FUN

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Fundamental of Nursing
Admission, Discharge, Transfer,
and Referrals
Dr; mosa alfageh

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Admission
Entering a hospital for nursing care and medical or surgical treatment
discharge
Discharge is the termination of care from health care agency
Patient transfer within your facility from a unit to another one
A referral is the process of sending someone to another person or agency for
special services
transfer
referral
Definitions;

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Types of Admissions
Type Explanation Example
1. In patient Length of stay more than 24 hours Acute appendicitis, acute
pneumonia.
a) Planned (non urgent) Is scheduled in advance Elective or required major
surgery
b) Emergency
admission
Unplanned, stabilized in emergency
department and transferred to nursing
care unit
Unrelieved abdominal or
chest pain , major trauma
c) Direct admission Unplanned, emergency department
bypassed
Acute condition as
prolonged vomiting and
diarrhea
2. Out patient length of stay less than 24 hours Minor surgery , cancer
therapy ,physical therapy
a) Observational Monitoring required , need for
inpatient admission determined within
23 hours
Head injury , RTA , unstable
vital signs

4. Medical authorization
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The admission process
 A physician determines whether a client's condition requires special tests ,technical
care Or require treatment unavailable anywhere other than in a hospital .
• Physician advises both client and nursing staff to proceed with admission
process
The admitting department
• Clerical personnel gathers information
• Initiate the medical record with data
• Prepares addressograph to stamp laboratory test , requests forms that
accompany a laboratory specimen
• The admissions personnel notify nursing unit and escort client to the unit.
• An identification bracelet contain client’s name and identification number
• Nurse is responsible for replacing missed or removed bracelet as possible

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Nursing Admission Activities
1. Preparing the client’s room
2. Welcoming the client
3. Orienting the client
4. Safeguarding valuables and clothing
5. Helping the client wear hospital’s gown if indicated
6. Compiling the nursing data base
7. Reconciling medication
8. Administering initial treatment
The admission process

6. 1.Prepare the client’ room
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1. Prepare the specific room for the client after information from the admission
department and before the client arrival to department
2. Room prepared generally by all basic supplies and any special supplies needed
for the special care to client before arrival
3. Place O2 equipment , IV stand or anything required at the time of initial
treatment
Notes ; each bedside stand is generally stocked with the following
• Wash basin
• soap dish
• emesis basin
• water carafe
• bedpan and a urinal

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8. 2.Welcoming the client
 One of the most important steps in admission is to make the client feel welcome
 On arrival , the admitting nurse greets the client warmly with a smile and a
handshake
 The admitting nurse wears a name tag , introduces himself or herself and also
introduces clients who share the room
 A client who feels unwanted is likely to have a poor, and lasting ,negative first
impression of the unit
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10. 3.Orienting the client (Help person become familiar with a new environment)
facilitates comfort and adaptation the nurse describe the following ;
 Nursing station location , toilet …
 Where to store clothing and personal items
 How to call for nursing assistance from the bed and bathroom
 How to adjust hospital bed and regulate the room lights
 How to operate the television
 Daily routine such as meal times , doctor visits and
 when surgery is scheduled
 When laboratory or diagnostic tests are performed
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11. 4.Safeguarding valuables and clothing
 Nurses give valuable jewelry and money to family members.
 If not possible, the nurse must carefully observe the agency's policies.
 Place clients' valuables as money or jewelry in hospital's safe temporarily.
 Makes a descriptive notation in medical record Identifying type of valuables and how
they safeguarded.
 Losing items have serious legal implications for nurse and health agency.
 Have second nurse or security person present when safeguarding valuable Make
inventory signed by both nurse and client to avoid discrepancies between entrusted &
those returned & gives one copy to the client.
 Identify client-owned equipment as wheelchair with large, easily read label
 The health care agency is responsible for replacing lost or broken items if negligence the
staff causes accidental damage or loss.
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12. 5.Helping the client undress
f the client cannot undress without the nurse's help, the nurse does the following:
 Provides privacy
 Has the client sit on the edge of the bed.
 Removes the client's shoes.
 Gathers each stocking, sliding it down the leg and over the foot.
 Helps the client lie down if weak or tired.
 Releases fasteners as zippers and buttons and removes the item of clothing in most
comfortable and least disturbing manner.
 He or she has the client lift the hips to slide clothes up or down.
 Lifts the client's head to guide garments over it.
 Rolls client from side to side to remove clothes that fasten up front or back.
 Covers client with a bath blanket after removing outer clothing, or puts a hospital
gown, explaining that hospital gowns fasten in the back.
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13. 6.Compiling the Nursing Data Base
 On admission , the nurse begins assessing client and collect information for the
database.
 Physical assessment skills , which include taking vital signs
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Administering initial treatment
Reconciling medication
Medication reconciliation refers to obtaining and verifying the medication a client
is currently taking, dosage, frequency , and route are necessary and reporting for
physician
The nurse give the drug ordered immediately by the end of admission process
Then programing the frequency of administration of drug upon hospital policy

14. Initial nursing plan for care
 Once all admission data are collected, develops an initial plan for client's care as
possible but no later than 24 hours following admission.
 The initial plan identifies the client's priority problems and may include the client's
projected needs for teaching prior to discharge.
 Revise care plan as more data accumulate or client's condition changes.
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Care plan for client
Medical Admission Responsibilities
 The nurse notifies physician when the admission procedure is completed.
 Physician orders medications, treatments, lab & diagnostic tests, diet & activity and
rest .
 He obtains history & performs physical examination within 24 hours of admission.
It may include: identifying data, chief complaint, history review of systems &
conclusion.

15. Common Responses to Admission
 Client admission is a unique & emotionally traumatic experience for client.
 Leaving home security & entering unfamiliar health care facility compound stress of
physical illness and contribute to emotional & social distress.
 Some common reactions to admission include anxiety, loneliness, decreased
privacy, and loss of identity. Nurse may also identify one of following nursing
diagnoses:
 Anxiety
 Fear
 Decisional Conflict
 Situational Low Self-esteem
 Powerlessness
 Social isolation
 Risk for ineffective therapeutic regimen management
 Loss of identity
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16. Client caring for responses to admission
 Let client express all his feelings and concerns
 Discuss with him his situation , listen carefully
 Build trust with client and family
 Supporting the client and family
 Tell the client and family success stories for previous cases like his situation
 Let client feel that he in place like home
 Treat the client that visits not restricted except in situations affect his health status
 Tell the client that he is a partenner and encourage him/her in sharing the plan of
care
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Discharge is ”the termination of care from a health care agency
Steps in the Discharge Process
 Discharge planning
 Obtaining a written medical order
 Completing discharge instructions
 Notifying the business office
 Helping the client leave the agency
 Writing a summary of the client’s condition at discharge
 Requesting that the room be cleaned

18. Obtaining authorization for medical discharge
 The physician determines when the client is well enough for discharge
 The physician writes the discharge order provides
 Written prescriptions for the client and
 indicates when a follow up appointment should occur
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Leaving against medical advice (AMA) is a term that applies to situations in which the
client leaves before the physician authorizes the discharge.
Providing discharge instructions
When the nurse anticipates that a client will be discharged home
He or she
He or she establishes the anticipated knowledge , skills , and community resources
that the client will need to maintain a safe level of self care

19. discharge planning technique involves using the acronym
METHOD as a guide
 M =Medication
 E = Environment
 T = Treatment
 H = Health teaching
 O = Out patient referral
 D = Diet
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example
Nursing activity
topic
Insulin
Instruct the client about drugs that will be self-
administered
M-
medication
Remove scatter
rugs
Explore how the home environment can be
modified to ensure the client's safety
E-
environme
nt
Dressing changes
Demonstrate how to perform skills involved in
self-care and provide opportunities for
returning the demonstration
T-
treatment
Signs and
symptoms of
complications
Identify information that is necessary for
maintaining or improving health
H – health
teaching
Physical therapy
Explain what community services are available
that may ease the client's transition to
independent living
O –
outpatient
referral
Low-fat diet
Arrange for the dietitian to provide verbal and
written instructions on modifying or
restricting certain foods or suggestions for
altering their methods of preparation
D- diet

21. Notifying the Business Office
 Before the client leaves the agency, the nurse notifies the business office for
verification of insurance or for future payments.
Discharging a Client
 Gathering Belongings
 Arranging Transportation
 Escorting the Client
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Writing a Discharge Summary
After the client has left the health care agency, the nurse documents the discharge
activities and client's condition as:
 Vital signs before leaving
 Discharge reasons, date and time
 General patient condition (consciousness, activity, feeding ...)
 Each instructions you give to the patient about his condition.
Terminal Cleaning
Except in unusual circumstances, housekeeping personnel prepare the client's room for
the next admission.

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Transfer: “ discharging a client from one unit or agency and admitting
him or her to another without going home”
 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
 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
Steps Involved in Transfer

23. A referral - is the process of sending someone to another person or agency
for special services.
In referral the client must be oriented for:
 Day of referral
 Time of referral
 Place and
 Phone to ask and clarify
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