ADMISSION/ DISCHARGE

PROCESS
FUNDAMENTALS OF
NURSING SCIENCE NRSG 223
NWAOMAH, E. E. 2020
 Learning Objectives

At the end of the lesson students will be able to:

Demonstrate adequate understanding of the 4
main steps involved in the admission process

Identify and manage the 4 common responses

that could occur when patients are admitted to
a health agency

Explain the steps involved in discharge process

 Learning Objectives

Explain 3 examples of how transfers are used in the

course of patient care
Explain the differences between transferring, and
referring patients
 Admission Process
Admission is a process that takes place when a person
is received into the health care agency for observation,
investigation, diagnosis, treatment and care. It could
be for less or more than 24 hours.
Four steps involved are:
Obtaining medical authorization
Compiling billing information
Completing nursing admission activities
Fulfilling mandated medical responsibilities
 Medical Authorization

Medical authorization is the approval of the

admission of a patient to the healthcare
facility by the primary care provider
The physician determines patient’s
condition and decides on admission
Physician advises both patient and nursing
staff to proceed with the admission process
Note that admission could be initiated from
EC, outpatient clinic or from home
 Compilation of Billing Information
The admitting Department
Clerical personnel gathers personal information
Initiation of medical record with the data obtained
Fact finding mission(patient address, place of
employment, insurance, personal data)
Identifying bracelet (patient’s name, ID #, name of
patient’s physician, & room number)
Notification of possible admission to the nursing unit
Patient escorted to the ward or unit by orderly with
admission slip / medical note
 Nursing Admission Responsibilities/ Activities 1

Preparing the patient’s room with made up bed

Preparation of admission trolley (patient gown,
admission forms, TPR tray, sphygmomanometer,
stethoscope, assessment and screening equipment
e.g. urine specimen container)
Welcome the patient warmly and introduce self
Orientating the patient (showing the location of
relevant places and rooms and explaining how to use
equipment to the patient; including visiting times
and policies relating to patient’s stay in hospital)
 Nursing Admission Responsibilities / Activities 2

Safeguarding valuables and other patient property

Help patient to undress and perform admission
assessment e.g. skin assessment ensuring privacy is
maintained
Compiling the nursing data base in the admission
form
 Medical Admission Responsibilities

Physician notified of admission for the

purpose of obtaining medical orders
Medical history obtained (identifying data,
patient’s chief complaint, history of present
illness, personal history, a review of the body
systems; physical examination must be
documented with 24 hours of admission
Performed by MD, resident, medical intern or
house officer, medical student
Common Reactions to Admission and Nursing Interventions

Common Reactions Nursing Interventions

1. Anxiety – vague uneasy 1. Acknowledge the
feeling, appears sad, uneasiness, provide
restless, trouble explanations and
sleeping, reduced instructions before any
appetite new experience or
procedure
2. Make frequent contact
2. Loneliness -
and be available and
offer help to the patient,
allow liberal visiting
hours
Common Reactions to Admission and Nursing Interventions
Common Reactions
3. Decreased privacy –
sharing room with
stranger, doors are opened,
many people pass by
4. Loss of identity –
wearing of institutional
gowns, treated in an
impersonal manner
Nursing Interventions
3. Demonstrate respect for /
ensure protection of each
patient’s right to privacy; knock
& ask for permission to enter if
doors closed or curtain drawn;
encourage use of chapel for
solitude
4. Learn and call all patients by
name, display family photos that
reaffirm their uniqueness, allow
use of personal items like
pillows, pajamas, plates, blanket.
Involve patient in planning and
implementing own care.
 Documentation of Admission

Date and time of admission

Age and gender of patient
Overall appearance
Mode of arrival to the ward
Room/bed number where patient is admitted
Initial vital signs and weight
List and type of allergies
Present condition of the patient
Reason for admission, planned treatment and
investigations
 Example

Mr. Don George, a 65 year-old retired police officer

admitted to room 5A by stretcher from emergency
care with moderate dyspnea. Oxygen on flow at
2L/NC, wt 60kg on bed scale wearing only a pajamas.
T-37.2; p-96; BP-176/98 in right arm while lying; R-
28. Voided 270mls of urine after admitted. No known
allergy. In high fowler position at time of report with
respiration of 20 at rest. Chest x-ray booked for 4pm.
----------------Signature / Title
 Discharge Process

A process that involves multidisciplinary planning and

coordination of patient’s continuing care after leaving
hospital or health care facility
Consists of:
 Obtaining a written medical order for discharge
 Completing discharge instructions
 Notifying the business office
 Helping the patient to leave the health care agency
 Writing a summary of the patient’s condition at time of
discharge
 Requesting for terminal cleaning of the room or bed space
 Authorization for Medical Discharge

Determined by the physician when patient is well enough

or improved
Written before leaving the ward after patient is examined
by the physician
D/C Against medical Advice (AMA) – leaving by this
method applies to situations in which the patient leaves
the hospital without the authorization of the physician
If patient determined to leave, patient must sign a special
form which releases the physician and the health agency
from future responsibility for any complications that may
arise. If patient refuses to sign the form, it must be noted
in the medical record.
 Providing Discharge Instruction

Planning for discharge begins when patient is

admitted
Nurse identifies the anticipated skills and knowledge
need of the patient
Use of the acronym ‘METHOD’ a technique in
providing discharge instruction (medications,
environment, treatments, health teaching, outpatient
referral, diet)
Nurse reviews the teaching, gives the patient
prescriptions to fill, provides written summary of
discharge instructions
 Notifying Business Office
To verify that billing and insurance information are
complete and that the patient has signed a consent
form authorizing the release of medical information to
the insurance provider
Make future financial arrangements

Discharging a Patient
Gather patient’s belongings
Arrange for transportation- prevent delay to avoid
another day’s charge
Escorting the patient – taken to the door in a
wheelchair or allowed to walk there with assistance
 Discharge Summary Information

Use clear, concise descriptions in client’s own language

( interpreter can be used)
Provide step-by-step description of how to perform a
procedure e.g. home medication administration.
Reinforce explanation with printed instruction
Identify precautions to follow when performing self-
care or administering medications
Review signs and symptoms of complications that
should be reported to the physician
 Discharge Summary Information

List names and phone numbers of health care

providers and community resources that the client can
contact
Identify any unresolved problem, including plans for
follow –up and continuous treatment e.g. wound
dressing, daily injections, tube feeding
Document actual time of discharge, mode of
transportation, and who accompanied the client
 Writing a Discharge Summary

Nurse documents a summary of the discharge

activities.
Sample: No fever or wound tenderness at present.
Sutures removed. Abdominal incision is intact. No
dressing applied. Given prescription for Keflex. Able to
repeat how many capsules to self –administer per dose,
the appropriate times for administration, and possible
side effects. Repeated signs and symptoms of infection
and the need to report them immediately.
 Writing a Discharge Summary

Instructed to shower as usual and temporarily avoid

lifting objects over 7kg for about 6 weeks. Informed to
keep follow-up appointment in 1 week with physician
as indicated on discharge instruction sheet. Given
patient’s copy of written discharge summary. Escorted
to business office in wheelchair accompanied by
spouse. Assisted into private car without any unusual
events.
 Terminal Cleaning

Before requesting for terminal clean, nurse

strips the bed linen and cleans bed with
disinfectant
Housekeeper cleans and prepares the
vacated room for the next patient admission
Bedside cabinet restocked with basic
equipment and items for use
 Transferring Patients
Involves discharging a patient from one unit or
agency and admitting him/her to another without
going home in the interim
Can take place when a patient’s condition changes
for better or worse
Facilitating a Transfer
When an admitted patient is transferred to another
health care facility, the transfer is conducted
similarly to a discharge
 Guidelines for Transferring Patient

Inform patient and family as early as possible of the

need for transfer ( as soon as decision is made)
Encourage the family and patient to investigate and
collaborate on which facility they prefer, if time
permits
Communicate with the agency or unit where patient
will be transferred
Make photocopy of the medical record if the patient
has given written permission and is being transferred
to a different health facility
 Guidelines for Transferring Patient

Provide a brief verbal and written summary of the

patient’s condition, treatment, care to the facility to
be transferred
Collect all of the patient’s belongings and transfer
with the patient
Transfer within the hospital
Purpose is to ensure continuity of care
Transfer patient’s belongings and hospital
equipment with patient
Notify appropriate unit of the transfer
 Transfer Outside the Hospital
Transfer from an acute care hospital to an extended
care facility/ long-term care facility
Extended care facility (ECF) – institutions that provide
care for people who are unable to care for themselves,
but who do not require hospitalization e.g. group
homes for assisted living, adult day care centers, senior
residential communities, & nursing homes
 Nursing Homes

Three classifications:
Skilled nursing facilities: private hospital ( 24hr
nursing care, referred by a physician, person requires
technical nursing skills such as bowel / bladder
retraining, changing sterile dressing, administration
of enteral feeding
Intermediate care facilities: dementia unit (provide
care to people with mental or physical conditions
requiring institutional care but not 24hr nursing care.
Patient may wander or are confused, needing
assistance with medications, bathing, dressing,
toileting, and mobility.
 Nursing Homes Contd.

Basic care facilities: rest home (provide custodial

care; emphasis is on providing shelter, food, laundry
services in a group setting; patient assume much
ADLs on their own)
 Referring Patients

Is the process of sending someone to another

professional or agency for specialized care and services
Made for patients who are being discharged to their
homes or still on admission
Can be made to private practitioners or specialists
Examples of agencies patients may be referred to:
hospice, home health care, visiting nurse,
district/community nurse, adult protective services
 Class Activity

Besides being ready for a new patient and greeting the

patient warmly, what other factors might help to make
a good first impression on patients?
Professional looks/dressing; appearance
Engaging the family members in the caring process
How a patient is handled
Ward appearance
Relationship with other staff and patient on the ward