ADMISSIONS/DISCHARGE/TRANSFER

ADMISSION

• (ENTERING A HEALTH CARE AGENCY FOR NURSING CARE AND

MEDICAL/SURGICAL TREATMENT)
• INVOLVES:
A. AUTHORIZATION FROM A PHYSICIAN
B. COLLECTION OF BILLING INFO FROM THE ADMITTING
DEPARTMENT
C. COMPLETION OF THE ADMISSION PROCESS BY THE NURSE
D. DOCUMENTING PT’S MED HX & PHYSICAL EXAM
E. INITIAL MEDICAL ORDERS FOR TREATMENT
RESPONSIBILITIES OF THE ADMITTING
DEPARTMENT
• GATHER INFO FOR BILLING
• INITIATE COMPLETION OFMEDICAL RECORDS
• PREPARE ID BRACELET. THIS IS THE SINGLE
MOST EFFECTIVE WAY OF IDENTIFYING THE
PATIENT
• MAY BYPASS IN EMERGENCY SITUATION
• AN ADDRESS Or GRAPH CARD IS MADE
• CONSENT FORMS ARE SIGNED, EG. LIVING
WILL, DIRECTIVES, WAIVERS
• INITIAL ORDERS OBTAINED
• VERBAL REPORT GIVEN TO FLOOR RN
• PATIENT IS ESCORTED
 REASONS FOR ADMISSION

• For diagnostic investigations to be done

• For treatments which may be medical or surgical
• For observation
 NURSING RESPONSIBILITES

• PREPARE ROOM

• IDENTIFY SELF

• ORIENT PATIENT

• GATHER INFO
 PREPARE ROOM

• PROVIDE PERSONAL CARE • BED IN HIGH POSITION IF

ITEMS ARRIVING BY GUERNEY

• SUCTION • BED IN LOW POSITION IF

ARRIVING BY WHEELCHAIR
• OXYGEN
• BLUE PADS IF NECESSARY
• IV POLE
 ADMISSION PROCEDURE (EMERGENCY;
PATIENT IN A WHEEL CHAIR or stretcher)
Advance Preparing
Wash hands and assemble the following
depending on the condition of the patient
• Temperature tray
• Resuscitation/emergency tray
• Oxygen apparatus
ADMISSION OF PATIENTS CONT’d

• Tray for venipuncture

• Suction apparatus

• Blood pressure apparatus

• Bed to suit patient’s condition.

ADMISSION PROCEDURE
(PLANNED/AMBULANT PATIENT)

1. Welcome Patient/ relatives to the ward/unit and introduce

yourself and any other nurse present who will attend to the
patients

2. Collect the necessary documents i.e. admission papers and

other information from the accompanying nurse
 IDENTIFY SELF

• MAKES PT FEEL SECURE

• MAKES PT FEEL WELCOME

• ALLEVIATES ANXIETY/FEAR
 GATHER INFORMATION

THE NURSE WILL GATHER INFO ABOUT:

• MEDICAL ORDERS
• TX’S
• LABS
• TESTS
• DIET
• ACTIVITY
• PHYSICAL ASSESSMENT WITHIN 24HRS.
ADMISSION OF PATIENTS CONT’d

1. Identify and confirm patient by name particulars

2. Provided seats for patient and the relatives to make them
comfortable
3. Gather information from patient and if necessary the relatives
to fill the admission papers.
4. Depending on the condition of the patient, provide an
admission bed.
5. Assist patient to change into pyjamas or hospital gown and
give identification bracelets if applicable
 ORIENT PATIENT
• LOCATION OF NURSE’S STATION
• CLOTHES STORAGE
• CALL LIGHT
• BED CONTROLS
• LIGHT SWITCHES
• TELEPHONE POLICY
• TV CONTROLS
• MEALTIMES
• SOILED LINEN ROOM/AREA
• SAFETY MEASURES SUCH AS
BEDRAILS
• VISITING HOURS
• WHAT TESTS ARE SCHEDULED
• DIET
• ROOM BOUNDARIES
• SCHEDULED SURGERY TIME
• TIMES FOR DR VISITS
• HOT WATER SUPPLY
• EXIT AREA IN CASE OF EMERGENCY
ADMISSION OF PATIENTS CONT’d

6. Provide privacy and do baseline assessment of patient and

document (observation, vitals etc.), collect specimen if ordered.
7. Serve prescribed urgent medication if applicable.
8. Take care of patient’s valuables if necessary.
9. Ensure patient have signed the consent form for treatment.
 VALUABLES

• WHEN DOCUMENTING VALUABLES, MAKE SURE TO USE

WORDS LIKE:
• WHITE/YELLOW METAL NOT GOLD
• CLEAR STONE NOT DIAMONDS, RUBIES, ETC.
• HAVE A WITNESS
• HAVE NURSE & PT SIGN VALUABLES LIST
• DON’T FORGET DENTURES, GLASSES, ETC.
• WHEN TRANSFERRING PT, SIGN-OFF WITH NURSE
• KNOW YOUR FACILITY’S VALUABLES POLICY
 PATIENT COMFORT

• PROVIDE PRIVACY. (SHUT DOOR & PULL CURTAIN.)

• ASSIST IF NEEDED TO REMOVE CLOTHING AND PUT GOWN ON.
• PROVIDE EXTRA BLANKETS IF REQUESTED.
• COLLECT INFO FOR DATABASE.
• PERFORM INITIAL ADMISSION ASSESSMENT IF APPROPRIATE.
(SOME FACILITIES REQUIRE AN RN TO DO INITIAL ASSESSMENTS).
• OBTAIN PHYSICIAN ORDERS FOR TX’S, LABS, TESTS, MEDS,
ACTIVITY, ETC. WITHIN 24HRS.
COMPONENTS OF A MEDICAL HISTORY

•IDENTIFYING DATA
•CHIEF COMPLAINT
•PERSONAL HX
•PAST HEALTH HX
•HX OF PRESENT ILLNESS
•FAMILY HX
•REVIEW OF BODY SYSTEMS
•CONCLUSION
ADMISSION OF PATIENTS CONT’D

10. National health insurance scheme is explained to the patient and

relatives.
11. Patient’s relatives are informed about the visiting hours, things
needed on admission. Patient is allowed to see relatives and bid
them goodbye.
12. Patient is oriented to ward set-up and its environment.
13. The nursing process is used to care for the patient
ADMISSION OF PATIENTS CONT’d

14. Patient’s name and particulars are entered into the

admission and discharge book as well as the ward
state. Admission is documented in the nurse's notes.
ADMISSION OF PATIENTS TO THE HOSPITAL.

• ADMISSION: it is the entry and acceptance of a patient to stay

in a health facility for the purpose of observation , investigation
and treatment . Clients coming in for admission may walk-in
(ambulant ) or not.

• TYPES OF ADMISSIONS
1. ELECTIVE/ PLANNED/ROUTINE
2. EMERGENCY
 TYPES OF ADMISSION

• INPATIENT

• OUTPATIENT
 INPATIENT STAY

• LONGER THAN 24HRS

• PLANNED:
NO IMMEDIATE THREAT
PLANNED ELECTIVE SURGERY, TESTS
PT IS PREPARED
• EMERGENCY:
UNPLANNED
STABILIZE IN EMERGENCY ROOM (CHEST PAIN, TRAUMA)
• DIRECT ADMISSION:
UNPLANNED
BYPASS EMERGENCY (VOMITING, DIARRHEA)
• Elective /Planned Admission: with this
type of admission the medical officer or
the health care provider arranges with
the patient on a convenient date for
admission. Patient is informed well
ahead of time to enable him prepare
for the admission.

• Patient is taken through the admission

process from the OPD.
 ADMISSION OF PATIENTS TO THE
HOSPITAL

Emergency Admission- with this type of

admission patient reports to the hospital in a
critical condition; he/she is usually brought in
by people (relatives, friends or a good
Samaritan).

The patient is transported to the ward in a

wheel chair or stretcher. These type of
patients need immediate treatment.
 OUTPATIENT STAY

• LESS THAN 24 HRS

• OBSERVATIONAL:
HEAD INJURY
PREMATURE LABOR
UNSTABLE VITAL SIGNS
WHAT TO WATCH FOR IN NEWLY ADMITTED PATIENTS

• ANXIETY

• LONELINESS

• DECREASED PRIVACY

• LOSS OF IDENTITY
 ANXIETY

• APPEARANCE • HOW TO HELP

• Exhibits Separation Anxiety. • Acknowledge feelings.
• Sad. • Provide explanations and
instructions before performing
• Worried. procedures.
• Restless. • Inquire about stress due to
children/pets/spouse at home.
• Reduced Appetite.
• Reassure. Separation Anxiety
• Insomnia. can cause the elderly to be
confused and disoriented.
 LONELINESS

• Make frequent contact with your patient.

• Orient your client.

• Allow liberal visitation.

 DECREASED PRIVACY

• Pull curtain and close door.

• Knock.
• Identify room boundaries,
esp. if sharing room.
• Be careful of exposing
patient.
• Patient feels uncomfortable
because of unkempt
appearance, so announce
visitors.
 LOSS OF IDENTITY

• Call patient by name

they prefer.
• Allow patient to wear
own gown.
• Display pictures.
• Give them some choices.
(bathing, eating, etc.)
ADMISSION PROCEDURE…

1. Welcome patient/ relatives to the ward/unit and introduce

your self and any other nurse present to the patients

2. Collect the necessary documents i.e. admission papers and

other information from the accompanying nurse

3. Identify and confirm patient by name, particulars

 ADMISSION PROCEDURE…

4. Quickly assess the patient’s general condition

5. Receive patient into an already prepared bed –

depending on the condition.

6. Patient is changed into bed clothing if possible

ADMISSION PROCEDURE...

7. privacy provided and patient is assessed i.e.

checking of vital signs, observation and
examination- general appearance, skin for
abnormalities, pain, breathing pattern, complaints,
general reaction of the patient, level of
consciousness, etc.

8. Relevant history is taken from patient or relatives

ADMISSION PROCEDURE...

9. Ensure consent form is signed.

10. Patient’s valuables are taken care of if necessary
11. National health insurance scheme is explained to the
patient and relatives.
12. Patient’s relatives are informed about the visiting hours,
things needed on admission. Patient is allowed see
relatives and bid them goodbye.
 ADMISSION PROCEDURE

13. Depending on the condition specimen collected and tested.

14. Nurse patient using the nursing process.
15. Administer prescribed medications
16. Patient’s name and particulars are entered into the
admission and discharge book as well as the ward
state. Admission is documented in the nurse's notes
Admission process...

The Role of the Nurse in the Admission Process

• meeting the immediate needs of the patient- physical and
emotional
• Thorough assessment of the patient- nursing process
• Ensure patient is assigned to the appropriate room.
• Write admission report- day and night report
• Ensuring comfort and reducing anxiety of patients and
relatives
 TRANSFER OF PATIENTS

Transfer of patient within a healthcare facility/hospital

It is the movement of a patient within the same health facility

Types
• Transfer in/Trans –in: when patient is moved from one unit or
ward of first admission to a new unit or ward. E.g. Medical to
Surgical Ward, Emergency Ward to the Medical or Surgical
Ward for update treatment. The receiving ward must be
informed about trans in before it is done.
 TRANSFER
• DISCHARGING A PATIENT FROM
ONE UNIT OR AGENCY AND
ADMITTING THEM TO ANOTHER UNIT
• INFORMS PATIENT/FAMILY
• COMPLETE TRANSFER SUMMARY
• SPEAKS WITH NURSE ON TRANSFER
UNIT
• TRANSPORTS
PATIENT/BELONGINGS/SUPPLIES &
CHART
• CHECKS ORDERS/MAKES NEW
ADDRESSOGRAPH CARD W/NEW
ROOM #
ROLES…

Steps
• prepare a suitable bed to receive patient
• Assemble the necessary equipment depending on the
patients condition i.e. oxygen apparatus, suction
machine, vital signs tray.
• Receive incoming patient, relatives and accompanying
nurse warmly.
ROLES…
TRANS IN (CONT…)

• Take over the transfer notes and personal belongings of the

patient from accompanying nurse.
• confirm patient’s identity with accompanying nurse
• Ask for clarification on vital issues pertaining to the patient’s
condition from the accompanying nurse.
• Introduce self and other nurses on duty to patient and
relatives
TRANS IN (CONT…)

• Do a quick assessment of the patient’s condition and needs and

act accordingly
• Admit patient using the nursing process
• Orient patient and relatives to ward and its environment, routine
of the unit if necessary
• Document time of patient’s arrival in the nurse's notes, admission
and discharge book and ward state.
TRANSFER OF PATIENTS
Transfer out/ trans out(CONT…)

Transfer out/ trans out: it could be from unit to unit

or facility to facility

Steps
• Confirm with receiving unit
• Assess patients condition
• Arrange for accompanying nurse
• Arrange for appropriate vehicle- where applicable.
Transfer out/ trans out(CONT…)

• Collect all necessary data

• Explain reason of transfer to patient and relatives and reassure them
to reduce anxiety
• Obtain written consent for transfer
• Pack patient’s belongings
• Collect patient’s medications , investigations results and transfer notes
• Assist patient to dress up
• Assist patient into wheel chair, stretcher, ambulance where applicable
Transfer out/ trans out(CONT…)

• hand over patient’s notes and belongings to

the accompanying nurse.
• Enter patient’s name in the A&D book, ward
state and nurse's notes.
DISCHARGE OF A PATIENT FROM THE HOSPITAL

Discharge occurs when a patient leaves the hospital

after a period of treatment to his or her home; it
normally done at the discretion of the medical team
when patient is fit or his condition is stable or upon
patient's own request.

It is important that patients and relative have a prior

knowledge of the intended discharge.
DISCHARGE PLANNING

• It is a process that facilitate the transition of the

client from the health care institution to the most
independent level of care, home or another health
facility.

• The over all goal of discharge planning is to

provide the most appropriate level and quality of
care throughout all stages of the client illness. To
ensure adequate continuity of care.
DISCHARGE OF A PATIENT FROM THE HOSPITAL

The role of the nurse in discharge planning

• Include all caregivers involved in the care of the patient i.e.
physiotherapist ( multidisciplinary)
• Adequate assessment of patient during all the stages of care to
identify discharge needs.
• Assess health teaching needs of client and family and provide family
members with the knowledge and skills to care for the client in the
home setting e.g. wound care, range of motion exercises.
• Assess home situation i.e. bathroom facilities, doorway, steps , home
arrangement etc.
DISCHARGE OF A PATIENT FROM THE
HOSPITAL...

STEPS
• Ensure discharge is ordered by a medical officer or
signed letter from patient
• Patient and relatives are informed about discharge
• They are educated on the need for continuing treatment
and follow up care
DISCHARGE…

• Ensure patient’s hospital bills are worked out and

submitted to the health insurance officer or paid at the
revenue office by patients who are not members of
the scheme.
• Receipt number is entered into the A&D book and the
receipt handed over to the patient.
• Relatives are directed to collect prescribed drugs from
the pharmacy if applicable.
 DISCHARGE…

• Drug administration is well explained to patient and

relatives as well as education on home and follow up
care

• Help patient to pack belongings.

• All patient’s valuables in the nurses custody is handed

over to patient and relatives, it is recorded, witnessed
and signed.
DISCHARGE…

• Patient and relatives are once again reminded of the

review date and exactly where to report on the said date.

• Bed linen is removed, bed and lockers are

decontaminated.

• Discharge is documented in the nurse's notes, A&D book

and ward state.
DISCHARGE
• TERMINATION OF CARE FROM A HEALTH
CARE AGENCY
• METHOD (ACRONYM)
M-MEDS
E-ENVIRONMENT
T-TREATMENT
H-HEALTH TEACHING
O-OUTPATIENT REFERRAL
D-DIET
• AMA (Against Medical Advice)
PT LEAVES PRIOR TO OBTAINING A WRITTEN
ORDER. NURSE REQUESTS PT TO SIGN FORM.
IF REFUSES, NURSE MUST LET PT LEAVE AND
NOTE REFUSAL TO SIGN AMA IN CHART.
 NURSES RESPONSIBILITY FOR DISCHARGING A PATIENT

• GATHER BELONGINGS/CHECK INVENTORY

• ARRANGE TRANSPORTATION
• INFORM PT OF CHECKOUT TIME TO AVOID BEING BILLED
FOR AN EXTRA DAY
• ESCORT UNTIL PT SAFELY INSIDE VEHICLE
• WRITE DISCHARGE SUMMARY
• TERMINAL CLEANING. BED STRIPPED AND DISINFECTANT
USED. BEDSIDE CABINET RESTOCKED/CLEANED.
WHO/WHAT IS INVOLVED IN A PLANNED DISCHARGE?

PHYSICIAN’S ORDER UNIT SECRETARY

CALLS FOR TRANSPORT,
COPIES CHART/ORDERS
CARE PROVIDER RN OR SOCIAL WORKER

SAFEKEEPING EXTENDED CARE FACILITY

PATIENT NURSE-EXPLAINS
DISCHARGE INSTRUCTIONS
TO FAMILY/CARE GIVER
 SETTING STANDARDS

• *REMEMBER*
• THE AMERICAN NURSE’S ASSOCIATION SETS
THE STANDARD FOR PT CARE &
DOCUMENTATION FOR RN’S
• LPN’S ARE GOVERNED BY JCAHO
• DO NOT USE “SEEMS” OR “APPEARS” IN
DOCUMENTATION. IMPLIES DOUBT AND LACK
OF KNOWLEDGE.