Admission Discharge.pptx

Topic: Admission,
Transfer & Discharge
Mr. Suresh Chander
Nursing Tutor
HCN,SRHU

Introduction:-
Admission to hospital can be traumatic experience
with anxiety and fear for anyone. The nurse is
one of the most important persons that meets
client in hospital. The duration and severity of
illness influence his/her reaction to hospital
procedure.

Definition:-
Admission is defined as allowing a patient to stay
in hospital for observation, investigation,
treatment and care.

Objectives: -
 To investigate influences on decision-making
about admissions in acute medical care.
 To investigate how frontline experience and new
models of care contribute to reducing avoidable
acute admissions.

Purposes:-
 To receive the patient in the ward for admission
according to his condition.
 To provide comfort and safety to the patient.
 To provide immediate care.
 To ready for any emergency.
 For performing any surgical interventions.
 For performing various diagnostic studies.

Cont…
 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.
 To establish nurse patient relationship

Principles:-
 Sudden change or strangeness on the
environment produces fear and anxiety.
 Entering the hospital is a threat to one’s personal
identity.
 People have diversity and behaviors.

General instruction:-
 To receive the patient and help him to adjust
environment.
 To welcome and establish a positive initial
relationship with patient and relatives.
 To obtain needed identifying data related to
patient.
 To provide immediate care, safety and comfort.

Types of Admission
1.Planning:
 Emergency admission
 Routine admission
2.Time Period:
 Short Term
 Long Term
3.Purpose:
 Diagnostic Admission
 Therapeutic Admission

Types of admission:
Types of admission
Planning:
. Routine
. Emergency
Time Period:
.Short Term
.Long Term
Purpose:
. Diagnostic
.Therapeutic

1. Planning:-
 Emergency admission: - Patients admitted in
acute immediate conditions requiring
immediate treatment e.g. Trauma, poisoning,
burns, heart attack etc.
 Routine admission: - Patient are admitted for
investigation, medical and surgical treatment.
E.g. HTN, DM, bronchitis, cholecystectomy.

2. Time Period:
Short Term admission: In this type of
admission, the patient’s stay is only for few days
for examples- jaundice, Fever etc
 Long Term admission: In this type of
admission, the patient’s may stay in the hospital
for a long term( for months or more) for
example spinal injury.

3. Purpose:-
 Diagnostic admission: In this admission,
patient are admitted only for the purposes of
some investigation or diagnostic tests for
example colonoscopy
Therapeutic Admission: In this admission, the
patient is admitted for the treatment of his/ her
underplaying disease.

Preparation of articles: -
S.
N.
Articles Rational
1. All articles for an open bed, bottom
sheet, draw sheet, mackintosh, top
sheet, and blanket.
To keep the bed ready to receive the
patient.
2. 2 bed sheets To cover the bed and another to
cover the patient.
3. Hot water bag in cold weather. to keep the bed warm
4. Other articles required for daily
care TPR tray, pong bath tray, a set
of hospital clothes, stethoscope,
Sphygmomanometer.
To be ready to give are to the
patient. It can save time and energy
for nurses.

Unit and its preparations: -
Unit: - Unit is a place where the patient 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: -
Following points should be taken care of while
admitting a patients to the hospital:
 Keeping the bed ready.
 Position the bed according to patients needs.
 Assemble necessary equipment and supplies.
 Assemble special equipment and supplies.
 During emergency/ critical condition, quickly
collect only important data or information.
 Never leave the patients alone in casualty.

Cont…
 Speak clearly and slowly when talking to the
elderly patients.
 Medico legal cases should have the MLC stamp
and number in documents / case sheet of
patients.

Roles and responsibility of nurse: -
Nurse has following role in the admission of the
patients. It includes:
 Preparation of unit or room
 Entry of the patients with courteous /polite
 Availability of equipments
 Proper observation and meeting needs of
patients.
 Orientation of patients and attendants
 Follow hospital polices

Cont…
 Deal carefully with communicable diseases
patients
 Address with name to the client
 Proper recording of valuable belongings.

Transfer process from one unit to other:
Transfer of patient from one unit to other unit of
the hospital will be according to the hospital
need and type of care that the patients required.
Transfer of patient can be from one ward to
another ward.

Procedure:
 Explain to the patient that he or she is going to
be transferred to the other units.
 Explain the purpose of transfer.
 Inform the unit or ward where the patients has
to be transferred.
 Inform the receiving nurse.
 Identify the method of transfer like wheelchair
or stretcher.
 Make sure all the documents are updated before
shifting the patients.

Cont…
 Inform the patient arrival to the unit.
 Transfer the patient and assist him.
 Hand over all the documents as well as patients
valuables to the receiving nurse.

Transfers are used when there is a need
to:
 Facilitate more specialized care in a life-
threatening situation.
 Reduce health care costs.
 Provide less intensive nursing care

Steps Involved in Transfer
 Informing client and family about the transfer.
 Completing a transfer summary.
 Speaking with a nurse on the transfer unit to
coordinate the transfer.
 Transporting the client and his or her
belongings, medications, nursing supplies, and
chart to the other unit.

Discharge of patient from hospital
 Definition: - Discharge is the termination of
care from a health care agency. Planning for
discharge actually begins on admission, when
information about the patient is collected and
documented.
 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.

OBJECTIVES:
 List discharge screening tool components.
 List components of patient discharge education.
 Describe techniques for improving patient
discharge education.

Types of discharge:
 Planned discharge
 LAMA
 Parole
 Abscond
 Referral
 Discharge on request

1.Planned discharge ( Cured):
Planned discharge means patients has completed
the initial and actual management of disease in
the hospital. Now patient does not need the
direct supervision. Planned discharge is done
when the patients condition stabilize and patient
is ready to go to home.

2. LAMA ( leave against medical advice)
: -
When the client does not want to continue his
treatment and want to leave against doctor
advice, patient gone with LAMA. Risk and
complication explained to the patient and family
members.

3. Parole:
Parole is used in psychiatric hospitals. The patient
can be sent to home for 2-3 days by the approval
of psychiatrist in charge. If patients dose not
come or returns after the parole, the discharge
process should be done according to the hospital
protocol.

4. Absconded: -
When client leave hospital without any
information to hospital authorities. During the
treatment process, the client leaves hospital
without clearing his dues.

5. DOR( discharge on request)
When client is not willing to take treatment from
hospital on his personal request .Doctor gives
discharge order while describing his condition.

6. Transfer to other hospital: -
Patient is referred to other hospital where his
medical treatment can be continued because of
better/ specialized services. For example: client
admitted with cancer is referred to cancer
hospital.

7.Referral:
Referral means to the shift the patients to other
unit or other hospital for further management.

8.Death: -
The patients may die during his / her stay in the
hospital. In this situation, it is the nurses
responsibility to hand over the body of the
patients ( Deceased) to relatives after doing all
formalities.

Discharge Planning
The patient, family members, medical staff,
nursing staff, social worker, dietician all work
together to coordinate the discharge. The doctor
plans the discharge with the patients and leaves
a written order on patients chart.
The discharge planning should be ideal. Involve
the patients and family members in discharge
planning of the patients.
The IDEAL discharge planning approach focus on
the key points:

1.Include:
Include the patient and family members in the
process of discharge planning:
 Always include family members in group
meeting
 Recognize family members who will provide
care to the patients.

2. Discuss:
Five main area to avoid problems at home need to
discuss with the patients and family:
 Discuss about home environment and activities
 Discuss the medication
 Discuss the warning signs
 Explain test results to the family members
 Discuss regarding follow- up visit

3. Educate:
Educate the patient and family members in simple
language about the condition of the patients.
Regarding diet, exercises and medications.

4. Assess:
Assess how well doctors and nurses has explained
the diagnosis, condition and steps in the
patient’s care.

5. Listen:
Listen to the patient and families goals,
preferences observation and concern.

Steps for discharging patients: -
1. Written consent /instruction for discharge and
follow up
2. Make sure all instruction for care will be
understand by patients and relatives.
3. If relatives want LAMA have him signs LAMA.
4. Assist the patient to dress and hand over to
belongings with the sings of witnesses.

Cont…
5. Collect discharge slip and hand over to patient
and relatives.
6. Complete the patient’s record and discharge
summery.
7. Transport the patient’s belongings via wheel
chair. Assist the patient into vehicle.
8. Care of unit after discharge.

Discharge procedure: -
 Do not discharge the patient without doctor’s
procedure.
 Instruct the patient regarding care, medication
and follow up.
 Hand over the personal belongings to the
patient, deposited at the time of admission with
a written receipt.
 Check the hospital property during the discharge
time.

Cont…
 Before leaving the hospital nurse should confirm
whether he /She has clear all the hospital bills.
 If patient not able to walk nurse should assist to
the patient.
 Nurse should inform to dietary department for
discharge.
 If any patient leaves the hospital he should be
asked to sings a release form with time and date.
 The nurse should confirm all document are
completed and sent to medical record section.

Role of nurse in discharge:
In MLC cases:
 When a patient has to be discharged, inform the
police on duty in the hospital and to the CMO.
 Discharge after the clearance.
 If MLC patients absconds, inform nursing
supervisor, CMO immediately and treating doctor.
 No MLC patients can leave the hospital with
LAMA.
 The care given to the patients should be
documented timely, accurate and duly signs the
nurses notes.

Cont…
 Record related the treatment of patient has to be
stored safely and should be handed over to the
authorized person as designated by the hospital
authority.
 In case of death of an MLC, the body is not to
be handed over to the relatives. Label the body
properly and kept in mortuary/ Morgue.
 CMO/ Police officer should be informed
Simultaneously.

Care of unit after discharge
 Room is cleaned if discharge patient had
communicable disease than fumigation should
be done.
 Window and doors are opened.
 Then door window, furniture is washed and
cleaned.

Cont…
 All the articles used by the patient should be
replace to utility room after washed and cleaned
if need to sterilized send to CSSD or disinfect
by chemicals
 All articles kept ready for next use.
 Used linens send to launder.
 Mattress, pillow, blanket etc. should be exposed
to sunlight according to hospital policy.

REFRENCECES:-
1. Maninder kaur, Lakhwinder kaur, Fundamental of
nursing, edition 2014 page no 52-61
2. Taylor, C., et al.: Fundamentals of Nursing: The Art and
Science of Nursing care, 7th ed., 2011, Philadelphia:
Lippincott Williams and Wilkins, P.P.158-167.
3. Timby , B.: Fundamental Nursing Skills and Concepts,
9th ed., 2009, Philadelphia: Lippincott Williams and
Wilkins, P.P.158- 167.
4.Jyoti kathwal, Text book of Nursing foundation , Edition
2021, Page no 61 to 73
5.Carol Taylor,Pamela Lynn,Jennifer L. Barlett, SAE
Editors Vol 1 (2021) page no 335 to 346

Admission Discharge.pptx

Admission Discharge.pptx

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Admission Discharge.pptx