Fundamental of nursing -Process of Hospitalization.pptx

Process of Hospitalization
Ghaffar Ahmed
Lecturer INC

Objectives
 Define the terms admission, transfer and discharge.
 Understand the procedure for admission, transfer and discharge.
 Identify nurse’s responsibility during admission, transfer and
discharge.
 Recognize nurse role in preparing patients and family for discharge.
 Discuss the normal reaction of patient being hospitalized.

Nursing
 Nursing encompasses autonomous and collaborative care
of individuals of all ages, families, groups and communities,
sick or well and in all settings.
 It includes the promotion of health, the prevention of illness,
and the care of ill, disabled and dying people.

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.

Admission
Admission is defined as allowing a patient to stay in hospital
for
 Observation
 Investigation
 Treatment
 Care

Cont ………
 Admission is the entry of a patient into a hospital /ward for
therapeutic /diagnostic purposes.

Purposes of Admission
 To undergo evaluation & treatment.
 To know what is really happening in his/her body.
 To provide emotional security to the newly admitted patient
and his family.

Types of Admission
1. Emergency admission
2. Routine admission
 Emergency admission In this, patients are admitted in acute
conditions requiring immediate treatment.
 Examples. Patient with RTA, Poisoning, burns and cardiac or
respiratory emergency.

 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.

Unit and it’s preparation
 It 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.

Cont…….
 Prepare the treatment table
 Ensure all the equipment are completed
 Check ventilation
 Ensure patient privacy

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.

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
 Ask the patient to change clothes into hospital gown if
necessary

 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

 Orientation to the patient and relatives
 The equipment's /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.

 Record & Report
 Admission Book
 Preparation of Paper
 Drug Book
 Diet Book
 HMIS Entry
 Cot List

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.

 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”.

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

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
 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.

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.

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.

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

Types of Discharge
 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.
 DAMA/LAMA:
Discharge/Leave Against Medical Advice.
 TRANSFER:
Transfer to other unit or hospital.
 ABSCOND:
Abscond from Hospital.
 REFFERAL :
Referred for further management.

 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:-

Discharge planning
 Nurses play an important role in discharge planning in the
hospital.
 Continuity of care is important.
 To achieve continuity of care, nurses use critical thinking
skills and apply the nursing process.
 Discharge planning is a centralized, coordinated,
interdisciplinary process.

ESSENTIALS OF PLANNED DISCHARGE
 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.

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.

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.

Nurses Responsibility in Discharge 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

 Nurses Responsibility in Discharge AFTER DISCHARGE
 Documentation.
 Care of patient’s room and articles

Nurses responsibility in 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.

Checklist
 M
 E
 T
 H
 O
 D

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

Reference
 Berma A, Snyde S. Fundamentals of Nursing. 9th ed. Tamil Nadu,
India: Kozier & Erb's; 2017.
 Website:
 https://nursekey.com/admission-transfer-and-discharge-process/

Fundamental of nursing -Process of Hospitalization.pptx

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