Hospital Admission and Discharge

1. 1. HOSPITAL ADMISSION & DISCHARGE Prepared By Monika Devi NR

M.Sc.Nursing GMCH Jammu
2. 2. ADMISSION DEFINITION • “Admission of a client means, allowing a client to stay
in the hospital for observation, investigations and treatment of the disease he/she is
suffering from.” • “Admission is the entry of a patient into a hospital /ward for
therapeutic /diagnostic purposes.” 2 Monika Devi N R
3. 3. TYPES OF ADMISSION EMERGENCY ROUTINE/ ELECTIVE 3 Monika Devi N
R
4. 4. 4 Monika Devi N R
5. 5. EMERGENCY ADMISSION • Clients are admitted in acute conditions requiring
immediate treatment. • E.g.: patient with heart attack, poisoning, breathing difficulty,
RTA( Road traffic accident) etc • Patient should be admitted in casualty or emergency
department to save the life of the patient. 5 Monika Devi N R
6. 6. ROUTINE/ ELECTIVE ADMISSION • Clients are admitted for investigations and
planned treatment and surgeries. • E.g.: patient with diabetes, hypertension, appendicitis,
jaundice etc 6 Monika Devi N R
7. 7. PURPOSE OF ADMISSION • To receive the patient in ward for admission according
to his/her condition • To welcome the patient • To provide comfort and safety to the
patient • To provide immediate care • To be ready for any emergency 7 Monika Devi N R
8. 8. • To assist the patient in adjusting to the hospital environment • To obtain information
about patient such as address, guardian, any information that serves as a basis of care e.g.
Allergy, diabetes. • To establish Nurse-patient relationship 8 Monika Devi N R
9. 9. CLIENT’S EMOTIONAL REACTION • Anxiety • Fear • Denial • Emotionally upset •
Anger • Sad 9 Monika Devi N R
10. 10. PREPARING THE UNIT FOR ADMISSION • The admitting office notifies the unit
prior to the patient’s arrival, so that the room/bed can be prepared. • Some of the
activities carried out by the nurse before the patient is to be admitted are: • Keeping the
bed ready: open the bed, fold back the bedspread, top blanket, and top sheet. Cover the
bed with full length mackintosh and two bath towels in order to protect from soiling 10
Monika Devi N R
11. 11. • Position the bed: for ambulatory client, the bed should be in normal position. If
client has to arrive on stretcher, the bed should be in lowest position. Make sure furniture
in the room is arranged to ensure easy access to the bed • Assemble the necessary
equipment and supplies : hospital admission pack, which contains items such as drinking
glass, papers, lotion etc should be ready at bedside. A hospital gown should be available,
although the client may choose to wear own clothes 11 Monika Devi N R
12. 12. • Assemble special equipment and supplies: the client may require oxygen therapy,
cardiac monitoring or suction equipment. The nurse should make sure that the equipment
is functioning properly and is ready for patient use. 12 Monika Devi N R
13. 13. PREPARATION OF ARTICLES FOR ADMITTING THE PATIENT Articles
Rationale All articles for an open bed: draw sheet, mackintosh, blanket, bottom sheet, top
sheet To keep the bed ready to receive the patient in a calm manner Full bed length
mackintosh To protect the bed from soiling with excreta/blood etc Two bath blankets/
bed sheets To cover the mackintosh and another to cover the patient 13 Monika Devi N R
14. 14. Articles Rationale Hot water bags in cold weather To keep warm before hand Other
articles required for daily care of the patient e.g. vital signs tray, set of hospital clothes.
To be ready to give care to the patient. To save time & energy of nurse Any other special
equipment such as oxygen, suction, monitoring equipment To meet emergency in life-
saving situations 14 Monika Devi N R
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18. 18. 18 Monika Devi N R
19. 19. ADMISSION PROCEDURE STEPS RATIONALE SCIENTIFIC PRINCIPLE
NURSING PRINCIPLE Prepare room, arrange all items in place & adjust height of bed
To feel safe & secure and easy transfer from stretcher to bed To relieve fear & anxiety
and encourage adjustment Comfort & safety Check patient’s identification and greet
him/her & relatives. Introduce yourself To help them to feel at ease To encourage
adjustment Comfort & individuality 19 Monika Devi N R
20. 20. STEPS RATIONALE SCIENTIFIC PRINCIPLE NURSING PRINCIPLE Observe
client’s vital signs & symptoms for laboratory tests, if required To know condition of
patient on admission, to assist physician in line of treatment To detect any variations
from normal Therapeutic effectiveness Provide privacy. Give admission bath, if needed.
Change to hospital clothes To relax & make patient comfortable. To make important
observations To help in relaxation of patient Comfort & therapeutic effectiveness 20
Monika Devi N R
21. 21. STEPS RATIONALE SCIENTIFIC PRINCIPLE NURSING PRINCIPLE Explain
use of bathroom & other equipment in the room or ward Place call bell & locker in easy
reach of patient Explain meal timing and visiting hours to client & relatives To help the
patient be at ease & knowing how to use equipment to prevent accidents Help in
adjusting to new environment, reduces anxiety, helps in preventing accidents. Comfort &
safety Return patient’s valuable and clothing To provide client with his/her own
valuables safety 21 Monika Devi N R
22. 22. STEPS RATIONALE SCIENTIFIC PRINCIPLE NURSING PRINCIPLE Answer
queries of client & relatives Decrease anxiety & fear Helps to avoid stress comfort
Complete necessary records according to agency policy which includes nursing history &
assessment Important part of client’s permanent record Record of patient's data
Individuality & therapeutic effectiveness 22 Monika Devi N R
23. 23. MEDICO LEGAL CASES • A medico-legal case is one where besides the medical
treatment; investigations by law enforcing agencies, are essential to fix the responsibility
regarding the present state / condition of the patient. 23 Monika Devi N R
24. 24. 24 Monika Devi N R
25. 25. MEDICO-LEGAL CASES INCLUDE: • Accidents like Road Traffic Accidents
(RTA), Industrial accidents • Cases of trauma with suspicion of foul play • Electrical
injuries • Poisoning • Chemical injuries • Burns • Sexual Offences • Attempted suicide •
Domestic violence and child abuse 25 Monika Devi N R
26. 26. • Cases of asphyxia as a result of hanging, drowning, suffocation etc • Death in the
operation theatre • Death due to Snake Bite or Animal Bite • Drug overdose • Drug abuse
• Dead brought to the Emergency Dept (Found dead) and deaths occurring within 24
hours of hospitalization without establishment of a diagnosis 26 Monika Devi N R
27. 27. Role During Mlcs • In emergencies, resuscitation and stabilization of the patient will
be carried out first and medico legal formalities may be completed subsequently. The
consent for treatment is implied in all emergencies • Hospitals will maintain a MLC
register and the MLC will be initiated and documented in the register. • Medicolegal
documents should be considered as confidential records and should be stored under
safe27 Monika Devi N R
28. 28. ROLES & RESPONSIBILITIES OF NURSE DURING ADMISSION PROCEDURE
• At the time of admission, the registered nurse perform complete assessment of the
patient. • Enter patient name, date and time of admission, chief complains, medical
diagnosis in the admission file or patient file. 28 Monika Devi N R
29. 29. ROLES & RESPONSIBILITIES OF NURSE DURING ADMISSION PROCEDURE
• Document - the source of information (family, patient, care giver or health care person
or significant person). • Check the document if patient has previous hospitalization and
past major illness. • Take patient vital signs (pulse, temperature, respiratory rate, height
and weight). 29 Monika Devi N R
30. 30. • Document if patient and family has valuables brought to the hospital. If yes, hand it
over to the relatives with their signatures. • At the time of arrival to the unit or ward
patient and family will be given orientation regarding the unit, visiting rooms, patients
right and responsibilities. • In medico-legal case, the police has to be informed and the
nurse has to keep documents confidential & under safe custody. 30 Monika Devi N R
31. 31. DISCHARGE DEFINITION • “Discharge of patient from the hospital means,
relieving a person from hospital setting, who admitted as an inpatient in that hospital” •
“Discharge or dismissal from the hospital means the departure of patient from the
hospital” • “Discharge from the hospital is the point at which the patient leaves the
hospital and either returns home or is transferred to another facility such as one for
rehabilitation or to a nursing home.” 31 Monika Devi N R
32. 32. TYPES OF DISCHARGE TRANSFE R DAMA/ LAMA PLANNE D DEATH
ABSCOND 32 Monika Devi N R
33. 33. TYPES OF DISCHARGE • PLANNED DISCHARGE: Patient’s treatment is over
and the attending physician has discharged the patient • ABSCOND: Patient leaves the
hospital without prior information • LAMA/DAMA (left against medical advise/
discharge against medical advise): In LAMA/DAMA, patient chooses to leave the
hospital before the treating physician recommends discharge 33 Monika Devi N R
34. 34. • TRANSFER: Patient is transferred to another health care facility or within the same
hospital from one ward to another • DEATH: after death of patient, the dead body is
handed over to the relatives after completing the discharge procedure 34 Monika Devi N
R
35. 35. PURPOSE OF DISCHARGE • To be certain that the patient has the information on
his/her condition. • To inform about the follow-up visits or referral to other health
agencies. • To teach the Nursing procedure or care he/she needs at home & to take re-
demonstration • To provide for a safe, efficient return of all patient’s clothing, valuables
& to check that all hospital equipment & clothing in the hospital 35 Monika Devi N R
36. 36. • To help make the safest arrangements possible for the patient at the time of
discharge • Provide continuity of care at home • To assist the patient to manage
successfully the change from hospital environment to home environment • To prevent
 any misunderstanding or difficulties for the patient or hospital in relation to patient’s
discharge, medicines, bills. 36 Monika Devi N R
37. 37. DISCHARGE PROCEDURE STEPS RATIONALE SCIENTIFIC PRINCIPLE
NURSING PRINCIPLE Make sure that there is a written instruction for discharge &
follow-up prescription To prevent legal implications. The attending physician is required
to give clear written instruction for discharge & follow- up prescription Continuity of
medical advise. Consumer’s rights Safety of the patient 37 Monika Devi N R
38. 38. STEPS RATIONALE SCIENTIFIC PRINCIPLE NURSING PRINCIPLE Make
certain that the family & patient understand the instruction for care ( diet, medication,
exercise) Understanding of instruction by patient & family will help in better care Help
the client to adjust to new regime To reduce client anxiety Comfort & safety If patient or
relative decides to leave the hospital against medical advise of his doctor, have him sign
LAMA form The patient’s or guardian ‘s signature acknowledges full responsibility &
own risk of leaving the hospital’s care Protection of hospital against legal implication
Safety & good workmanship 38 Monika Devi N R
39. 39. STEPS RATIONALE SCIENTIFIC PRINCIPLE NURSING PRINCIPLE Assist the
patient to dress, check & pack belongings To conserve strength & avoid loss of any
personal belongings Helps to reduce anxiety & stress Comfort & safety Collect the
discharge slip & prescription that the patient is to take with him for follow-up care To
make him self-reliant Gradual adjustment to home life & after care reduces anxiety &
promotes health Comfort & safety Complete patient’s record & discharge summary
Because of legal implications, it is important that all the hospital document should be
completed Hospital records from legal evidence Safety & protection of hospital policies
39 Monika Devi N R
40. 40. STEPS RATIONALE SCIENTIFIC PRINCIPLE NURSING PRINCIPLE Transport
the patient & his belonging via wheel chair. Assist the patient into the vehicle To ensure
safety of patient, hospital personnel are responsible until patient leaves hospital Helps
patient to have sense of belonging & maintain inter- personal relationship Safety &
maintaining inter-personal relationship Care of unit after discharge To keep ready the unit
for admission of new patient Ensure cleanliness for the next patient Safety & good
workmanship Economy of time, material & energy 40 Monika Devi N R
41. 41. ROLES & RESPONSIBILITIES OF NURSE DURING DISCHARGE
PROCEDURE • 1. See doctor’s written order for discharge: no client should be
discharged without doctor’s written order • 2. Explanation of discharge procedure • 3.
Hand over personal belongings: clothing, jewellery or other valuables that were entrusted
with hospital at the time of admission should be returned to client. 41 Monika Devi N R
42. 42. ROLES & RESPONSIBILITIES OF NURSE DURING DISCHARGE
PROCEDURE • 4. Check and receive any hospital property: any of the hospital property
that was given to client for his/her use in hospital should be checked and received back
before he/she leaves • 5. Teach nursing procedures to be continued at home, get it’s
practice done: Provide instructions regarding medication, follow-up visit 42 Monika Devi
NR
43. 43. • 6. Confirm bill paid: Before client leaves, nurse should confirm that the client has
paid the hospital bill • 7. Inform other departments regarding discharge. • 8.
Documentation: the nurse should check that the charts & files are completed 43 Monika
Devi N R
44. 44. • 9.Arrange transport: if the client is not able to walk, then the nurse should see that
he/she is transferred either on a wheel chair or stretcher • 10. If DAMA :-check consent,
the form should state that the person is leaving against medical advise of doctor and that
neither doctor nor the hospital can be held responsible for any ill effect happening after
the departure • 11.Care of patient’s room and articles after discharge 44 Monika Devi N
R
45. 45. CARE OF UNIT AFTER DISCHARGE • After a client is discharged & before
admitting another patient, the room is cleaned & aired. • All articles used by client should
be taken to utility room, washed, cleaned, sterilized if necessary or disinfected by
chemicals. The articles are re-arranged and kept ready for next client • Used linen should
be sent to laundry • Mattress, pillows, blankets etc should be exposed to sunlight and then
the bed is made with fresh linen • If the room was used for a client with communicable
disease, it should be fumigated 45 Monika Devi N R
46. 46. Thank you 46 Monika Devi N R