patient admission

1. PATIENT ADMISSION – NURSING PROCEDURE
Patient admission, hospital stays and discharges follow an established procedure, i.e. planned
nursing activities. For patients requiring long-term care and repeated hospitalization, the
activities must be coordinated so that the nursing care is continuous. The specific medical
treatment prescribed by the doctor, and the nursing regime followed by the nurse, are
administered by the nurse in order to meet patient needs. The nurse monitors patient
responses throughout the stay.
ADMISSION PROCEDURE
Admission to the nursing unit prepares the patient for his stay in the health care facility.
Whether the admission is scheduled or follows emergency treatment.
Definition
 Admission is defined as allowing a patient to stay in hospital for observation,
investigation, treatment and care
 Admission is the entry of a patient into a hospital/ward for therapeutic or
diagnostic purposes
Purpose
 To establish guidelines regarding admission of patients
 To make the patient feel welcome, comfortable and at ease
 To acquire vital information regarding the patient
 To assess the patient from which the nursing care plan can be initiated and
implemented
Principle Involved
 Sudden change or strangeness on the environment produces fear and anxiety
 Entering the hospital is a threat to one’s personal identity
 People have diversity of habits and modes of behavior
 Illness can be novel experience for the patient and bring stress on his physical
and mental health.
GeneralInstructions
 To receive the patient and help him to adjust to the hospital environment
 To welcome and establish a positive initial relationship with the patient and
relatives
 To obtain the needed identifying data concerning the patient
 To provide immediate care, safety and comfort
 To collaborate with patient in planning and providing comprehensive care
 To observe, report signs and symptoms and general condition of the patient
 To secure safety of the patient and his belongings.
Types of Admission
 Emergencyadmission: means the patient are admitted in acute
conditions requiring immediate treatment, e.g. patient with accidents
poisoning, burns and heart attacks.

2.  Routine admission: the patients are admitted for investigation and
medical or surgical treatment is given accordingly, e.g. patients with
hypertension, diabetes and bronchitis.
Equipment
Gown, personal property form, valuables envelope, admission form, nursing assessment
form, thermometer, emesis basin, bedpan or urinal, bath basin, water pitcher, cup, and tray,
urine specimen container, if needed. An admission pack usually contains soap, comb,
toothbrush, toothpaste, mouthwash, water pitcher, cup, tray, lotion, facial tissues, and
thermometer. An admission pack helps prevent cross-contamination and increases nursing
efficiency
Preparationof Equipment
 Obtain a gown and an admission pack
 Position the bed as the patient’s condition requires. If the patient is
ambulatory, place the bed in the low position; if he is arriving on a stretcher,
place the bed in the high position
 Fold down the top linens
 Prepare any emergency or special equipment, such as oxygen or suction, as
needed.
Preparationof the Patient
 Greet the patient and his relatives and introduce yourself to them
 Receive the patient cordially and seat comfortable
 Introduce him to other person in the ward
 Complete the admission record
 Collect history and carry out simple physical examination
 Carry out the prescribed treatment and keep a record
 Help the patient to maintain personal hygiene and change into hospital clothes
 Orient the patient to the ward-toilet bath room, drinking water supply, nurse’s
station and treatment room
 Hand over the patients valuable to his relatives
 Issue visitor pass
 Encourage patient to take hospital diet especially when therapeutic diet is
ordered
 Obtain local address or telephone number, relatives lodge room and document
in admission record
Procedure
 Adjust the room lights, temperature and ventilation
 Make sure all equipment is in working order prior to the patient’s admission
 Admitting the adult patient
 Speak slowly and clearly, greet the patient by his proper name, and introduce
yourself and any staff present

3.  Compare the name and number on the patient’s identification bracelet with
that listed on the admission form. Verify the name and its spelling with the
patient. Notify the admission office of any corrections
 Quickly review the admission form and the physician’s orders. Note the
reason for admission, any restrictions on activity or diet, and any orders for
diagnostic tests requiring specimen collection
 Escort the patient to his room and, if he is not in great distress, introduce him
to his roommate. Then wash your hands, and help him change into a gown or
pajamas; if the patient is sharing a room, provide privacy
 Take and record the patient’s vital signs and collect specimens if ordered.
Measure his height and weight if possible. If he cannot stand, use a chair or
bed scale and ask him his height. Knowing the patient’s height and weight is
important for planning treatment and diet and for calculating medication and
anesthetic dosages
 Show the patient how to use the equipment in his room. Be sure to include the
call system, bed controls, TV controls, telephone and lights
 Explain the routine at your health care facility. Mention when to expect meals,
vital sign checks and medications. Review visiting hours and any restrictions
 Take a complete patient history. Include all previous hospitalizations illnesses,
and surgeries; current drug therapy; and food or drug allergies. Ask the patient
to tell you why he came to the facility. Record the answers (in the patient’s
own words) as the chief complaint. Follow up with a physical assessment,
emphasizing complaints. Record any wounds, marks, bruises or discoloration
on the nursing assessment form
 After assessing the patient, inform him of any tests that have been ordered and
when they are scheduled. Describe what he should expect
 Before leaving the patient’s room, make sure he is comfortable and safe.
Adjust his bed, and place the call button and other equipment (such as water
pitcher and cup, emesis basin, and facial tissues) within easy reach. Raise the
side rails.
Documentation
After leaving the patient’s room, complete the nursing assessment form or your notes, as
required. The completed from should include the patient’s vital signs, height, weight,
allergies, and drug and health history; a list of his belongings and those sent home with
family members; the results of your physical assessment; and a record of specimens collected
for laboratory tests.
TRANSFER PROCEDURE
The patient is usually hospitalized in the same department from which they are discharged.
The health condition changes in some patients so much that they are transferred and treated
by another department or another treatment unit of the same or different department or in the
same or another healthcare facility
Definition
Transfer is defined as preparing patient, completing necessary records and shifting patient to
another department within the hospital or to another hospital/home

4. Transfer/referral is the preparation of a patient and the referral records to shift the patient to
other department within the hospital or to another hospital
Purpose
 To obtain necessary diagnostic tests and procedure
 To provide treatment and nursing care
 To provide specialized care
 To place most appropriate utilization or available personnel and services
 To match intensity of nursing care based on patients level of needs and
problems
Preparation
 An explanation of the transfer to the patient and his family
 Discussion of the patient’s condition and care plan with the staff at the
receiving unit or facility
 Arrangements of transportation, if necessary
Types of Transferof the Patient
 Internal transfer: to transfer the patient in a unit that provides special care or
care suited to his needs, e.g. from general ward to ICU
 External transfer: to transfer the patient from one hospital to other hospital for
the purpose of special care, e.g. from general hospital to specialized hospital –
cancer centre
Preliminary Assessment
 Assess the method for transport, inform receiving nurse
 Maintain patient’s physical well being during transport to new nursing unit
 Provide verbal report about patient’s condition to the receiving unit nurse
 Be sure all documentation including care plan is completed
 Assist patient’s arrival to the new unit
 Announce patient’s arrival to the new unit
 Transport patient to a new room and assist in transfer to bed
 Hand over to receiving nurse
Equipment
 Wheelchair/stretcher
 Identification labels
 Patients belongings
 X-rays, investigation reports, patient record and file
Preliminary Assessment
 Check the doctor’s order for transfer of patient
 Inform the patient and relatives
 Inform to the ward sister where the patient needs to be transferred
 Check the chart for complete recording of vital signs, nursing care and
treatment given
 Collect patient’s X-ray, medicine and other belongings
 Cancel the hospital diet or transfer
 Assist the relatives to collect other belongings
 Make arrangement to settle the due bills if going to another hospital

5.  Record time, mode of transfer and general condition of the patient
 Assist in transferring risk patient to wheelchair/stretcher and accompany
patient to new area
 Handover patient documents, belongings and report verbally to the incharge
nurse/and sister
 Collect the ward articles
 Inform to the concern person/department regarding transfer of the patient
 Clean unit thoroughly and keep ready for next patient
Procedure
 Explain the transfer to the patient and his family. If the patient is anxious
about the transfer or his condition precludes patient teaching, be sure to
explain the reason for the transfer to his family members especially if the
transfer is the result of a serious change in the patient’s condition. Assess his
physical condition to determine the means of transfer, such as a wheelchair or
a stretcher
 Using the admissions inventory of belongings as a checklist, collect the
patient’s property. Be sure to check the entire room, including the closet,
bedside stand, over bed table, and bathroom
 Gather the patient’s medications from the cart and the refrigerator. If the
patient is being transferred to another unit, send the medications to the
receiving unit; if he is being transferred to another facility, return them to the
pharmacy
 Notify the business office and other appropriate departments of the transfer
 Have a staff person notify the dietary department, the pharmacy, and the
facility telephone operator about the transfer (if within the facility)
 Contact the nursing staff on the receiving unit about the patient’s condition
and drug regiment and review the patient’s nursing care plan with them to
ensure continuity of care
Transferto an Extended-Care Facility
 Make sure the patient’s physician has written the transfer order on his chart
and has completed the special transfer form. This form should include the
patient’s diagnosis, care summary, drug regimen, and special care instructions,
such as diet and physical therapy
 Complete the nursing summary, including the patient’s assessment, progress,
required nursing treatments, and special needs, to ensure continuity of care
 Keep one copy of the transfer form and the nursing summary with the
patient’s chart, and forward the other copies to the receiving facility
Transferto an Acute-Care Facility
 Make sure the physicians have written the transfer order on the patient’s chart
ad has completed the transfer form as discussed above. Then complete the
nursing summary
 Depending on the physician’s instructions, send one copy of the transfer form
and nursing summary and photocopies of pertinent excerpts from the patient’s
chart such as laboratory test and X-ray results, patient history and physical
progress notes, and record of vital signs to the receiving facility with the
patient
Special considerations:if the patient requires an ambulance to take him to another
facility, arrange transportation with the social services department.

6. DocumentationRecord the time and date of transfer, the patient’s condition during
transfer, the name of the receiving unit or facility, and the means of transportation
DISCHARGE PROCEDURE
Effective discharge requires careful planning and continuing assessment of the patient’s
needs during his hospitalization. Ideally, discharge planning begins shortly after admission.
Purpose
 To ensure continuity of care to patient after discharge
 To assist patient to complete hospital formalities before returning home
 To assist patient to return to a state of optimal independent living
 To assist the patient in discharge process
 To acknowledge patients right in deciding to leave hospital
Reasonsfor Discharge
 Cured
 Transfer to other hospital
 Discharged at request
 Discharged against medical advice
 Death
Equipment
Wheelchair, unless the patient leaves by ambulance, patient’s chart, patient instruction sheet,
discharge summary sheet, plastic bag or patient’s suitcase for personal belongings
GeneralInstruction
Prepare patient and family during hospitalization with adequate information in relation to
probable date of discharge, approximate in patient bill and relevant home care
Departments to be informed
 Drug return to pharmacy department
 Diet cancellation
 Oxygen/ventilator charges summary
 Accounts department
 Billing section
Preliminary Assessment
 Check doctor’s written orders for discharge
 Inform patient and relatives about discharge
 Document relevant discharge information
 Make sure all the fees are included such as special investigations, special
matters or devices, doctors or surgeon’s fees and narcotic drug used (if any)
 Obtain discharge prescription after retaining the medicines to be continued for
that day and after discharge. Send all other continued for that day and after
discharge. Send all other medicines for refunding (include ward replacement)
 Send chart to billing section with relevant information
 One bill is ready and chart is received back in ward, ensure that bill is settled.
Check the cashier’s signature in the discharge bill
 Help the patient to obtain discharge summary, medical certificate and drugs

7.  Ensure that patient is instructed regarding medication follow up, outpatient
visit, etc
 Accompany the patient up to transport near exit gate
Procedure
 Before the day of discharge, inform the patient’s family of the time and date of
discharge
 Obtain a written discharge order from the physician. If the patient discharges
himself against medical advice, obtain the appropriate form
 If the patient requires home medical care, confirm arrangements with the
appropriate facility department or community agency
 On the day of discharge, review the patient’s discharge care plan (initiated on
admission and modified during his hospitalization) with the patient and his
family. List prescribed drugs on the patient instruction sheet along with the
dosage, prescribed time schedule, and adverse reactions that he should report
to the physician. Ensure that the drug schedule is consistent with the patient’s
lifestyle to prevent improper administration and to promote patient compliance
 Review procedures the patient or his family will perform at home. If
necessary, demonstrate these procedures, provide written instructions, and
check performance with a return demonstration
 List dietary and activity instructions, if applicable, on the patient instruction
sheet and review the reasons for them
 Check with the physician about the patient’s next office appointment; if the
physician hasn’t yet done so, inform the patient of the date, time and location
 Retrieve the patient’s valuables from the facility’s safe and review each item
with him. Then obtain the patient’s signature to verify receipt of his valuables
 Obtain from the pharmacy any drugs the patient brought with him
 If appropriate, take and record the patient’s vital signs on the discharge
summary form. Notify the physician if any signs are abnormal such as an
elevated temperature
 Help the patient get dressed if necessary
 Collect the patient’s personal belongings from his room
 After checking the room for misplaced belongings, help the patient into the
wheelchair, and escort him to the exit; if the patient is leaving by ambulance,
help him onto the litter
 After the patient has left the area, strip the bed linens and notify the
housekeeping staff that the room is ready for terminal cleaning
Special Considerations
 Whenever possible, involve the patient’s family in discharge planning so they
can better understand and perform patient care procedures
 Before the patient is discharged, perform a physical assessment. If you detect
abnormal signs or the patient develops new symptoms, notify the physician
and delay discharge until he has seen the patient
Documentation
 Record the time and date of recharge
 The patient’s physical condition
 Special dietary or activity instructions
 The type and frequency of home care procedures
 The patient’s drug regimen
 The dates of follow-up appointments
 The mode of departure and name of the patient’s escort

8.  A summary of the patient’s hospitalization, if necessary
After Discharge
 Record time, date and condition of the patient at departure
 Send chart to medical record department and inform to the concern
departments
 After the patient has gone, the bed should be washed, blankets kept in
sunlight, Mackintosh washed and dried
 The room cleaned, all utensils cleaned and kept ready for next use
 In case of infected cases, utensils should be disinfected and then cleaned. The
linen should be disinfected and then send to laundry
 When discharging the medicolegal cases, the patient dead body should be
handed over to the police, before that concerning police station should be
informed about the patient’s discharge/death
 Patient or dead body is handed over to the police and asks the police to sign
with date and time
Discharge Teaching Goals
 Understand his illness
 Complies with his drug therapy
 Carefully follows his diet
 Manages his activity level
 Understands his treatments
 Recognizes his need for rest
 Knows about possible complications
 Knows when to seek follow-up care
PATIENT ABSCONDED FROM HOSPITAL
 Patient went out of the hospital without Doctor’s or other staff’s knowledge
 Hospital does not know that the patient left and they do not know when the
patient left
 They found out during next rounds
 Patients may not have discussed with the doctor/hospital about going out
 It is wrong to write, for example, that the patient absconded at 7 PM. If the
doctor (either directly or through other paramedical staff) knows the time
patient went out, it is not absconded; it is Left against Medical Advice
Left against Medical Advice (LAMA)
 Doctor asked the patient to stay/continue treatment
 Patient/patient’s relatives did not inform their plan of leaving the hospital, but
they left suddenly
 But the hospital was aware of them going out and the time patient left
 Doctor had said that taking the patient out may endanger life
 Patient/patient’s relatives did not sign anything
 Hospital may not give any discharge summary
 In fact, patient may not have discussed with the doctor/hospital about going
out
 Since the doctor (either directly or through other paramedical staff) knows the
time the patient is going out, it should be recorded as “Patient left Against
Medical Advice”
MEDICOLEGALCASE

9. A medicolegal 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. The case, therefore, has both medical and legal implications
Registering MLC is a MUST: attending casualty medical officer (CMO) has the authority to
decide whether the case is to be registered as medicolegal or not. There is no scope for
acceding to request/pressure from the relatives, patient himself or his colleagues regarding
the registration of MLC. Even if the accident (e.g. trauma) has happened several days ago, if
the complaints merit an MLC, then MLC should be registered.
Medicolegal cases: the following cases should be considered as medicolegal and as such the
medical officer is “duty-bound” to intimate to the police regarding such cases:
 All cases of injuries and burns – the circumstance of which suggest
commission of an offence by somebody (irrespective of suspicion of foul play)
 All vehicular, factory or other unnatural accident cases specially when there is
a likelihood of patient’s death or grievous hurt
 Cases of suspected or evident sexual assault
 Cases of suspected or evident criminal abortion
 Cases of unconsciousness where its cause is not natural or not clear
 All cases of suspected or evident poisoning or intoxication
 Cases referred from court or otherwise for age estimation
 Cases brought dead with improper history creating suspicion of an offence
 Cases of suspected self-infliction of injuries or attempted suicide
 Any other case not falling under the above categories but has legal
implications
Admissions and Discharge
 Whenever a medicolegal case is admitted or discharged, the same should be
intimated to the nearest police station at the earliest. It is always better to
inform the police through the casualty of the hospital where the medicolegal
register is usually maintained and necessary entries can be made in it
 While discharging or referring the patient, care should be taken to see that he
receives the Discharge Card/Referral Letter, complete with the summary of
admission, the treatment given in the hospital and the instructions to the
patient to be followed after discharge
 Failure to do so renders the doctor liable for “negligence” and “deficiency of
service”
 If the patient is not serious and can take care of himself, he may be discharged
on his own request, after taking in writing from him that he has been explained
the possible outcome of such a discharge and that he is going on his own
against medical advice
 Police have to be informed before the said patient leaves the hospital.
Sometimes the patient, registered as a medicolegal case, may abscond from
the hospital. Police have to be immediately informed, the moment such an
instance comes to the notice of the doctor/hospital staff
Death of a person admitted as a medicolegal case: the following are the do’s and don’ts in
case a person admitted as a medicolegal case expires.
 Inform the police immediately

10.  Send the body to the hospital mortuary for preservation, till the legal
formalities are completed and the police releases the body to the lawful heirs
 Request a medicolegal postmortem examination
 Do not issue a death certificate – even if the patient was admitted
 The dead body should never be released to the relatives; it should only be
handed over to the police