Hospital Admission and Discharge

Hospital Admission and Discharge

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  HOSPITAL ADMISSION & DISCHARGE Prepared By MonikaDevi NR M.Sc.Nursing GMCH Jammu
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  ADMISSION DEFINITION • “Admissionof a client means, allowing a client to stay in the hospital for observation, investigations and treatment of the disease he/she is suffering from.” • “Admission is the entry of a patient into a hospital /ward for therapeutic /diagnostic purposes.” 2 Monika Devi N R
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  TYPES OF ADMISSION EMERGENCY ROUTINE/ ELECTIVE 3 Monika DeviN R
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  EMERGENCY ADMISSION • Clientsare admitted in acute conditions requiring immediate treatment. • E.g.: patient with heart attack, poisoning, breathing difficulty, RTA( Road traffic accident) etc • Patient should be admitted in casualty or emergency department to save the life of the patient. 5 Monika Devi N R
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  ROUTINE/ ELECTIVE ADMISSION •Clients are admitted for investigations and planned treatment and surgeries. • E.g.: patient with diabetes, hypertension, appendicitis, jaundice etc 6 Monika Devi N R
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  PURPOSE OF ADMISSION •To receive the patient in ward for admission according to his/her condition • To welcome the patient • To provide comfort and safety to the patient • To provide immediate care • To be ready for any emergency 7 Monika Devi N R
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  • To assistthe patient in adjusting to the hospital environment • To obtain information about patient such as address, guardian, any information that serves as a basis of care e.g. Allergy, diabetes. • To establish Nurse-patient relationship 8 Monika Devi N R
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  CLIENT’S EMOTIONAL REACTION • Anxiety •Fear • Denial • Emotionally upset • Anger • Sad 9 Monika Devi N R
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  PREPARING THE UNITFOR ADMISSION • The admitting office notifies the unit prior to the patient’s arrival, so that the room/bed can be prepared. • Some of the activities carried out by the nurse before the patient is to be admitted are: • Keeping the bed ready: open the bed, fold back the bedspread, top blanket, and top sheet. Cover the bed with full length mackintosh and two bath towels in order to protect from soiling 10 Monika Devi N R
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  • Position thebed: for ambulatory client, the bed should be in normal position. If client has to arrive on stretcher, the bed should be in lowest position. Make sure furniture in the room is arranged to ensure easy access to the bed • Assemble the necessary equipment and supplies : hospital admission pack, which contains items such as drinking glass, papers, lotion etc should be ready at bedside. A hospital gown should be available, although the client may choose to wear own clothes 11 Monika Devi N R
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  • Assemble specialequipment and supplies: the client may require oxygen therapy, cardiac monitoring or suction equipment. The nurse should make sure that the equipment is functioning properly and is ready for patient use. 12 Monika Devi N R
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  PREPARATION OF ARTICLESFOR ADMITTING THE PATIENT Articles Rationale All articles for an open bed: draw sheet, mackintosh, blanket, bottom sheet, top sheet To keep the bed ready to receive the patient in a calm manner Full bed length mackintosh To protect the bed from soiling with excreta/blood etc Two bath blankets/ bed sheets To cover the mackintosh and another to cover the patient 13 Monika Devi N R
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  Articles Rationale Hot waterbags in cold weather To keep warm before hand Other articles required for daily care of the patient e.g. vital signs tray, set of hospital clothes. To be ready to give care to the patient. To save time & energy of nurse Any other special equipment such as oxygen, suction, monitoring equipment To meet emergency in life-saving situations 14 Monika Devi N R
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  ADMISSION PROCEDURE STEPS RATIONALESCIENTIFIC PRINCIPLE NURSING PRINCIPLE Prepare room, arrange all items in place & adjust height of bed To feel safe & secure and easy transfer from stretcher to bed To relieve fear & anxiety and encourage adjustment Comfort & safety Check patient’s identification and greet him/her & relatives. Introduce yourself To help them to feel at ease To encourage adjustment Comfort & individuality 19 Monika Devi N R
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  STEPS RATIONALE SCIENTIFIC PRINCIPLE NURSING PRINCIPLE Observeclient’s vital signs & symptoms for laboratory tests, if required To know condition of patient on admission, to assist physician in line of treatment To detect any variations from normal Therapeutic effectiveness Provide privacy. Give admission bath, if needed. Change to hospital clothes To relax & make patient comfortable. To make important observations To help in relaxation of patient Comfort & therapeutic effectiveness 20 Monika Devi N R
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  STEPS RATIONALE SCIENTIFIC PRINCIPLE NURSING PRINCIPLE Explainuse of bathroom & other equipment in the room or ward Place call bell & locker in easy reach of patient Explain meal timing and visiting hours to client & relatives To help the patient be at ease & knowing how to use equipment to prevent accidents Help in adjusting to new environment, reduces anxiety, helps in preventing accidents. Comfort & safety Return patient’s valuable and clothing To provide client with his/her own valuables safety 21 Monika Devi N R
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  STEPS RATIONALE SCIENTIFIC PRINCIPLE NURSING PRINCIPLE Answerqueries of client & relatives Decrease anxiety & fear Helps to avoid stress comfort Complete necessary records according to agency policy which includes nursing history & assessment Important part of client’s permanent record Record of patient's data Individuality & therapeutic effectiveness 22 Monika Devi N R
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  MEDICO LEGAL CASES •A medico-legal case is one where besides the medical treatment; investigations by law enforcing agencies, are essential to fix the responsibility regarding the present state / condition of the patient. 23 Monika Devi N R
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  MEDICO-LEGAL CASES INCLUDE: •Accidents like Road Traffic Accidents (RTA), Industrial accidents • Cases of trauma with suspicion of foul play • Electrical injuries • Poisoning • Chemical injuries • Burns • Sexual Offences • Attempted suicide • Domestic violence and child abuse 25 Monika Devi N R
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  • Cases ofasphyxia as a result of hanging, drowning, suffocation etc • Death in the operation theatre • Death due to Snake Bite or Animal Bite • Drug overdose • Drug abuse • Dead brought to the Emergency Dept (Found dead) and deaths occurring within 24 hours of hospitalization without establishment of a diagnosis 26 Monika Devi N R
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  Role During Mlcs •In emergencies, resuscitation and stabilization of the patient will be carried out first and medico legal formalities may be completed subsequently. The consent for treatment is implied in all emergencies • Hospitals will maintain a MLC register and the MLC will be initiated and documented in the register. • Medicolegal documents should be considered as confidential records and should be stored under safe27 Monika Devi N R
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  ROLES & RESPONSIBILITIESOF NURSE DURING ADMISSION PROCEDURE • At the time of admission, the registered nurse perform complete assessment of the patient. • Enter patient name, date and time of admission, chief complains, medical diagnosis in the admission file or patient file. 28 Monika Devi N R
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  ROLES & RESPONSIBILITIESOF NURSE DURING ADMISSION PROCEDURE • Document - the source of information (family, patient, care giver or health care person or significant person). • Check the document if patient has previous hospitalization and past major illness. • Take patient vital signs (pulse, temperature, respiratory rate, height and weight). 29 Monika Devi N R
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  • Document ifpatient and family has valuables brought to the hospital. If yes, hand it over to the relatives with their signatures. • At the time of arrival to the unit or ward patient and family will be given orientation regarding the unit, visiting rooms, patients right and responsibilities. • In medico-legal case, the police has to be informed and the nurse has to keep documents confidential & under safe custody. 30 Monika Devi N R
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  DISCHARGE DEFINITION • “Dischargeof patient from the hospital means, relieving a person from hospital setting, who admitted as an inpatient in that hospital” • “Discharge or dismissal from the hospital means the departure of patient from the hospital” • “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.” 31 Monika Devi N R
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  TYPES OF DISCHARGE TRANSFE R DAMA/ LAMA PLANNE D DEATH ABSCOND 32 Monika DeviN R
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  TYPES OF DISCHARGE •PLANNED DISCHARGE: Patient’s treatment is over and the attending physician has discharged the patient • ABSCOND: Patient leaves the hospital without prior information • LAMA/DAMA (left against medical advise/ discharge against medical advise): In LAMA/DAMA, patient chooses to leave the hospital before the treating physician recommends discharge 33 Monika Devi N R
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  • TRANSFER: Patientis transferred to another health care facility or within the same hospital from one ward to another • DEATH: after death of patient, the dead body is handed over to the relatives after completing the discharge procedure 34 Monika Devi N R
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  PURPOSE OF DISCHARGE •To be certain that the patient has the information on his/her condition. • To inform about the follow-up visits or referral to other health agencies. • To teach the Nursing procedure or care he/she needs at home & to take re-demonstration • To provide for a safe, efficient return of all patient’s clothing, valuables & to check that all hospital equipment & clothing in the hospital 35 Monika Devi N R
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  • To helpmake the safest arrangements possible for the patient at the time of discharge • Provide continuity of care at home • To assist the patient to manage successfully the change from hospital environment to home environment • To prevent any misunderstanding or difficulties for the patient or hospital in relation to patient’s discharge, medicines, bills. 36 Monika Devi N R
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  DISCHARGE PROCEDURE STEPS RATIONALESCIENTIFIC PRINCIPLE NURSING PRINCIPLE Make sure that there is a written instruction for discharge & follow-up prescription To prevent legal implications. The attending physician is required to give clear written instruction for discharge & follow- up prescription Continuity of medical advise. Consumer’s rights Safety of the patient 37 Monika Devi N R
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  STEPS RATIONALE SCIENTIFIC PRINCIPLE NURSING PRINCIPLE Makecertain that the family & patient understand the instruction for care ( diet, medication, exercise) Understanding of instruction by patient & family will help in better care Help the client to adjust to new regime To reduce client anxiety Comfort & safety If patient or relative decides to leave the hospital against medical advise of his doctor, have him sign LAMA form The patient’s or guardian ‘s signature acknowledges full responsibility & own risk of leaving the hospital’s care Protection of hospital against legal implication Safety & good workmanship 38 Monika Devi N R
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  STEPS RATIONALE SCIENTIFIC PRINCIPLE NURSING PRINCIPLE Assistthe patient to dress, check & pack belongings To conserve strength & avoid loss of any personal belongings Helps to reduce anxiety & stress Comfort & safety Collect the discharge slip & prescription that the patient is to take with him for follow-up care To make him self-reliant Gradual adjustment to home life & after care reduces anxiety & promotes health Comfort & safety Complete patient’s record & discharge summary Because of legal implications, it is important that all the hospital document should be completed Hospital records from legal evidence Safety & protection of hospital policies 39 Monika Devi N R
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  STEPS RATIONALE SCIENTIFIC PRINCIPLE NURSING PRINCIPLE Transportthe patient & his belonging via wheel chair. Assist the patient into the vehicle To ensure safety of patient, hospital personnel are responsible until patient leaves hospital Helps patient to have sense of belonging & maintain inter- personal relationship Safety & maintaining inter-personal relationship Care of unit after discharge To keep ready the unit for admission of new patient Ensure cleanliness for the next patient Safety & good workmanship Economy of time, material & energy 40 Monika Devi N R
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  ROLES & RESPONSIBILITIESOF NURSE DURING DISCHARGE PROCEDURE • 1. See doctor’s written order for discharge: no client should be discharged without doctor’s written order • 2. Explanation of discharge procedure • 3. Hand over personal belongings: clothing, jewellery or other valuables that were entrusted with hospital at the time of admission should be returned to client. 41 Monika Devi N R
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  ROLES & RESPONSIBILITIESOF NURSE DURING DISCHARGE PROCEDURE • 4. Check and receive any hospital property: any of the hospital property that was given to client for his/her use in hospital should be checked and received back before he/she leaves • 5. Teach nursing procedures to be continued at home, get it’s practice done: Provide instructions regarding medication, follow-up visit 42 Monika Devi N R
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  • 6. Confirmbill paid: Before client leaves, nurse should confirm that the client has paid the hospital bill • 7. Inform other departments regarding discharge. • 8. Documentation: the nurse should check that the charts & files are completed 43 Monika Devi N R
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  • 9.Arrange transport:if the client is not able to walk, then the nurse should see that he/she is transferred either on a wheel chair or stretcher • 10. If DAMA :-check consent, the form should state that the person is leaving against medical advise of doctor and that neither doctor nor the hospital can be held responsible for any ill effect happening after the departure • 11.Care of patient’s room and articles after discharge 44 Monika Devi N R
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  CARE OF UNITAFTER DISCHARGE • After a client is discharged & before admitting another patient, the room is cleaned & aired. • All articles used by client should be taken to utility room, washed, cleaned, sterilized if necessary or disinfected by chemicals. The articles are re-arranged and kept ready for next client • Used linen should be sent to laundry • Mattress, pillows, blankets etc should be exposed to sunlight and then the bed is made with fresh linen • If the room was used for a client with communicable disease, it should be fumigated 45 Monika Devi N R
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  Thank you 46 Monika DeviN R