The document discusses admission and discharge processes in nursing. It defines admission as allowing a patient to stay in the hospital for care and treatment. The main purposes of admission are for evaluation, treatment, and providing emotional support. There are two main types of admission - emergency and routine. Discharge planning involves coordinating between medical staff, nursing, and the patient/family. The nurse's role includes preparing patients and families for discharge, ensuring understanding of home care needs, and proper documentation.

1. Admission and discharge process
in nursing

2. Hospital
• A hospital is a place where people who are
ill are looked after by Nurses and Doctors.
• Hospital is an institution providing medical
and surgical treatment and nursing care
for sick or injured people.

3. 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 /diagnostic
purposes.

4. Purposes of admission
• To undergo evaluation & treatment
• To know what is really happening in
his/her body right oft it to be fixed
• To provide emotional security to the newly
admitted patient and his family

5. principles
• Sudden change or strangeness in 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
behaviour
• Illness can be novel experience for the client
and bring the stress on his physical and
mental health

6. Types of admission
• 1. Emergency admission
• 2. Routine admission

7. Emergency admission
• Patients are admitted in acute conditions
requiring immediate treatment. Examples.
Patient with RTA, Poisoning, burns and
cardiac or respiratory emergency.

8. Routine admission
• Patients are admitted for investigation,
diagnostic and medical or surgical
treatment. Treatment is given according to
patients problem. E.g. Patient with
hypertension, diabetes mellitus etc.

9. Unit and it’s preparation
• Unit or ward is a place where the patient is
kept during hospital stay. The admitting
department notifies the unit prior to the
patients arrival so that room /bed can be
prepared.

10. • Prepare the treatment table
• Ensure all the equipment are completed
• Check ventilation
• Ensure patient privacy

11. Special consideration
• Admission cause undue stress (emotional
factors as well as financial capability must
given utmost importance)
• Be observant consider the individual
patient needs
• Provide an individual admission procedure
• Show may efficiency and concerns

12. Admission procedure
• Meet and receive the patient
• Verify the patient data, by checking the
record sheet, chart.
• Introduce immediate personal
• Assist patient to the treatment area
• Inpatients department (I.P.D)

13. • Transporting the client from O.P.D to I.P.D
• Reception of the client by the ward sister
• Preliminary observation of the client
• Helping the client to occupy his bed
• Ask the patient to change clothes into
hospital gown
• Care of the valuable and cloths

14. Perform examination and
evaluation procedure
• Perform examination and evaluation
procedure establish base line values like
vital signs, do history taking, physical
examination etc.
• Coordinate with the physician and carry
out initial orders
• Give the treatment and instructions as
need

15. Orientation to the patient and
relatives
• The equipments /instruments
• Use of call system and telephone
• Treatment schedule
• Visitors timings
• Other health care team members
• Policy and rules and regulations
• Care of patients valuable etc.

16. Record & Report
• Admission Book
• Preparation of Paper
• Drug Book
• Diet Book
• HMIS Entry
• Cot List/bed list

17. Medico – Legal issues
• Medico-legal cases (MLC) are an integral
part of medical practice that is frequently
encountered by Medical Officers
• Proper handling and accurate
documentation of these cases is of prime
importance to avoid legal complications
and to ensure that the Next of Kin (NOK)
receive the entitled benefits.

18. Definition of MLC
• MLC is defined as “any case of injury or
ailment where, the attending doctor after
history taking and clinical examination,
considers that investigations by law
enforcement agencies (and also superior
military authorities) are warranted to
ascertain circumstances and fix
responsibility regarding the said injury or
ailment according to the law”.

19. Examples of MLCs.
• Accidents like Road Traffic Accidents
• Cases of trauma with suspicion of foul play
• Electrical injuries
• Poisoning, Alcohol Intoxication
• Burns and Scalds
• Sexual Offences
• Attempted suicide

20. • Role and Responsibilities of Nurse in
admission procedure
Nurse should deal every effort to be
friendly and courteous with the patient and
family members
Make proper observation of patients
condition
Orient patient and relatives regarding
hospital polices

21. • Deal with patient carefully who is suffering
from communicable disease or illness.
Isolate if necessary
• Patients valuables and clothes should be
handed over to relatives with proper
recording.

22. Discharge Procedure
• The patient, the family, medical staff,
nursing staff, social worker, dietician all
work together to coordinate the discharge.
• The doctor plans the discharge with the
patient and leaves a written order on the
patient’s chart.

23. Introduction
• The patient may have concerns regarding
managing own care at home. Provisions
such as home health care may be needed,
as ordered.
• Assessment needs to be done as to what
help the patient will need at home.
Discharge planning involves the entire
healthcare team.

24. Definition
• “Discharge of patient from the hospital
means, reliving a person from hospital
setting, who admitted as an inpatient in
that hospital”.

25. Types of Discharge
1. PLANNED DISCHARGE:- Patient completes the
initial, actual management in the hospital and
now he or she need not to be under direct
supervision of that hospital.’
2. DAMA/LAMA: Discharge/Leave Against Medical
Advice
3. TRANSFER: Transfer to other unit or hospital
4. ABSCOND: Abscond from Hospital
5. REFFERAL : Referred for further management

26. Consent for DAMA
• I am leaving the hospital ward against
medical advice. Doctor explained me about
my disease condition and ill effects of
discharge against medical advice. Doctors
and Nursing staffs will not be responsible for
any ill effects happening after my departure”.
• Name of the patient / relative :-
• Relation:-
• Signature:-
• Date :- Time:-

27. Rehabilitation of the client
• The rehabilitation begins when a client 1st
come in contact with the health care team.
The nurse is concerned with facilitating
optimal independence for a client weather a
client is experiencing a short term illness or a
crippling health problem

28. • The rehabilitation has a following objective:
a) To return to those ability which have been
affected by illness to the highest level
possibility
b) To prevent further disability
c) To protect the client present abilities
d) To assist the client to use his existing abilities

29. Discharge planning
• A suitable day is fixed for the termination of
care in the hospital and the relatives are
informed of it, so that they could prepare to
take the client home. It enable the relative to
clear the bill without hurry and to bring the
clothing for the client

30. • Some of the nursing procedure which the
client may have to continue at home, should
be taught to him or anyone of his family
members who will be caring for him at home.
• The client should be given the explanations or
instructions about his treatment, diets,
exercise, or medications etc. sufficiently early
so that he can make clarifications and be sure
that he has understood all the explination

31. • The client should be demonstrate and made
familiar with type of diet he has to continue at
home
• Watch for the reaction of the client about his
discharge. Most clients are happy when their
physicians tell them that they can leave
Hospital.
•

32. Discharge procedure
• Written order by doctor.
• Discharge card.
• Informing other departments.
• Check payment of the bills.
• Hospital glossaries taken back.
• Returning of the personal belongings.
• Arrangement for transport.
• Documentation.

33. Steps involved in the Discharge
Planning
• Evaluation of the patient by qualified
personnel
• Discussion with the patient or his relatives
• Planning for homecoming or transfer to other
place
• Determining if caregiver training or for other
support
• Referrals to home care agency or appropriate
support
• Arranging for follow-up appointments or tests

34. Nurses Responsibility in Discharge
• PREPARATION FOR DISCHARGE
• Planning in the beginning.
• Plan for rehabilitation and follow-up need.
• Teach nursing procedures to be continued
at home, get it’s practice done.
• Arrangement for transport.

35. • DURING DISCHARGE PROCEDURE
• See doctor’s written order.
• Explanations.
• Hand over personal belongings.
• Check and receive any hospital property.
• Confirm bill paid.
• Inform other departments regarding
discharge
• Arrange transport.
• DAMA:- check consent

36. • AFTER DISCHARGE
• Documentation.
• Care of patient’s room and articles

37. MLC Discharge
• Check for medico legal history.
• Notify medical officer in charge.
• Abscond cases immediately contact medical
officer in charge.
• Maintain all documents in a proper manner.
• Take in written handing over and taking of
articles.
• Never discharge patient without written order
by physician.

38. Checklist method
• M = MEDICATION
• E = ENVIRONMENT
• T = TREATEMENT
• H = HEALTH TEACHING
• O = OUT PATIENT REFFERAL
• D = DIET