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Admission & Discharge in Hospital FON ppt.pptx

This is the ppt of Admission and discharge in hospital which includes the procedure of admission and discharge along with the types of admission and discharge respectively.

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HOSPITAL ADMISSION & DISCHARGE. PREPARED BY:- MS. NISHA PRASAD
ADMISSION:-  The entrance of a patient into a health care agency such as hospital or a private clinic is termed as admission.  Admission is the entry of an individual into a hospital/ ward for diagnostic, therapeutic or rehabilitative purposes.
DEFINITION OF ADMISSION:-  Receiving a patient to stay in a hospital for observation, investigation, diagnosis, treatment and care.
Purposes of admission:-  To provide immediate care.  To provide safety and comfort to the patient.  To manage and improve the general condition of patient.  To diagnose the condition by observing signs and symptoms of a disease condition.  To be ready for any emergency.  To facilitate follow up of the patient.  To obtain information about patient such as any information that serves as a basis of care e.g. Allergy, Diabetes etc.  To establish IPR (INTERPERSONAL RELATIONSHIP).
Indications of admission:-  Diagnostic purposes.  Therapeutic aspect for treatment.  Surgical interventions.  Conditions requiring expert care.
Types of hospital admission:-  There are various types of admission:- EMERGENCY/ UNPLANNED/ NON ELECTIVE ADMISSION.  When patient requires immediate treatment.  E.g. accident, poisoning. ROUTINE/ PLANNED ADMISSION.  Patient who requires long term care.  E.g. surgeries, cancer or any chronic condition.
TYPES BASED ON STAY:-  IN PATIENT (IPD):-  Length of stay generally more than 24 hours.  Includes planned, emergency and direct admission.  OUT PATIENT (OPD):-  Length of stay less than 24 hours.  Includes observational admissions.
Unit & its preparation:-  The patient care unit is the area of hospital in which the patient receives care during the hospital stay after hospital admission.  The patient unit is of three types:-  1. Private room:- only one patient is admitted.  2. Semi-private room:- two patients are admitted.  3. Ward:- three or more patients admitted.
Components of patient unit:-  FURNITURE- Bed (with side rails), bedside stand, bedside table.  LINENS- Mattress, sheets, pillow cases, blankets, bath blanket, face towel, wash cloth and gowns.  TOILET EQUIPMENTS- Wash basin, soap dish, toothbrush, tooth paste, mouth wash, emesis basin, bedpan and urinal for male patient.  Other ARTICLES- Call bell, screen, telephone, waste basket/dustbin, built in blood pressure setup, suction and oxygen on the wall.
PREPARATION OF UNIT/ ADMITTING THE PATIENT:-  While admitting the patient into ward the nurses completes a number of procedures includes:-  Prepared admission bed.  Orientation of the patient to ward and unit procedures.  Collection of history and physical assessment.
Data required for the admission of the patient:-  Name of the patient-  Age, sex/gender,-  Marital status-  Address-  Occupation-  Income-  Mobile number-  Adharcard no.
ARTICLES:-  Prepared bed.  Vital signs assessment tray.  Weighing machine(scale).  Admission advisory form.  Documents such as:-  Doctor’s order sheet  TPR sheet.  Nursing assessment form.  Nurses record sheet.  Laboratory master sheet.
 Additional sheets as indicated:-  Intake output chart.  Diabetic urine chart.  Admission consent form.  Specific flow sheets.  Kidney tray or emesis basin.  Tissue paper.  Bedpan/urinal  Bath towels & wash cloth.
Preparation of articles:- Articles:-  Prepared bed.  Vital signs tray.  Weighing machine.  Kidney tray.  Documentation sheet.  Screen.  Emergency trolley. Rationale:-  To receive the patients.  To monitor vital signs of patient.  To measure weight of patient.  To collect waste product.  For proper documentation.  To provide privacy.  For any emergency.
PROCEDURE-ADMISSION:-  In routine admission:-  OPD  Gathers info of the patient & record.  DOCTOR’S OFFICE  Doctors make decision for admission.  ADMISSION OFFICE  For allocation of ward & bed.  WARD
 In emergency admission:-  This is the situation in which every second is precious.  So patient is directly admitted in the causality/ emergency department.  The bed should be prepared and the emergency tray and trolley should be ready.  The equipment should be checked and should be in a working condition to save time.
ADMISSION PROCEDURE- NURSING ACTION:-  Receive the patient cordially.  Introduce yourself and greet them.  Check’s the patient identification and general condition.  Make the patient feel comfortable.  Prepare all required equipment and bring the articles to the bedside.  Orient the patient to physical setup of ward and nurse’s station.  Assist the patient to bed and provide comfortable position.  Complete necessary records according to hospital policy which includes nursing history and assessment (vitals, height & weight etc).
Preliminary observation of the patient:-  Patient’s general facial expressions – denote not only their emotional reactions but also the presence of pain or fatigue.  Any discoloration of the skin such as yellowish or pale – denotes-jaundice, bluish-denotes-cyanosis.  Observe the patient if undernourished/ malnourished.  Further observation can be made while rendering care to the patient.
Special considerations:-  Isolate the patient if suffering from communicable disease.  Orient the patient and his/her relatives to hospital/ward policies.  Avoid physical or psychological trauma.  Be cautious and kind to the patient & relatives.  Observe policies in dealing with medico-legal cases.  Never leave the patient alone in the causality.
MEDICO-LEGAL CASES/ISSUES (MLC):-  An 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 are warranted to ascertain circumstances and fix responsibility regarding the said injury or ailment according to law”.  Simply it is a medical case with legal implications for the attending doctor where the attending dr. after eliciting history and examining patient, thinks that some investigation by law enforcement agencies is essential.  Or a legal case requiring medical expertise when brought by the police for examination.
Examples of medico-legal cases:-  Accidents (RTA, industrial accidents).  Burns and scalds.  Sexual offences.  Criminal abortions.  Attempted suicide.  Poisoning, alcohol intoxication.  Cases of trauma with suspicion of foul play.  Electrical injuries, chemical injuries.  Domestic violence, child abuse.
Legal implications in admission:-  Immediately inform the physician.  OPD records, admission cards should be kept under lock and key and do not show records to anyone else from the health care team.  All the belongings should be kept under custody.  Accurate recording of the body discharge should be there.  Do not discard or destroy any evidence without discussing with the physician.  Take the consent from the relatives before any procedure.
ROLES & RESPONSIBILITIES OF THE NURSE:-  When the patient comes, take case sheet & receive patient in admission bed.  If patient is very ill, inform dr. incharge immediately.  Complete the admission register & other admission records side by side.  Make general observation from head to toe, check height, weight & vital signs.
 Hand over the patient’s belongings & valuables to relative or ward incharge for safe custody.  Assist the physician in examining patient and carry out the orders & investigations.  Subsequently learn the patient’s habits, interests, hobbies & health history.  If patient is admitted for operation or any treatment requiring anesthesia, take the consent.  If patient is on specific diet, encourage patient to take diet from hospital only.
DISCHARGE FROM THE HOSPITAL.  Discharge of patient from the hospital means, relieving a person from hospital setting, who admitted as an inpatient in that hospital.  This is the stage when patient is shifted from hospital to home. A formal statement in written form is given from the hospital.
TYPES-  Planned discharge/cured & discharge: Patient is cured and leaves hospital after physician’s advice.  DAMA/LAMA: Discharge Against Medical Advice/Leave Against Medical Advice.  TRANSFER:- transfer to other unit or hospital.
 REFFERAL:- Referred for further management or better treatment by physician.  ABSCOND:- when patient leaves hospital without any prior information to hospital staff & also without clearing dues.  DOR (Discharge On Request):- discharge is given on personal request of patient when not willing to take treatment.  DEATH:- When patient not recovered from illness & dies.
CONSENT FOR DAMA/LAMA:-  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:
DISCHARGE PLANNING:-  “IDEAL” DISCHARGE PLANNING;  I:- Include the patient & family members as partner in discharge process.  D:- Discuss with patient & family 5 key areas to prevent problems.  1. management of disease at home.  2. warning signs & problems.  3. explain test results.  4. explain medications.  5. follow up.
 E:- Educate patient & family about discharge process to reduce anxiety.  A:- Assess whether patient is able to understand the process.  L:- Listen to patient & family members and respect their preferences.
ESSENTIALS OF PLANNED DISCHARGE:  Written order by Doctor/physician.  Discharge card.  Informing other department.  Check payment of the bills(no due).  Hospital glossaries taken back.  Returning of the personal belongings.  Arrangement for transport.  Documentation.
Points to remember:-  Ensure that no dues certificate is taken before handling over the discharge slip to patient.  Inform the relatives well in advance about discharge.  Change the dressings when the patient is ready for discharge.  Provide clear instructions in regard to the use of drugs, diet to be taken, personal & environmental hygiene and follow up units.  Keep the record in safe custody & hand over to central registration office.
DISCHARGE PROCEDURE:-  The physician writes on patient’s chart that which patient is to be discharged.  The patient & family members are instructed regarding medication, treatment and follow up.  Patient’s personal belongings which were entrusted to the hospital personnel at time of admission should be checked and returned to them. The nurse should receive a receipt from the patient.
 The articles in patient’s unit should be checked and ensure that they are complete, including bed linens.  Check the payment of all hospital bills. Arrange a wheel chair or stretcher if patient is not able to walk or not allowed to walk.  If any patient leaves the hospital against medical advice he/she should be asked to sign a release form. The form should state that patient is leaving against the advice of Dr. nor the hospital can be held responsible for any ill-effects happening after his/her departure.
 Complete all the records of patient and send them to record section.
MEDICO-LEGAL ISSUES:-  Inform hospital authorities about discharge of medico legal patients.  On Discharge:-  If patient is transferred from one ward to another, it should be clearly entered & signed.  Discharge notes must be kept under lock and key.
 In case of death of patient:-  Physician must inform CMO (Chief Medical Officer) and send the body for post mortem examination.  Nurse must provide written instructions for handling the body to mortuary/police officer with complete name, address, identification number and signature of witness.  List of all articles of the patient should be maintained.
ROLES & RESPONSIBILITIES OF THE NURSE:-  Preparation for discharge:-  Planning in the beginning.  Plan for rehabilitation & follow up need.  Teach nursing procedures to be continued at home, get its practice done.  Arrangement for transport.
During discharge procedure:  See doctor’s written order.  Explanations done.  Hand over personal belongings.  Check & receive any hospital property.  Confirm bill paid.  Inform other department regarding discharge.  Arrange transport.  If DAMA check consent.
 After discharge:-  Documentation.  Care of patient’s room and articles.
Nurses responsibility in MLC discharge: check for medico legal history of patient. Notify medical officer in charge. If abscond case immediately contact MO in charge. Maintain all documents in proper manner. Take in written handing over & taking of articles. Never discharge patient without written order by physician.
Checklist:- METHOD  M: MEDICATION  E: ENVIRONMENT  T: TREATMENT  H: HEALTH TEACHING  O: OUT PATIENT REFFERAL  D: DIET
CARE OF THE UNIT AFTER DISCHARGE:-  After the patient is discharged, room is cleaned.  Windows and rooms are opened.  All the articles used by the patient are washed and sterilized or disinfected by chemicals.  Disposable things are discarded and linens send to laundry.  Mattress, blankets and pillows are posed to the sunlight.  In c/o communicable diseased patient fumigation of room & articles should be done.