Prepared By Monika Devi NR M.Sc.Nursing GMCH Jammu

1. HOSPITAL ADMISSION
&
DISCHARGE
Prepared By
Monika Devi NR
M.Sc.Nursing
GMCH Jammu

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.”
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3. TYPES OF
ADMISSION
EMERGENCY
ROUTINE/
ELECTIVE
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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
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6. ROUTINE/ ELECTIVE ADMISSION
• Clients are admitted for investigations and planned
treatment and surgeries.
• E.g.: patient with diabetes, hypertension,
appendicitis, jaundice etc
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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
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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
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9. CLIENT’S EMOTIONAL
REACTION
• Anxiety
• Fear
• Denial
• Emotionally upset
• Anger
• Sad
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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
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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
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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.
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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
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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
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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
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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
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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
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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
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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.
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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
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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
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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
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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.
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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).
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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.
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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.”
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32. TYPES OF
DISCHARGE
TRANSFE
R
DAMA/
LAMA
PLANNE
D
DEATH
ABSCOND
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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
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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
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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
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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.
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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
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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
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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
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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
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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.
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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
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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
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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
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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
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46. Thank you
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