1

CHAPTER
Admission and Discharge

1.1: ADMITTING APATIENT IN HOSPITAL

I INTRODUCTION
The usual admission routine in a hospital follows the pattern as depicted below:

Injured/ill patient accompanied by the relative

Unplanned/emergency
admission
Planned/routine
admission

Reception staff refers and Admitting clerk provides information

guides to triage room form to be filed up by the relative

Patient assessed and categorized Admitting staff checks for availability of

according to severity of illness or rooms and informs the nurse in-charge
injury using triage code of the ward for making necessary
arrangements

Referred for immediate consultation

and treatrment according to severity
of problem
Nurse ín-charge prepares the unit
for new admission
Depending upon treatment required
severity of illness or injury physician
directs for discharge, admission or
transfer to different facility. Information Once patient unit is ready the nurse
is sent to the admitting department (along with supporting medical team)
regarding the same
receives the patient for further treatment|

IDEFINITION
Receiving apatient to stay in the hospital for observation, investigation, diagnosis, treatment, and care.
PURPOSES
I. Towelcome the patient and establish a positive relationship with patient and close relatives.
2. To offer immediate management and care in acute conditions.
O 1o0rient patient to immediate environment and services available.
1oacquire baseline data of apatient through history and physical examination.
5. Tocollahborate with patient in planning and providing comprehensive care.
 ARTICLES
Procedures
I. Prepared bed iv Nurses' record
2 TheIometer tray V. Progress record
3 BP appatatus vi. Laboratory master sheet
Nursing4 Weighing achine (scale) vii. Additional sheets as indicated. ,such ass
5 Admission advisory form (from admitting department)
6. Documents, such as:
chart,intake output chart, and
admission consent form specificdiabeti
Fundamentali. Doctor's order sheet 7. Kidney tray or emesis basin
IPR sheet 8. Tissue paper
iii Nursing assessment form 9. Bedpan and/or urinal
10. Bath towels and wash cloth.

1:
Section
I PROCEDURE
Nursing ection Rationale
Before procedure
Lower the bed and fold down top sheet and bedspread Makes it convenient for the patient to
Arrange room furniture for easy access from bed get into bed
Reduces risk of fall
Assembie
speciallequipments, such as suction equipment, oxygen supplies, pole
for V ine, etc.. and Prevents delay in cases where immediate
make sure they are in
4
During procedure
working condition required.
treatmer:
Receive the patient and family cordially. ldentify the
siip.Check the details, such as patient with the admission
advance payment, unit and room assigned.
Introduce yourself and escort the patient and family to the
6
Prepare the patient's record with all the necessary assigned room. Reduces anxiety
hospital number, unit, and room or bed information, such as name,
number in each record.
1. Check for admission
consent whether it is dulv sianed bypatient and/or
Collect the patient's old records if indicated from medical relative. Provides baseline for assessment of condition on admisoes
8. Check the records department.
patient's weight, vital signs and record it.
9. Coliect the history and doa Provides baseline for assessment of condition on admit
condition of the patient. simple physical examination and observe thegeneral Provides baseline for assessment of condition on
10. Orient patient to the admissio
physical set up of the ward, such as
room, toilet and bathroom nurses'station, treatment
facilities, and drinking water Reduces the strain of finding the details by
cupboard, call light, kitchen, etc., supply, patient's
and also orient the patient to the himself.
ward
11. Explain about the
facilities available, such as canteen, dietary, routines.
pharmacy, safety rules related to fire, accident, etc. telephone, Reduces the strain of finding the details by
12. Explain the
hospital policies regarding visiting hours, gate himseif.
staying with patients and pass, attendants
13. Have family leave restrictions in the ward.
patient's room unless they choose to assist
undressing. Close door and curtains. patient with Provides for privacy and prepares patient for care.
14. Give a bath if needed and
15. Initiate care
provide hospital gown.
which do not require
compress, tepid sponge, etc. physician's order if needed, such as cold
16. Obtain detailed
nursing history and physical
policy. examination findings per hospital Alerts nurses to
as
17. Obtain specimens, such as urine, blood or substances to which the patient is alergc
and gains understanding
obtained. any other, for tests if not of the patient's problems.
already Serves for basic screening.
18. Inform patient about
procedures treatments scheduled for the next shift or
day and clarify any related or
questions. Provides opportunityfor the patients to
19
Encourage patient to send the valuables home. If the remain informe.
them, list the items on a paper and have the patient prefers to keep
Place the valuables in safe custody. patient or family member sign it. Accounts for safe placement of valuables and prevents loss
20 Be sure that the call light is
within reach, bed is in lowered position and side
rails are raised. Provides for patient safety
After procedure
21. Wash hands
22.Record history and assessment findings in appropriate forms.
23. Notify physician of patient's arrival and report any unusual findings
24. Inform dietary department regarding patient's arrival and type of diet ordered Patient's condition may reguire immediate attention.

Contd.
 5
Cortd
|Nursing action Rationale
Chapter
25 Write the admission notes inchudingthe folioing detalls Date ime of patienr's
arrival to the ward. age mode of arrival. patien's complaints for wich he is
topita zed, variations in vital signs and ary other abnormalites observed. siuchas
prere ores, rashes etc, the orientztion gven and theful signature of the ure
1:
Admission
ISPECIAL CONSIDERATIONS
1 Information regarding an admission is recenved from outpatient admitting office rbeemergency department
altered. considering the priority ot
In admission of sick patients or emergency situations, steps of the procedure may
2 needs. and

3. General information regarding facilities available can be provided in writen form, eg. parmphlets. Discharge

1.2: DISCHARGING APATIENT FROM HOSPITAL

INTRODUCTION
Documentation. planning and discharge summary in a hospital is as depicted below:.
Confirm and issue DiSCHARGE" orders from consultat

Improper Lack of Delayed

documentation planning discharge
Sumnaries

Preparation of cumulative hospital The healthcare team (nursephysician)plans discherge and checks
charges and processing of final using the acronym METHOD
bill by the cashier M-Medication-pending and take home ist of mediones
E- Environment-prepare room for next admission.educate about
evironmental considerations specic to patent need
Patient settles bi after T- Treatment-confrm and terminate any ongoing procedure and infom
verification and receives receipt of instruct about oontinued home care treatment
payment H- Health teaching-specific patient and family teaching
0-Outpatient referra-inform follow-up schedule and prompt reporting
case of emergency
Financial
D-Diet-infom and stop patient requirement to dietary department teach
burden
patient any specificdietary patern to be followed as per orders

Lack of
resouroes.
medica ad
Nurseldoctor ensure adequate Family
communication of discharge sheet.
prescription order and solve any query
adjustment
Expectation
relevant to discharge for patient
improvement

Schedule and arrange for pick DISCHARGE

up/transfer of patient
*"DISCHARGE orders can be of three types
Discharge or advice
2 Drscharge on request
3Dscharge aganst medical advice
in discharge process
Tert n val shape ndicates factors that can cause delay

I DEFINITION
Discharge planning is a centralized, coordinated, multidisciplinary process which ensures that the episode of treatrment and/
healthcare team and hospital.
or care to the patient is formally concluded by the
I GENERAL PRINCIPLES
1. Patient and family understands the diagnosis, anticipated level of functioning, discharge medications and anticipated
medical follow-up.
 6 2. Specialized instructionsor training is provided to the patient and family to ensure that proper care after discharge will he
dures provided to the patient.
3. Community support systems are coordinated to enable the patient to return home.
4. Relocation of the patient and coordination of supportsystem or transfer to another healthcare facility are performed.
ARTICLES
Wheelchair or stretcher.
Patient
idamental
N relevantdocuments: Discharge booklet,prescription order.
IPROCEDURE
Rationale
Nursing oction
Assessment
1 Assess patient'shealthcare needs at the time of discharge using nursing Planning for discharge begins at the time of adrmision and continues
Section history, care plan and ongoing assessment of physical abilities and throughout patient's stay in the agency.
cognitive function from time of admission.
Assess patient's and familys need for health teaching related to home Improves understanding of healthcare needs and ability to achieve
home.
therapies. restrictions resulting from health alterations and possible self-care at
complications.
3 Assess with patient and family any environmental factors within home May pose risks to safety as a result of limitations created by illnese
that might interfere with self-care, e.g., size of room, bathroom facilities, or certain therapies.
stairs, etc.
4
Collaborate with physician and staff in other disciplines, eg. physical Amultidisciplinary assessment ensures acomprehensive discharge
therapist, social worker, etc. plan.
Consult other health team members about needs after discharge, e.g. determine
Members patient's
of all healthcare disciplines should collaborate to
needs and functional abilities.
dietitian, social worker. Make appropriate referrals.
6. Preparation of patient before the day of discharge
a. Suggest ways to change physical arrangement of home to meet Patients level of independence and ability to retain function can be
patient's needs if required. maintained within safe environment.
b. Provide patient and family with information about community Community resources may offer support to patient and family.
healthcare resources. Gives opportunities to practice new skills, ask questions and obtain
c. Conduct teaching sessions with patient and family as soon as possible necessary feedback.
during hospitalization in anticipation of preparation for discharge,
eg. signs and symptoms of complications. Use of medical equipment,
etc.

7. Preparation on the day of discharge

a. Allow patient and family to ask questions Relieves anxiety and ensures that safe care is provided to patients
b. Check physician's discharge orders for prescription and change in Discharge is authorized only by physician. Early information about
treatments. discharge permits the nurse to attend to any last minute treatment
or procedure, wellin advance before discharge.
c. Deterrmine whether patient or family has arranged for transportation Determines method of transport
home
d. Check all closets and drawers for belongings. Obtain copy of valuables Prevents loss of items. Relieves nursing department of liability for
list signed by patient. Account for allvaluables when required. losses.
e. Provide patient with prescriptions for medications ordered by
physician
f. Provide information about follow-up visit and home healthcare Review of drug information provides feedback to determine success
in learning about medications and its administration.
facilities available.
Ensures that patient attends regular follow-up in the hospital.
9. Provide printed teaching material as per patient's reguirement with
necessary instructions.
h. Obtain wheel chair for patients who are unable to ambulate. Helps patient review instructions that are provided by the healthcare
team.
Provides for safe transport.
8. Complete documentation of patient's discharge in nurses' notes.
9 Ensure that the discharge summary from physician is ready. Discharge summary is essential for documenting patient's status and
time patient leaves the hospital.

|SPECIAL CONSIDERATIONS
1. Ifpatient is getting discharged "against medical advice" (AMA), inform physician and nurse in-charge and complete the
AMA form as per hospital policy.
2. Patientswho may need detailed instructions and follow-up visit to the home after discharge include:
Newly diagnosed chronic disease, such as diabetes mellitus Patients with emotional or mental instability
Patients after major and radical surgery > Patients who lack financial
resources
Patients who are socially isolated º Patients who are terminally ill.