a straw if intestinal gas is a problem. - If a patient has not had a bowel movement in 3 days, with doctors’ orders administer a laxative or enema as needed, Effects Immobility on the Urinary System - Risk for UTI, because urine can pool in the renal pelvis of the kidney. - Risk to develop kidney stones ( renal calculi)  - Risk for urinary retention (when voiding on a bedpan they are less likely to completely empty the bladder) Preventative Measures - Provide adequate fluid intake to prevent concentrated urine. - Encourage 8oz or more every 2 hours unless they are on fluid restriction. - Assist the patient to urinate in a sitting position to encourage full emptying of the urinary bladder. Male patients may be able to urinate best if they are allowed to stand at the bedside. (Must have doctors order) - Assess the patent output. They should void at least every 8 hours. o If the patient who is properly hydrated is unable to void, they may need to be catharized to drain the bladder. o If patient has not voided in 6-8 hours use a portable ultrasound device to scan the bladder for urinary retention. (With doctor orders) Effects of Immobility on the Integumentary System - Pressure injury, also called skin breakdown or a decubitus ulcer. - Shearing occurs when the skin layer is pulled across muscle and bone in one direction while the skin slides over another surface, such as a bedsheet, in the opposite direction. Preventative Measures - Provide adequate nutrition because tissues need proper nutrients and protein to repair. - Reposition patients in bed at least every 2 hours and those in a wheelchair every hour if they are unable to turn or shift their own weight. - Inspect bony prominences for redness at least every 2 hours. - Use mild soaps to cleanse the skin. - Gentle but thorough drying to maintain skin integrity. - Apply lotions to dry skin after bathing to keep the skin hydrated. - Provide appropriate surface for the patient, such as a mattress overlay, specialized mattress, or specialty bed. Effects on immobility on the Neurological System - Depression, anxiety, hostility, and fear are common adverse effects. - Sensory deprivation may also occur when a patient must lie in bed all day and night, especially if the patient is alone in the room. Patient may experience auditory or visual hallucinations. - Difficulty sleeping when they are unable to get out of bed and be active. Nursing Measures to prevent psychological complications.  - Minimize sensory deprivation by ensuring the patient has distractions to occupy themselves. o Tv, radio, books, magazines, newspapers, and puzzles. - Try to involve their senses with pleasant smells, tastes, sounds, and sights. - Help patient improve sleep pattern by encouraging them to remain awake and alert most of the day. - Allow patient to do as much as possible during patient care. o Helping with their bath o Performing active ROM exercise o Making decisions about their care - Allow patient to express concerns. - Encourage visits from family and friends. Ergonomic Principles Focuses on factors of a objects design (like chairs and beds) that contribute to comfort, safety, efficiency, and ease of use - Bed positions correspond to clients' conditions and physiological needs - Perform mobility assessment prior to moving position of clients Body Mechanics: use of muscle to maintain balance, posture, and body alignment Body alignment: keeps center of gravity, stable promoting comfort and reduce muscle strain  Good body mechanics reduce the risk of injury Center of Gravity -> Center of Mass - To lift an object, you must overcome the weight of objects and know its center of gravity - In upright position –> center of gravity is pelvis - Center of gravity shifts as they move To create a stable base of support - Spread your feet shoulder width apart, bend the hips and knees for greater stability and balance  The closer the line of gravity is to the center of the base of support the more stable the individual is Lifting -> Risk of Injury - Twist while lifting - Lifting in small space - Lifting while kneeling or sitting - Lifting while arms are extended away from body - Working longer than 8hr - Client factor -> combative or uncooperative physical conditions that affect ability to be moved (pain) Tips when lifting - Use major muscle groups to prevent back strain - Tighten abs to support back muscles - Distribute weight to arms and legs to decrease strain - Use assistive devices when possible and get assistance when needed Lifting object from the floor - Flex hips, knees, and back - Bring object to thigh level - Bend knees, keep back, straight - Stand up while holding object close to body (this brings load to the center of gravity) Pushing or Pulling - Widen base of support - Pull towards is recommended rather than pushing away from center of gravity - Push -> move front foot forward - Pull -> move rear leg back - Face direction you are moving to - Use body as counterweight - Sliding, rolling, and pushing is less energy than lifting (decreased risk for injury) - Avoid twisting, and bending back while hips and knees are straight Transfer and use of Assistive Devices  - Evaluate situation, determine safest transfer method (can they bear weight? Can they assist?) - Client’s ability to help with transfer - Evaluate need for additional staff or assistive devices - Monitor use of mobility aids (canes, walkers, crutches) Preventing Injury - Know policy - Have staff assistance (one or more) - Plan to ask for assistance - Prepare environment, declutter - Explain process to pt - Safest way is with assistive devices - Maintain good body mechanics/ alignment - Use smooth movements when lifting Bed and Client Positions Semi Fowlers -> head of bed elevated 15 to 30 degrees (typically 30) - prevents regurgitation of enteral feeding and aspirations by client - Promotes lung expansion for clients who have dyspnea or are receiving mechanical ventilation Fowlers -> supine with head of bed elevated 45 to 60 degrees - Useful during procedures (nasogastric tube insertion and suctioning), allows for better chest expansion and ventilation. - Promotes Dependent draining after abdominal surgery High Fowlers -> supine with head 60 to 90 degrees - Promotes lung expansion by lowering the diaphragm and thus helps severe dyspnea - Helps prevent aspiration during meals Supine or Dorsal Recumbent -> lies on back with head and shoulder elevated on a pillow, forearm on pillows or at their side. Foot support - Foot support prevents foot drop & maintains proper body alignment - Ensure vertebrae is in straight alignment Prone -> pt lies flat on their abdomen and chest, head to one side, back in proper alignment  - Pillow placed under leg, promotes relaxation by permitting some knee flexion and dorsiflexion of ankle - Promote drainage from mouth after throat or oral surgery, but inhibits chest expansion (short term use only) - Helps prevent hip flexion contractures following a lower extremity amputation Lateral or side lying -> lies on side with most weight on dependent hip and shoulder, arm in flexion in front of body - Pillow placed under head, neck, upper arms, and legs and things to maintain proper body alignment - Good sleeping Position - Turn pt regularly to prevent the development of pressure ulcers (30 degrees lateral position for clients at risk of pressure ulcers) Lateral semi-prone Recumbent position -> on their side halfway between lateral and prone positions with weight on their anterior ileum, humerus, and clavicle.  - Lower arm behind them upper arm in front, both legs flexed, upper leg flexed at greater angle than lower leg - Differs from side lying due to distribution of client's weight - Comfortable sleeping position, promotes oral drainage Orthopneic -> sits in bed or bedside with pillow on the overbed table across client's lap for arms to rest on - Allows chest expansion, beneficial for clients with COPD Trendelenburg -> entire bed is tilted with head of the bed lower than foot of bed - Facilitates postural drainage and venous return Reverse Trendelenburg -> entire bed is tilted with foot of bed lower than head of bed  - Promotes gastric emptying and prevents esophageal reflux Modified Trendelenburg -> pt remain flat with legs above their heart - Prevents and treats hypovolemia and facilitates venous return Admission Transfer and Discharge Admission - During the admission process you will make your first impression on the patient - Establish rapport. - Common patient reactions to admissions o Fear of the unknown, caused by a new diagnosis, tests or procedures, pain or discomfort, or even health care providers who are strangers. o Anxiety, which can be caused by problems with childcare during hospitalization, effect of hospitalization on one’s job, the cost and expenses of hospitalization, and separation from familiar surrounds and significant others. o Loss of control over things such as attire, modesty, privacy, daily schedule of activities and diet o Loss of identity, because the patient may feel they are just one of many patients, a patient number or a diagnosis. If the patient is a child - Allow parent to hold the child for as much of the admission process as you can. - Physically get down to the child’s level rather than towering above the child.  - Smile and talk softly and slow. - Allow child to hold and become familiar with supplies or equipment that will be used in their care. - Be honest, never tell the child that a procedure will not hurt unless it is the truth. Anxiety - To help decrease anxiety, encourage the patients to ask questions. - Look for signs of understanding as you answer those questions. - Provide a brief but factual explanation of the patient’s diagnosis. - Avoid the use of medical terminology unless it is clear the patient understands it. Loss of control - Sharing a room with another patient - Sleeping in a different bed - Using a different toilet - Eating whatever food is provided regardless of how It was prepared. - Being forced to accommodate facility’s schedule. - Being awakened during the night for the provision of nursing care - Being disturbed by the normal hospital noises - Attire and modesty (having to wear a gown) - Loss of Identity - Patients feel loss of identity because they now have a room number, patient number, and call light they must use to obtain assistance. - Always address the patient appropriately “Mr” “Mrs” Admitting Procedure - Admitting staff obtains demographic data. - Form for “Authority to treat” - Identification bands Nursing responsibilities during admission - Introducing yourself, including your credentials, smile. - Check identification band. - If patient has roommate introduce patient to each other - Orientation should include. o Location of the nurse’s station in relation to the patient’s room o How to use call light o Location of bathroom o How to use telephone o How to operate bed. (Explain bed should be kept in its lowest position) o How to adjust lighting o How to operate the television o Location of personal items o Times meals are served, and any dietary restrictions ordered by the doctor. o Location of the cafeteria and snack machines  o Hours that you will be their nurse and how often your visits are to be expected. o Any policies for family, like visitation times, cell phone usage, tobacco use policy o When the doctor normally makes visits. - Admission Kit o Most hospitals provide a water bottle or large mug with a straw for water. o Personal items such as a toothbrush and small tube of toothpaste or lip balm are available if needed. o Provide a bedpan and urinal as appropriate. o Help if needed to undress and put on hospital gown. - Personal belongings Inventory o Complete an inventory of clothing and personal items, such as eyeglasses, dentures, and hearing aid. o Instruct patient to send all valuables such as, money, credit cards, or jewelry home with family. o Whatever you list on the inventory is what the hospital is responsible for returning to the patient. You must document only OBJECTIVE data. During the interview, it is important to obtain a thorough patient medical and surgical history, as well as a social history, including the following: - Diseases, injuries, and surgeries experienced by the patient. - Family medical history - Food, drug, seasonal, latex, or environmental allergies - Current prescription and over-the-counter medications, herbs, nutritional supplements, and illicit/recreational drugs - Pertinent health habits practiced by the patient, such as a special diet, use of sleep aids, smoking and tobacco use, alcohol use, dependence on laxatives for regular bowel movements, or use of assistive devices. - List of the patient’s complaints, such as discomfort, nausea, weakness, congestion, shortness of breath, fatigue, or itching - Living arrangements, such as whether there are stairs in their house and whether they live alone, with a spouse, in an assisted living facility, or with children. - Employment and type of work performed. The initial physical assessment should include: - Vital signs, including blood pressure, temperature, pulse, respirations, and oxygen saturation level, in addition to pain level, location, and characteristics. - Level of consciousness - Orientation to person, place, time, and situation - Auscultation of heart, breath, and bowel sounds - Assessment of bowel and bladder status and habits - Examination of pupils, mucous membranes, and skin - Peripheral pulses, capillary refill, color, temperature, range of motion, and strength of all extremities  - Actual weight and height, which should be assessed because most individuals are inaccurate when they are asked their weight and height Analyze Data - discharge planning should be initiated during the admission process. - You should collect data regarding the patient’s living arrangements; physical limitations; and ability to perform activities of daily living, such as bathing, dressing, toileting, and meal preparation. This provides you with a better picture of the patient’s current needs and needs that must be addressed in planning for discharge. Discharge - The primary goal when a patient is hospitalized is to keep the patients stay as short as possible. - Ensuring doctors order is in the (HER) electronic health record. - Reconciling medication - Providing discharge instructions - Assisting the patient with gathering their personal belongings and valuables - Documenting the patient’s condition, including vital signs - Assisting the patient to the car - Documenting the time of discharge and method of transportation - Notifying housekeeping so that the room can be cleaned. Discharge Teaching - Teaching about the patient’s illness and how it affects the patient’s life - Teaching dietary alterations to meet the patients’ needs. - Teaching safe and effective use of medications - Teaching how to perform treatments, such as testing finger-stick blood sugar levels, dressing changes. - Teaching methods of adaptation for daily living - Recommending support groups - Assessing the need for further care after discharge - Assisting the family to find a long-term care or assisted living facility that will meet their needs. Leaving against medical advice - If patient leaves before the doctor authorizes a discharge, this is known as leaving against medical advice. - You must attempt to reason with them and to explain why it is not in their best interest to leave. - If that fails, you will ask the patient to sign AMA form, which releases the hospital and physician from responsibility for the patients’ health status after they leave. - If the patient refuses to sign document in the nurses’ notes that the form was offered but the patient refused to sign it. Reconciling Medications  - The medication list must be reconciled with the prescription and over the counter medications the patient was taking at home and with their health care providers order while the individual was a patient in the facility. - It is the nurse’s responsibility to use caution when comparing the names of medications, the patient is taking before admission and comparing them to any new orders or dosage changes ordered at discharge. Discharge Instructions - Discharge instruction form includes. o When to return to the doctor office for a follow up o List of medications and how to take them, side effects. o Modifications or restrictions of diet/activity level o Signs and symptoms of worsening condition o Care if treatment that the patient is to continue at home. - After reviewing, ask the patients for questions and verify understanding. - One copy is given to patient and one copy in the patient’s chart. Final nursing responsibilities’ - assist the patient to gather personal belongings together. - Make certain any assistive devices such as eyeglasses, hearing aids, and dentures are safely placed with the personal belongings. - Check to see if the patient has valuables locked in the hospital safe. - Remember to have the patient sign the form for the receipt of the valuables and then sign the form yourself. - Discontinue any equipment and tubes that are to be removed before discharge and assess the patient’s vital signs if they have not been assessed within the last hour. - Document the patient’s condition and vital signs in the nurse’s notes, along with the time the patient actually leaves and the method of transportation. Patient Transfer The simplest transfer is the transfer of a patient from one unit to another unit within the same facility. To complete this type of transfer you will need to: - Obtain the physician’s order for transfer. - Explain the reason for the transfer to the patient and family. - Safety: Reconcile the patient’s list of medications, both prescription and over the counter, with any home medications and new health-care provider’s orders to ensure that nothing has been duplicated or omitted. - Gather the patient’s personal belongings, medications, and nursing supplies. - Complete a transfer summary form, which is used to document the patient’s condition and the reason for transfer, and a comprehensive list of the patient’s medications. - Phone a full report of the patient’s condition and plan of care to the receiving nurse on the new unit. - Document the time of transfer in the nurse’s notes. - Transfer the patient with all his or her belongings and chart to the new unit.