admission and discharge procedure

1. Admission and
discharge

2. • People enter into health care settings for many reasons;
either by patient itself or brought by others
• Mentaly illness, suicide cases, accidents, require legal
procedings
• Entering to hospital produces anxiety to both patient and
relatives

3. Definition – Admission
• Entrance of a patient into the ward or unit for evaluation
and treatment
• Admission means allowing patient to stay in the hospital
for observation, investigation, treatment and care

4. Purposes – admission procedure
• To welcome patient and establish a therapeutic relationship with
patient and relatives
• Provide immediate care
• Collect baseline data of patient through observation, history and
physical examination
• To provide orientation to patient and relatives
• To provide comprehensive care to patients

5. • For investigation purposes
• Collaborate with patient and bystander in planning care
• To provide health education to patient and family members
• To provide support and adequate information for continuing
care

6. Principles
• Sudden change in environment produces anxiety and fear in
patients
• Entering into hospital produces stress towards patient on
possible diagnosis
• Patient fear about losing their personal identity
• Patient differ in their behaviour pattern depending on their
age, sex, socio economic background and nationality

7. • Strange environment produces alteration in physical and
mental health
• Provide clean and safe environment to prevent cross
infection among patients

8. Need for hospital admission
• Curing aspects
• Healthy client admitted for investigations/ observation

9. Types
Emergency Routine

10. Types
Inpatient Out patient

11. Inpatient
( >24 hr)
Planned
Non urgent
, scheduled
Emergency
Unplanned
Direct
Unplanned

14. Admission procedure

15. Equipments required
 Gown
 Personal property forum
 Valuable envelope
 Admission form
 Nursing assessment form
 Thermometer
 Emesis basin
 Bedpan / urinal

16. • Admission pack
Soap
Comb
Tooth brush
Tooth paste
Lotion
Facial tissues
admission pack prevents cross contamination and improves nursing
efficiency

17. Preparation of equipment
• Obtain gown and admission pack
• Position bed as patient comfort
• Fold down top linens
• If needed, emergency or special equipment – oxygen, suction etc

20. Preparation of patient
• Greet patient and relatives
• Introduce yourself
• Complete admission record
• Physical examination and history collection
• Carryout treatment and keep a record
• Help the patient to maintain personal hygiene and change to
hospital clothes

26. For routine admission
• OPD Doctor’s office admission office ward

27. Special considerations
• Isolate the patient if suffering from communicable disease
• Make proper observations of the patient’s condition, record and
report
• Orient patient and his relatives to hospital/ ward policies
• Avoid physical and psychological trauma
• Be cautious and kind to the patient and relatives

28. • Observe policies in dealing with medico legal cases
• Collect necessary information about the patient from relatives and
patient
• Never leave the patient alone in the casualty

29. Legal implications in admission
• A nurse should take care of the following,
Immediately inform the physician
OPD records, admission should kept under lock and key
All the belongings should be kept under custody
Accurate recording of the body discharge
Take consent from relatives before any procedure
Do not discard or destroy any evidence without discussing with the
physician

30. Nurses responsibilities during admission of
patient
• In OPD
Receive with courtesy and offer a stool/ cghair to sit. If very ill-
place on examination table or stretcher
Fill identification data
Check vital signs and general condoition
Get the patient examined and admission slip completed by doctor
Direct relatives or bystander to medical record room to get case
sheet

31. • Inform concerned ward nurse
• As soon as case sheet get from MRD , attach the admission slip
with case sheet
• Carry out stated orders and emergency investigations
• Take the patient along with case sheet to the ward and endorse to
the ward nurse

32. In ward,
• When the patient comes, take the case sheet and receive patient in the
admission bed
• if the patient is very ill, inform to the doctor incharge immediately
• Complete admission register
• Make general observation from head to toe, vital signs, general
condition
• Give bath to the patient
• Dress the patient in clean hospital clothes, comb hair and make
comfortable
• Collect patient’s personal and health history

33. • Hand over patient’s belongings and valuables to the relative or
ward incharge for safe custody
• Assist physician in physical examination and carryout orders and
investigatons
• Take the consent for any treatment or operation
• Prepare diet slip
• Before relatives leaves for home, check any medicines , personal
supplies brought from home , visitor’s card and food pass
• Orient the patient
• Give psychological support

34. In case of Medico legal case admission
• RMO/ casualty medical officer/ MO incharge of MI room / duty
medical officer/ MO incharge ward, who is attending the case ,
may label a case as an MLC
• Eg.
• Assualt, accidents, cases of trauma with suspicion of foul play,
electrical injuries, poisoning, chemical injuries, burns and scalds,
sexual offences, criminal abortions, attempted suicide

35. Discharging the patient
• Discharge is the preparation of patient to leave the
hospital. A formal statement in written form is given
from the hospital in which he has been undergoing
treatment.

36. Objectives
• To complete obligation to hospital
• To ensure proper medical care after discharge
• To motivate the patient and relatives
• To promote independence and self reliance throughout
illness
• To promote good public relations.

37. Types
• Cured and discharged/ planned discharge
• Discharge to another hospital or another unit within the
hospital(referral)
• Discharge against medical advice(DAMA)
• Abscounded
• DOR (discharge on request)
• Death

38. Discharge planning
• Effective discharge require careful planning and continue
assessment of patient’s needs
• Effective discharge planning begins shortly after admission of the
patient
• A multi disciplinary approach is essential for planning

39. “IDEAL” – discharge planning
• I- include the patient and family members as partner in discharge
process
• D – discuss with the patient and family about 5 key areas to
prevent problems
management of disease at home
warning signs and problems
Explain the test results
Medications
Follwup

40. • E – educate the patient and family about discharge process
• A- assess whether patient is able to understand the process
• L – listen to patient and family menbers respect their preferences.

41. Discharge procedure
• The physician writes on the patient’s chart that which patient is to
be discharged
• The patient and family members are instructed regarding
medication, treatment and followup
• Patient’s personal belongings received at the time of admission
should checked and returned , also should receive a receipt from
the patient
• Articles in the patient’s unit should be checked and ensure they
are complete

42. • Check the payment of all hospital bills
• Arrange a wheel chair or stretcher if pt is not able to walk or not
allowed to walk
• If any pt leaves the hospital against medical advice he should be
asked to sign
the form should state that “ pt is leaving against the advice of
doctor and neither the doctor nor the hospital can be held
responsible for any ill effects happening after his departure”
• Complete all the records of pt and send them to record section.

43. Nurse’s responsibilities in discharging the
patient
• Inform the pt and the relatives a day or two before the discharge
• Get the discharge slip prepared after checking the vital signs and
examining the patient
• The nurses should see that the patient’s personal hygiene is
maintained, dressed in home clothes, has taken meals
• Hand over the patient’s belongings and any valuables, which have
been kept safely to the pt or relative

44. • Complete the admission unit and discharge registers, casesheet and
other records
• Hand over the case sheet and other records to medical records
department
• Inform the hospital authorities about the discharge if the pt is
medico-legal
• Hand over the discharge slip to the pt or relative and explain about:
Treatment and diet to be taken at home
Follow up visits
Any special advice

45. • Ensure that the pt receives all the medications as per
discharge slip
• Place the pt in the wheel chair or stretcher according to the
patient’s condition
• Immediately after the pt leaves, reorganize the pt unit

46. Transferring a patient
• Refers to that pt may require transfer either from the unit to
another or to another health care institution according to the
condition of the pt

47. Transferring procedure
• Check the orders of transfer to another unit.
• Assess the readiness of new unit where patient is to be shifted to
prevent inconvenience and waiting time.
• Explain the procedure of transfer to patient and family and
reason of transfer.

48. • Review the checklist of patient's belonging and valuable at the
time of admission so that all the belongings are transferred
with the patient.
• Asses and gather any other equipment that will be transferred
with patient, for example, infusion pump.
• Transfer the patient by using wheel chair or stretcher and
accompany the patient to promote safety during transfer.
• Document the time of transfer and other conditions like-
patient's condition when leaving unit, equipment and
medications transferred, description of personal belongings
sent with pt and report on pt given to receiving staff nurse

49. Transferring a Patient within the Facility
• The patient is transferred to a different unit of the
hospital if the health condition is deteriorating, for
example, shifting the patient from medical ward to ICU.
Explain the reason of transferring to the family members
before shifting the patient to reduce the anxiety as well as
to maintain continuity of care. Before transferring assess
the condition of the patient and equipment to be
transferred with patient. for example, medications,
patient's belongings.

50. • Transfer to An Extended Care Facility
1. Make sure that physician has written the transfer order
on patient's chart and transfer form (it includes the
patient's diagnosis, care summary, treatment plan, diet or
special care instructions).
2. Complete the nursing summary, including patient's
health assessment, progress and nursing treatment.
3. Attach one copy of transfer form and nursing notes with
patients chart and forward the other copies to the receiving
facility.

51. DISCHARGE LEAVE AGAINSTMEDICAL
ADVICE
(LAMA)Sometimes, patient expresses the desire to leave a hospital
against medical advice (AMA) and leaves the hospital without
physician's order for discharge this procedure is called DAMA
(Discharge Against Medical Advice) or LAMA (Left Against
Medical Advice). In this condition the physician will ask the patient
or family members to signs AMA form, the accepting responsibility
for their decisions.

52. • MEDICO-LEGAL CASES (MLC)
1. On discharge:
• a. If the patient is transferred from one ward to another, it should
be clearly entered and signed.
• b. No record should be handed over to relatives of the patient
and police.
• c. Name and address of the patient and relatives should be written
clearly.
• d. Physician must inform the discharge of the patient to CMO
(Chief Medical Officer).
• e. Discharge notes must be kept under lock and key.

53. 2. In case of death of the patient:
a. Physician must inform CMO and send the body for post
mortem examination.
b. Nurse must provide written instructions for handling the body
to mortuary/police officer with complete name, address,
identification number and signature of witness.
c. List of all articles of the patient should be maintained.

54. • DISCHARGE IN OTHER CONDITIONS
1. LAMA: If the patient leaves against medical advice, the nurse is
responsible to:
a. Follow the institutional policies for patient discharge do not
force the patient to stay in the hospital.
b. Explain about the critical condition of the patient.
c. Inform the medical officer.

55. a. Signature of the relatives, in which she writes that there is full
responsibility on the part of relatives about the risk of taking
away the patient with them.
b. Hospital equipment (given to patient during admission) and the
clearance of bills, should be checked before the discharge.
c. Records should be kept safe.

56. 2. Absconding: If the patient runs from the ward/ hospital, to
avoid this problem, the nurse must:
a. Check the number of patients admitted, discharged while
changing of the shifts.
b. Inform immediately the CMO in writing and get it signed.
c. Record of the patient should be kept under lock and key.

58. Test paper on 01/02/23 for 1
hr
topic- admission and discharge

59. • Types of hospital admission ( 2 )
• Nurses role in admission procedure ( 3 )
• Purposes of hospital admission ( 2 )
• Differentiate : DAMA and absconding ( 2 )
• Moving the patient from one room to another room or from one department
to another or from one hospital to another hospital called …. (1 )
a. Transfer
b. Admission
c. Discharge
d. Refferal

60. Thank you……..