Admission and discharge.pptx

INTRODUCTION
Admission to hospital can be traumatic experience
with anxiety and fear for any one. The nurse is
one of the most important persons that client
meet in hospital. The duration and severity of
illness influence his/her reaction to admission
procedure.
Definition: Admission is defined as a allowing a
patient to stay in hospital for observation,
investigation, treatment and care.
or
Admission is the entry of
a patient into to a hospital/ward for
therapeutic/diagnostic purpose.

6.Silence. A quiet period that allows a patient to
gather his thoughts. Of course, this would be an
occasional practice, used when you feel that the
patient could use a little time to think about his
response to a question or just to think
7.Broad openings: A few words to encourage
the patient to further discuss atopic; for example,
"and after that..." or "you were saying...“
8.Clarification: Statements or questions that verify
a patient's concern orpoint. "I'm a bit confused
about...Do you think you could go over thatagain
please?

BARRIER IN NURSE PATIENT INTERACTION
1.Transference – development of
an emotional attitude of the patient
eitherpositive or negative towards the nurse.
2.Resistance - development of ambivalent
feelings toward self exploration.
3.Counter Transference – transference as
experienced by the nurse

PURPOSE
 To receive the patient in the ward for admission
according to his condition.
 To welcome the patient.
 To provide comfort and safety to the patient.
 To provide immediate care.
 To be ready for any emergency.
 To assist patient in adjusting to hospital
environment.
 To obtain information about patient such as
address, guardian and any other information that
will serve as a basis of care e.g. diabetes.
 To establish a nurse-patient relationship.

PRINCIPLE
 Sudden change or strangeness on the
environment produces fear an anxiety.
 Entering the hospital is a threat to one’s
personal identity.
 People have diversity of habits and
behaviours.
 Illness can be traumatic experience for
the patient and bring stress on his
physical and mental health.

GENERAL INSTRUCTION
1. To receive the patient and help him to adjust
to hospital.
2. To welcome and establish a positive initial
relationship with patient and realatives.
3. To obtain needed identifying data concerning
the patient.
4. To provide immediate care, safety and
comfort.
5. To collabrate with patient in planning an
providing comprehensive care.
6. To observe, report sign and symptoms and
general condition of patient.
7. To secure safety of the patient and his
belongings.

TYPES
1.Emergency admission: In this, patients are
admitted in acute conditions requiring
immediate treatment e.g. patient with
accidents, poisioning, burns and heart
attack.
2. Routine admission: In this, patients are
amitted for investigation and medical or
surgical treatment. Treatment is given
according to patient’s problem . e,g. patients
with hypertension, diabetes and bronchitis.

UNIT AND ITS PREPARATION
Unit: It is a place where the patient is kept during
hospital stay. The admitting department notifies
the unit prior to the patient’s arrival so that
room/bed can be prepared.
Special consideration
Some of the activities carried out by the nurse before the
patient is to be admitted are:
1. Keeping the bed ready: Open the bed, fold back the
bed spread, top blanket and top sheet. Cover bed with
full length mackintosh in order to protect bed from
soiling.
2. Position the bed: For ambulatory client, bed ahould be
in normal position.

3. Assemble necessary equipment and
supplies: A hospital admission pack, which
contains items such as bath basin, drinking
glass, plate, thermometer, papers and lotion
should be ready at be side. A hospital gown
should be available although client may
choose to wear personal clothes.
4. Assemble special equipment and supplies:
The client may require oxygen therapy,
cardiac monitoring or suction equipment.

EQUIPMENT
 Admission bed
 Thermometer tray, BP apparatus and
sthetoscope
 Equipment used for physical examination such
as weighing machine, inch tape and other
articles.
 Admission slips.
 Patients case sheet, doctors, nurses and
progress notes.
 Investigation forms-blood x-ray, urine, stool and
sputum.
 Bath tray if needed.

PROCEDURE
1. Greet the patient and his relatives and introduce
yourself to the them.
2. Receive the patient cordially and seat comfortable.
3. Introduce him to other person in the ward.
4. Complete the admission record.
5. Collect history and carry out simple physical
examination.
6. Carry out the prescribed treatment and keep a
record.
7. Help the patient to maintain personal hygiene and
change into hospital clothes.
8. Orient the patient to the ward-toilet bath room,
drinking water supply, nurse’s station and treatment
room.

9. Hand over the patients valuable to his relatives.
10. Issue visitor pass.
11. Encourage patient to take hospital diet especially when
therapeutic diet is ordered.
12. Obtain local address or telephone number, relatives lodge room
and document in admission record.
 Role and responsibilty of a nurse
i. Nurse should make every effort to be friendly and courteous
with the patient.
ii. Make proper observation of patient’s condition.
iii. Orient patient and relatives to hospital policies.
iv. Observe policies in dealing with medico-legal cases.
v. Deal with patients very carefully who are suffering from
communicable disease, Isolate if necessary.
vi. Nurse should recognize the various the various needs of the
patient and meet them without delay.
vii. Nurse shoulf find out likes and dislikes of patient and include

Patient in his plan of care.
viii. Nurse should address the patient by their name and
proper life.
ix. Patient’s valuable and clothes should be handed over
to relative with proper recording.
Discharge:
Discharge planning/preparation
 Discharge preparation: Nurse is responsible for
ensuring that the patient is to be discharged.
Discharge from the hospital should never come
unexpectedly to the patient or to any of those
attending them. His discharge should be planned from
the time of his admission and he should be informed
sufficiently early of the day he can leave the hospital.
 Physical consideration: Physical interventions for
the inpatient with impaired activity include direct
physical care related to patient’s health problems for
example, occupational therapy is one type of physical
intervention

That prepares the patient for returning home
with disability that limits his activities of
daily life.
 Psycho-cognitive consideration:
psychological interventions are designed
to meet educational, psychological and
coping goals. Topics to be included, in pre-
discharge teaching are whom to call for
help and when, self care (such as wound
care) and heath maintenance topic
appropriate for the patients specific health
problems.

Anticipatory guidance is information given a
about a situation before the situation occurs s
that the patient can develop problem-solving
and coping strategies. Example: immediate
treatment of of heart attack to heart patient.
 Family considerations: Social and family
interventions are developed to meet social
support and resource goals. A patient may
develop a fear f going home especially if he/she
lives alone or fees isolated, involving social
support in care is an important nursing
intervention, Educating the family, another
nursing interventions can be given before the
patient id discharge.

 Ethical consideration: In panning home care for a
patient with impaired activity, four ethical consideration
are relevant:
1.Respect 2. Beneficence
3. Justice 4. Fidelity
 Home care: Home health care is defined as “All the
services and products that maintain, restore or promote
physical , mental and emotional health that are provided
patients in their home”.
DISCHARGE OF THE PATIENT
The experience of hospital whether for a brief or prolonged
period is one that makes a lasting impression on the
patient. Patient is prepared for discharge when he is
admitted in the hospital. He should be prepared physically
and psychologically to leave the hospital ward and his/her
willingness to continue the treatment in future. Preparing
the client to leave certain activities is also very important.

Example: salt restriction to heart patient.
TYPES OF DISCHARGE
1) Cured and discharged when the treatment of
the patient is over from the hospital.
2) LAMA-Left against Medical advice, due to any
personal reasons of the patient.
3) DOR- Discharge on request.
4) Absconded- Patient may abscond i.e. leave the
hospital without any prior information.
5) Transferred to the other hospital-i.e. refer the
patient to other hospital for further treatment.
6) Relieved from hospital i.e. treatment is over.
7) Death: patient may expire during
hospitalization.

Steps for discharging a patient
1. Make sure that there is written consent/instruction
for discharge and follow-up description.
2. Make sure that the family and the patient
understand the instruction for care (diet, medication,
activity exercise)
3. If the patient or relatives decide to leave the hospital
against advice of his doctor have him sign LAMA.
4. Assist the patient to dress, check and pack
belonging.
5. Collect the discharge slip and prescriptions that the
patient is to take with him for follow up care.
6. Complete the patient’s record and discharge
summary.
7. Transport the patient and his belogings via a wheel
chair. Assist the patient into vehicle

DISCHARGE PROCEDURE
1. No patient should be discharged without the
doctor’s written order.
2. Instructions regarding further care,
medication, treatment, follow up etc. should
be clearly written and interpreted to the
patient and his family members.
3. Provide the patient with the medications
direct him to purchase what is needed for
him.
4. Patient belongings such as clothings, money
and other valuable which were entrusted to
the hospital personnel at the time of
admission should be checked and returned
to him. The nurse should get a receipt from
the patient at the time of delivery.

5.Any of the hospital property that was given to the
patient fir his use in the hospital should be checked
and received back before he leaves.
6.Before patients leaves the hospital, the nurse should
conform whether he has paid all the hospital bills.
7. See the patient is ready to go home, recently bathed,
hair combed and dressed in clean clothes.
8. If the patient is not able to walk or not allowed to walk
to the conveyance, the nurse should see that safely
transferred either on a wheel chair or stretcher.
9.The dietary department should be informed of the
patient’s discharge.
10. If any patient leaves the hospital against medical
advice he should asked to sign a release form.

11.The nurse should see that the charts are completed
and sent to the office or to the record.
Care of unit after discharge
 After the patient is discharged and before admitting
another patient, the room is cleaned and aired.
 Windows and doors, windows, furniture are washed
and cleaned.
 All the articles used by the patient should be taken to
the utility room, washed, cleaned, sterilized if
necessary r disinfected by chemicals.
 These are re-arranged and kept ready for next use.
 Used linen are sent t laundry.
 Mattress , pillows, blanket etc should be exposed to
sunlight, and then the bed is re-made with fresh linen.
 If the room is used by the patient with cmmunicable
disease, it should be fumigated along with the articles
used by the patient.

DISCHARGE TEACHING GOAL
1. Understand his illness.
2. Complies with his drug therapy.
3. Carefully follow his diet.
4. Manages his activity level.
5. Understands his treatment.
6. Recognizes his need for rest.
7. Knows about possible complications.
8. Knows when to seek follow-up care.

TRANSFER PROCEDURE
Transfer is defined as preparing patient,
completing necessary records and shifting
patient to another department within the
hospital/home.
Transfer/referral are the preparation of a
patient and referral records to the 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 problem.

TYPES OF TRANSFER OF PATIENT
1. 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.
2. External transfer: To transfer the patient
from one hospital to specialized hospital-
cancer centre.
EQUIPMENT
i. Wheel chair/stretcher
ii. Identification level
iii. Patients belongings
iv. X-rays

PROCEDURE
 Check the doctor’s order for transfer of patient.
 Inform the patient and relatives.
 Inform the ward sister where the patient nees to
transferred.
 Check chart for complete recording of vital signs,
nursing care and treatment given.
 Collect patients x-ray , medicine an other
belongings.
 Cancel the hospital diet.
 Assist the relative to collect other belonging.
 Make arrangement to settle the due bills if going to
another hospital.
 Record time, mode of transfer and general
condition of the patient.

 Assist in transfer sick patient to wheel
chair/stretcher and accompany patient to
new area.
 Handover patient documents, belongings
and report verbally to the in charge
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.

RECORDING AND REPORTING
RECORD: Record is defined as a written,
formal, legal documentation of a client’s
progress and treatment. It is also defined as a
permanent , a long lasting account of
something on film or in writing which can be
reproduced.

PRINCIPLE
 It should be special purpose.
 Legal document should contain true facts.
 It should be written clearly and legibly.
 Accuracy and completeness are essential.
 Wording should be easily understood.
 Record of interview, examination, etc have to be
written immediately.
 It should be neat, simple and concise.
 Provision for easy access and kept safe.
 The necessary stationary should available .
 Records are confidential and to be produced only for
legal calling and not to anybody other than the
treating them.

PURPOSE OF RECORDING
1. Communication : The record serves as the vehicle
by which different levels of professionals who
interact with a client communicate with each other.
2. Planning patient care: Each health professional
uses data from the client records to plan care for
that client.
3. To provide the practitioner with data required for
the application of professional services for the
improvement of family’s health.
4. Education : records can frequently provide a
comprehensive view of the client, illness, effective
treatment strategies and factors that affect the
outcome of the illness.

5. Auditing health care agencies:
6. Research : information contained in a record
can be a valuable source of data for research.
8.Reimbursenment: For facility to obtain payment
through medicare , the client’s clinical record
must contain the correct diagnosis.
9. Legal documentation: The client record is a
legal document and is usually admissible in a
court as evidence.
10. Health care analysis: It assist a health care
planner to identify agency needs.
11.Health service planning: it provides baseline
data to estimate the long-term changes related
to services.

12. To provide the practitioner with data required for the
application of professional services for the
improvement of family’s health.
13. For vital statistics
14. Historical documents
15. Quality assurances.
ADMINISTRATIVE PURPOSES OF CLINICAL
RECORDS
 Legal documents : poisoning, assault, rape, LAMA,
burn, etc.
 Research or statistics: rates audit and nursing audit.
 Quality of care
 Continuity of care
 Informative purposes
 Teaching purposes of students
 Diagnostic purposes: test reports

PRINCIPLE OF RECORD
• Nurses should develop their own method of
expression and a form in record writing.
• Records should be written clearly and
appropriately.
• Records should be consistent with professional
and agency standards: they should be
complete, accurate, concise, organized and
timely.
• Record should contain facts based on
observation, conversation and action.
• Select relevant facts.
• Records are valuable legal documents and so

• Records should provide for periodic
summary to determine progress and to make
failure plans.
• Record s should be written immediately after
an interview. Use universally accepted
abbreviations.
• Subjective data is documented in the client’s
exact words within quotation mark.
• Information should have a logical manner.
• each recording should be signed by the
nurses. Signature includes name and the
title.

VALUES AND USES OF RECORDS
 Record provides basic facts for services.
Records show the health condition as it is and as
the patient and family accepts it.
 It provides basic for analyzing needs in terms of
what has been done, what is being done, what is
to be done and the goals towards which means
are to be directed.
 It provides basic for short and long term
planning.
 It prevents duplication of services and helps
follow up effectively.
 Helps the nurses to evaluate the acre and the
teaching which has been given.
 It helps the nurse organize her work in an orderly
way and to make an effective use of time.

 It serves as a guide to professional growth.
 It enables the nurse to judge the quality and
quantity of the work done.
 Records help them to become aware of and
to recognize their health needs.
 A record can be used as teaching tool too.
 Record serves as a guide for diagnosis ,
treatment and evaluation of services.
 It indicates progress.
 It may be used in research.

TYPES OF RECORD
1. CUMULATIVE OR CONTINUING RECORD: this is
found to be time saving and evaluate the progress of a
long period e.g. child’s record should provide space
for newborn, infant and preschool data.
The system of using one record for home and clinic
services in which home visits are recorded in blue and
clinic visit in red ink helps cordinate the services and
save time.
2. Family records: All records, which relate to the
members of family, should be placed in asingle family
folder.
separate record forms may be needed for different
types of services such as TB, maternity etc. All such
individual records which relate to members of one

TYPES OF RECORD IN HOSPITAL AND
COMMUNITY
1.Administrative
• Organizational chart
• Policy, rules and regulations
• Nursing procedure manual
• Job description
• Leave form and register
• Attendance register
• Condemnation register
• Different administrative format
• Master and shift rotation chart
• Equipment and supplies form and register.

2. Personnel records:
 Evaluation format:staff, nursing services, n
using program
 Anecdotal record
 Communicative records : application, joining,
resign, interview
 Incidental record
 Medical record
 Minutes of various meeting
 Various committee record and reports.
 Guidance and counseling records and

3.Clinical records
 Census form
 Family folder
 Patient/client file with various record
 Continuation sheet
 Investigation forms
 Diet form
 Nursing intervention record and reports
 Admission discharge register
 Registration records
 Special records and treatment chart
 Special monitoring records of the special unit.
E.g. I.C.U. , C.C.U. , labor room, neonatal unit,
dialysis unit etc.

 CSSD record forms, mother and child health
records cards, family planning record cards
etc.
 Referral records.

REPORTS
Reporting is communicating specific information to a
person or group of people by verbal oe written
method.
Nursing report: Reports are information about a patient
either written or oral. A report is a summary of
activities or observations seen, performed or heard.
Purposes of writing reports:
 to show the kind and quantity of service rendered over
to a specific period.
 To show the progress in reaching goals.
 To prepare the staff member for their day’s work.
 As an aid in studying health condition.
 As an aid in planning.

 To provide quality and continuity of work from
one shift to another.
 To avoid duplication of work.
 To interpret the services to the public and to
other interested agencies.
TYPES OF REPORT
1. ORAL REPORT: Used when the information
used is for a short time.
2. WRITTEN REPORT: Used when the
information is to be used for more than one
person and is of more permanent values.

DIFFERENT FORMS OF REPORT
1. Change of shift report
2. Telephone reports
3. Transfer reports
4. Incident reports
5. Legal reports

TREATMENT EFFECT

The treatment effect is a measure used to
compare treatments (or interventions) in
randomized experiments, evaluation of policy
interventions, and medical trials. The treatment
efefct measures the difference
in mean (average) outcomes between units
assigned to the treatment and units assigned to
the control. In a randomized trial (i.e., an
experimental study), the treatment effect can
be estimated from a sample using a comparison
in mean outcomes for treated and untreated
units.

SIDE EFFECT OF DRUG
A side effect is usually regarded as an undesirable
secondary effect which occurs in addition to the desired
therapeutic effect of a drug or medication. Side effects
may vary for each individual depending on the person's
disease state, age, weight, gender, ethnicity and general
health.
Side effects can occur when commencing,
decreasing/increasing dosages, or ending a drug or
medication regimen. Side effects may also lead to non-
compliance with prescribed treatment. When side effects
of a drug or medication are severe, the dosage may be
adjusted or a second medication may be prescribed.
Lifestyle or dietary changes may also help to minimize
side effects.

FOLLOW UP
 A follow-up is something that is done to
continue or add to something done
previously

 Ideally, follow-up visits will occur on the target
day, at 28 day intervals from EV date
 A follow-up visit schedule is fixed for each ppt
(based on Enrollment date) and does not
change based on actual visit completion date
 If the visit cannot occur on the target day, it
should be completed as close to the target
day as possible and within the visit window
 Visit windows are continuous, so
each day in follow-up is always in a
window

DIET REGIMEN
 diet is the sum of food consumed by a person
or other organism.[1] The word diet often implies
the use of specific intake
of nutrition for health or weight-
management reason.
 Regimen:any set
of rules about food and exercise that
someone follows,especially in order to impr
ove their health:
e.g.:After his heart attack the doctor put him on
a strict regimen.

Admission and discharge.pptx