Appendix 6
Admission/Transfer Checklist
Name / Date of Birth…..../…../….. / RiO number
……………..
Ward / Date of admission/Transfer / …..../…../…..
Admitting Nurse name / …………………………….
Nominate Named Nurse / …………………………….
Nominate Named Nurse / …………………………….
Person responsible for ensuring completion / Yes ü / N/A ü / Completion Date and Sign
To be completed prior to admission/transfer
FACE Risk Assessment / Referring professional
Mental Health Clustering Tool / Referring professional
RiO Documentation up to date and complete. / Referring professional
Has an OT assessment taken place? / Referring professional
Full physical investigations including bloods up to date. / Referring Team
CPA Meeting (including team from ward referred to)
CPA document all up to date / Referring professional
Arrange unit visit (invite carers if service user agrees) / Referring professional
Arrange transfer date/time on consideration of Mental Health Tribunal arrangements (report completion and attendance) / Referring Team
Statement of risk / Referring professional
IR1 summary / Referring professional
Contact Carers/Professionals involved and inform of transfer / Referring Team
RC1 form – change of Consultant responsibility to be complete / Consultant prior to transfer
Complete appropriate section of H4 form – authority for transfer from one ward to another under different managers – if applicable. / Referring Nurse
Arrange Named Nurse/Named Nurse handover / Referring Nurse
Transfer of medication/kardex and handover of date injection due if applicable and medication requiring pharmacy order / Referring Nurse
Update RiO bed state and bed board / Referring professional
For completion on day of admission/transfer
Ask service user how they would like to be addressed / Admitting Nurse supported by Nursing Team
Service user made to feel welcome and orientated to the ward. / Admitting Nurse supported by Nursing Team
Welcome pack given admits content explained and discussed with the service user / Admitting Nurse supported by Nursing Team
Inform all parties involved of admission/transfer including:
Next of Kin
Carers
All Members of the MDT
MHA Office (if applicable) / Admitting Nurse supported by Nursing Team
Contact carers and offer to meet within 7 days
Complete Property list on RIO / Admitting Nurse supported by Nursing Team
General Physical Observation:
· Height
· Weight
· BMI
· Blood Pressure
· Pulse
· O2 Stats
· Temperature
· Waist
· Resps / Admitting Nurse supported by Nursing Team
Seen By Doctor following completed:
· Full Physical Examination (including bloods & urinalysis) if not already complete
· Core Clinical Assessment
· Drug Kardex Completed
· Care Co-ordination risk assessment updates
FACE risk assessment / SHO/Admitting Nurse
Initial risk management plan / Admitting Nurse
Initial Care Plans:
· Observation
· Leave
· Orientation / Admitting Nurse
Acquire purple RIO back up file (if this did not arrive with service user / Admitting Nurse supported by Nursing Team
Order Medication / Admitting Nurse
If any allergies/sensitivities noted ensure this is:
a) Noted on RIO
Indicated on prescription sheet / Admitting Nurse supported by Nursing Team
If prescribed depot injection forward in diary / Admitting Nurse supported by Nursing Team
Any appointments including clozapine bloods to be forwarded in diary / Admitting Nurse supported by Nursing Team
Check MHA Status
Ensure relevant section papers in RIO support file. / Admitting Nurse supported by Nursing Team
Check section 17 leave is up to date and agreed leave appropriate for ward area arrange for Section 17 Leave to be rewritten / Admitting Nurse
Check T2 or T3 if applicable / Admitting Nurse supported by Nursing Team
Ensure Capacity assessment is current
Complete H3 form –right providing service user with relevant leaflet. / Admitting Nurse supported by Nursing Team
Complete appropriate section of H4 form – Authority for transfer from one ward to another under different managers / Admitting Nurse
Observation Status discuss with service user and documented. Service user provided with leaflet identifying there observation level / Admitting Nurse supported by Nursing Team
Please ensure all incomplete tasks above list are forwarded in the ward Diary
Follow up information to be completed in 7 days
LUNSERS / Named Nurse in collaboration with service user
Recovery Star initial session introducing the tool / Named Nurse in collaboration with service user
Complete Nutritional Tool ( care planning where necessary) / Named Nurse in collaboration with service user
Complete Self administration Assessment (in preparation for first MDT) / Named Nurse in collaboration with service user
Care planning session with service user, using recovery star to assist in formulation of relevant goals and SMARTER care plans / Named Nurse in collaboration with service user
Devise individualised weekly activity planner / Named Nurse in collaboration with service user
Arrange first MDT (within a 6 week period) / Named Nurse
Ensure service user is Registered with a GP / Associate Nurse
Apply for Bus Pass / Associate Nurse
Open Bank Account / Associate Nurse
Following referrals to be discussed where applicable:
· Optician
· Dentist
· Dietician
Smoking Cessation Nurse
At first MDT Review
Mental Health Clustering Tool (MHCT) / MDT
Initial Formulation (Main areas of need, consider how problems are maintained and goals / MDT
Re-visit FACE risk documentations and formulate risk / MDT
Formulate goals for placement in keeping with service user goals / MDT
Plans for discharge including flexible time scale / MDT
Carers to be offered “carers assessment / Named Nurse
Carers to be offered carers information pack / Named Nurse
Following first review (maximum 6 weeks)
Comprehensive Recovery Star / Named Nurse in collaboration with service user
Comprehensive SMARTER Care Plans guided by the service users long and short term goals as identified in Recovery Star / Named Nurse in collaboration with service user
All area of RIO current and up to date / Named Nurse
Complete Getting to know you assessment / Named Nurse and Carer
Every 3 Months
CPA Review Including
· Nursing care plan review & evaluation
· Re-visit formulation
· Risk documentation review
Mental Health Clustering Tool / MDT
Recovery Star Assessment / Named Nurse in collaboration with service user
Up Date relevant areas of RIO / Named Nurse
2
Northumberland, Tyne and Wear NHS Foundation Trust
Appendix 6 – Admission/Transfer Checklist – V03 – Iss 2 – Dec 17
Part of CC-CPA-PGN-01 – Adult PGN – (NTW(C)20–CC/CPA Policy)