CHP 4 Admission Discharge.pptx

Nursing Foundation 1

1. CHAPTER 4 Hospital Admission and Discharge

2. Learning Objectives Define admission Enlist the purposes of admission and types of admission Enlist the steps of health assessment Explain the procedure of admission Describe the role of nurse in admission process Define discharge and explain the type of discharge Describe the procedure of discharge and role of nurse in discharge

3. CHAPTER OUTLINE Admission to the Hospital  Definition, Purpose, Types of Admission  Unit and Its Preparation  Special Considerations  Admission Procedure  Medico-Legal Issues  Roles and Responsibilities of The Nurse Discharge from the Hospital  Purposes  Types: Planned Discharge, LAMA and Abscond, Referrals and Transfers  Discharge Planning  Discharge Procedure  Special Considerations  Medico—Legal Issues  Roles And Responsibilities of The Nurse  Care of The Unit After Discharge

4. MEANING OF ADMISSION Admission of a patient means allowing and facilitating a patient to stay in the hospital unit or ward for observation, investigation and treatment of the disease he/she is suffering from.

5.   DEFINITIONS OF HOSPITAL ADMISSION Hospitalization is admission to the hospital as a patient. Admission is defined as the entry of a patient in the hospital for diagnostic or therapeutic purposes. Admission is the process where patient needs admission in the hospital for observation, investigation, treatment and care .

6.   PURPOSES OF ADMISSION

7. PURPOSES OF ADMISSION Observation - To keep in round the clock supervision patient is admitted e.g., the patient with chest pain, palpitations. Immediate Care – Patients requiring urgent medical treatment for cardiac arrest, respiratory arrest and accidental cases require admission. Investigate – Patient is admitted to perform certain medical test before a line of treatment can be extended.

8. PURPOSES OF ADMISSION Treatment - For further management after diagnosis is made. Meet needs - Patients who can’t meet their physical needs on their own such as terminally ill patients and patients suffering with chronic diseases. Ready for emergency - Patients requiring watchful monitoring of medical experts in case of sudden exigency of hospital care need to be admitted to the hospital.

9.   TYPES OF HOSPITAL ADMISSION

10. BASED ON THE PURPOSE OF THE ADMISSION Diagnostic admission: Admission when the patient has to undergo some procedure and require investigation like biopsy. Therapeutic admission: Patient has already been diagnosed with medical condition and requires medical care for the improvement.

11. BASED ON THE LENGTH OF THE HOSPITAL STAY Short-term admission: Patient is admitted for a 24-48 hours in the hospital. Long-term admission: Patient suffers from a disease condition and needs more than 48 hours to recover from the disease condition.

12. BASED ON THE CONDITION OF THE PATIENT Routine admission: Patient is suffering from any disease condition like cholelithiasis and need to undergo any treatment and surgery. Emergency admission: Patient is suffering from life threatening condition like cardiac arrest, respiratory arrest, etc and requires immediate treatment.

13. CATEGORIES OF THE PATIENT ADMITTED IN THE HOSPITAL

14. UNIT AND ITS PREPERATION Meaning of unit: A unit or ward is defined as the division of the hospital or a room or hall in the hospital which has number of beds and shared by a number of patients, who require similar care. There are different types of wards or units in the hospital like medical and surgical wards.

15. UNIT PREPERATION Bed should be functioning properly. Linens and blanket should be clean. Make unoccupied bed. Prepare the admission bed Equipments like cardiac monitor, oxygen flow meter, suction machine should be functioning properly as per the needs of the patient. Ensure equipment Ensure the privacy of the patient and do not expose the patient unnecessarily. Ensure patient privacy Perform the initial assessment to assess the risk factors like risk of fall, risk of developing pressure sores, pain assessment, etc. Patient safety Identify the categories of patient. assess the financial constraints and explain the estimated cost of the treatment to the patient and the family. Financial burden Patient isolation The suspected patient or the patient with mild symptoms of COVID-19 and tuberculosis require isolation. Chart visiting time outside the unit. Instruct the family members to wear appropriate personal protective equipment (PPE) while meeting with patient.

16. DEALING WITH HOSPITALIZATION ANXIETY Ways to reduce the anxiety among patients: • Be empathetic with client. • Orient the client to the unit or the wards. • Maintain good interpersonal relationship with the patient. • Explain each and everything to the patient. • Provide privacy to the patient. • Respect the dignity of the patient. • Allow the patient to ventilate his/her feelings and clear the doubts of the patient.

17. PROCEDURE OF ADMISSION OF A PATIENT Meet and receive the patient Perform examination and initial assessment Coordinate with health care team members Orientation to the patients and others

18. MEET AND RECEIVE THE PATIENT Verify the patient data, by checking the record sheet, chart. Introduce yourself and other members of health team on duty. Assist patient to the treatment area. Ask the patient to change clothes into hospital gown if necessary. Put the identity bracelet.

19. PERFORM EXAMINATION AND INITIAL ASSESSMENT Conduct general head to foot examination. Check the height and weight of the patient. Assess the allergic history of patient. Send the investigation as prescribed by the physician. Do the initial assessment which includes pain assessment, risk of pressure ulcer assessment and fall risk assessment.

20. COORDINATE WITH HEALTH CARE TEAM MEMBERS Coordinate with all healthcare team members like physician, physiotherapist and dietician. Carry out the initial orders or instructions given by the physician. Provide the treatment as instructed.

21. ORIENTATION TO THE PATIENT AND THE OTHERS THE EQUIPMENT Orient the patient to the equipment and instruct the patient not to touch them unnecessarily. USE OF CALL SYSTEM AND TELEPHONE Educate the patient regarding use of call bell and telephone. TREATMENT SCHEDULE Explain the treatment schedule to the patient. VISITOR’S TIMINGS Explain the hospital policy regarding visiting to the family members. OTHER HEALTH CARE TEAM MEMBERS Orient the patient to the other healthcare team members. POLICIES, RULES AND REGULATIONS Inform the patient about the policy as well as rules and regulations of the hospital. CARE OF PATIENT’S VALUABLES Make the list of the patient’s valuables in the patient valuable handover form and hand it over to the family members at the time of the admission.

22. ARTICLES REQUIRED FOR ADMISSION

23. ARTICLES REQUIRED FOR ADMISSION

24. PROCEDURE OF RECEIVING A NEW PATIENT PATIENTS CAN BE ADMITTED FROM VARIOUS HOSPITAL DEPARTMENTS Outpatient department (OPD) Emergency Private clinics Referral

25. PROCEDURE OF RECEIVING A NEW PATIENT The duty manger will inform the head nurse regarding admission of the patient. The nurse will prepare the needed equipment and will make sure that all the equipment are functioning properly. Introduce yourself to the patient and welcome the patient. Adjust the height of the bed as per the condition of the patient. Escort the patient to the bed. Arrange the help if patient arrives on stretcher for shifting. Identify the patient using at least two identifiers like patient name, UHID No. (Unique hospital identification data) or MR No. (Medical record number). Orient the patient (fig. 3). Complete the process of the admission and change the status of the bed from vacant to occupied.

26. ORIENTATION OF THE PATIENT

27. PROCEDURE OF RECEIVING A NEW PATIENT Provide hospital clothes to the patient and perform initial assessment. Check the medications that patient have brought from the home to the hospital. Keep record of the medication and label it as patient’s own medications. Check the order of the doctor for treatment Send initial investigations as prescribed by physician. Inform to the doctor on duty and the dietician regarding patient admission. Tell the patient about any scheduled procedure or treatment. Document the patient’s condition and nursingaction that has been taken.

28. ADMISSION OF THE PATIENT IN INTENSIVE CARE UNIT OR EMERGENCY DEPAERTMENT Keep the articles ready required for the admission of the patient in the intensive care unit or emergency department and ensure that all the equipment are functioning properly. Keep the patient’s file ready Perform initial assessment and observe the condition of the patient. Reassure the patient and explain what is being done. Shift the patient to the ICU or emergency bed. Provide privacy to the patient and p ut identity bracelet to the patient. Review the allergic history and put allergy identity bracelet if required.

29. ADMISSION OF THE PATIENT IN INTENSIVE CARE UNIT OR EMERGENCY DEPAERTMENT M ake the patient wear hospital clothes. Make a list of the valuables and handover them to the primary caregiver and take a witness sign. Perform thorough physical examination and document the patient’s condition. Connect the cardiac monitor to the patient. Access an IV line and start maintaining intake output. Provide recovery position (left lateral) to the patient. If unconscious keep the mackintosh towel under the face to collect secretions.

30. TRANSFER OF THE PATIENT FROM ONE UNIT TO ANOTHER Explain about the transfer and its purpose to the patient and family members. Inform to the unit or ward where the patient has to be transferred and receiving nurse regarding patient’s condition and the equipment needed. Identify the method of transfer like wheelchair, stretcher and bed. Make sure all the documents are updated before shifting the patient. Inform the patient arrival to the unit. Transport the patient. Assist the patient in transfer to the bed. Match the patient identification details with the record sheets and accompany the patient to the area of shifting. Handover all the documents as well as patient valuables to the receiving nurse.

31. MEDICOLEGAL ISSUES IN ADMISSION OF THE PATIENT Concept : Medicolegal cases (MLC) have both medical and legal implications. Medicolegal cases are the cases where along with medical treatment of the patient, investigation by law is required to ascertain the responsibilities regarding the present state or condition of the patient . Definition : It can also be defined as the cases which require medical treatment but at the same time needs to be informed to the law enforcing authorities.

32. CASES CONSIDERED AS MEDICOLEGAL Accidental death Accident cases Injuries Poisoning Unnatural events under suspicious circumstances Violence Bullet injury Drowning

33. MEDICOLEGAL ISSUE DURING ADMISSION OF THE PATIENT Assault Intentional act that cause another person to fear that he/she is about to suffer physical harm. Injuries Damage to any part of the body caused by violence. Disclosure of the information Disclose information about patient’s condition, the methods of treatment and alternative for the treatment. Medical negligence Improper or unskilled treatment of a patient by a medical practitioner

34. ROLE OF NURSE IN ADMISSION OF MEDICOLEGAL CASES

35. ROLE OF NURSE IN THE ADMISSION OF THE PATIENT PREPARATION OF UNIT OR ROOM Role of nurse is to prepare the unit. Keep the bed ready. Linens and blanket should be clean. Position the bed. ENTRY OF THE PATIENT Enter the patient’s information in admission register as well as computer system. AVAILABILITY OF THE EQUIPMENT Ensure that all the articles and equipment are available and functioning properly. ORIENTATION OF THE PATIENT Orient the patient to the surroundings and hospital policies and protocols. MEETING NEEDS OF THE PATIENT Recognizing and meeting the various needs of the patient. CARE OF PATIENT’S VALUABLES AND CLOTHES Handover the patient’s valuables to the family members at the time of admission. TREATMENT Carry out the instructions as prescribed by the physician.

36. DISCHARGE OF THE PATIENT Definition: Discharge of a patient means departure of a patient from the hospital. It is also known as dismissal of patient from the hospital.

37. PURPOSES OF DISCHARGE Purposes of discharge To ensure continuity of care. For a safe and effective return of all the patient’s clothing and valuables. Help the patient to adjust effectively with the change of environment. To make sure that the patient has information about his/her condition.

38. TYPES OF DISCHARGE

39. PLANNED DISCHARGE The decision of discharge is taken by the attending doctor or physician when the patient has completed the initial and actual management of the disease in the hospital and now patient does not need the direct supervision.

40. LEAVE AGAINST MEDICAL REQUEST (LAMA) Also known as Discharge Against Medical Advice (DAMA), in this it is clearly explained by the doctor that taking the patient from the hospital may impose risk to the life of the patient, but still patient or patient’s family want to take the patient to some other hospital or to the home after signing a declaration form saying that the risks and consequences of taking the patient from the hospital were informed to the patient or family.

41. PAROLE It is used in psychiatric hospital and patient is sent to home for 2 to 4 days by the approval of psychiatrist in charge.

42. REFERRAL Shifting the patient to other units or to the hospital for further management.

43. DISCHARGE ON REQUEST Treatment is not complete but there is no immediate danger to the life of the patient in taking the patient out of the hospital.

44. PNEUMONIC – DISCHARGE PLANNING PNEUMONIC – DISCHARGE PLANNING The pneumonic that is used to describe the discharge planning is IDEAL.

45. DISCHARGE PLANNING Include : Include the patient and the family members in the process of discharge planning. Discuss : Five main areas like life at home, medications, warning signs, test results and follow up visits need to be discussed with patient and the family. Educate : Educate the patient and the family members regarding the condition, diet, exercise and medications. Assess : Assess how well doctors and nurses has explained the diagnosis, condition, and the steps in the patient’s care to the patient and the family members. Listen : Listen to the patient and his/her families goals, preferences, observations, and concerns.

46. PROCEDURE OF DISCHARGE Review the doctor’s order for discharge in written form. Prepare the cumulative hospital charges and return the extra medication to the pharmacy. Send the final cumulative billing sheet to the cashier and process the final bill. Patient settles the bill and receives payment paid slip. Patient or family members goes to the ward to collect the discharge summary and physician or staff explains about the medication and follow – up – date.

47. PROCEDURE OF DISCHARGE Remove the lines, tubing, cut off the identity bracelet and ask the patient to change the hospital dress. Transfer the patient to hospital lobby and document the return process of the patient in progress notes. Inform the housekeeping to clean the room. Check all the documents of the patient with medical record, change the status of the inpatient room and make the room ready for the next patient arrival.

48. ROLE OF NURSE IN DISCHARGE Role of the nurse in an MLC during discharge: Inform the police on duty in the hospital and to the Chief Medical Officer (CMO). Discharge only after the clearance. If patient absconds, inform the nursing supervisor, CMO and the treating doctor. No MLC patient can leave the hospital with LAMA. The care given to the patient should be documented timely, accurate and duly sign the nurses’ notes. Records related to the treatment of the 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, the body is not to be handed over to the relatives. Label the body properly and sent to the mortuary and inform CMO and police officer.

49. ROLE OF NURSE IN DISCHARGE

50. CARE OF THE UNIT AFTER PATIENT DISCHARGE When the patient is discharged, inform the housekeeping staff to clean the room and make it ready for the next patient arrival. Instruct the housekeeping staff to clean the furniture and windows and send the linens and blanket for the laundry. The articles which are used by the patient should be sent to the utility room for cleaning, sterilization and disinfection. Discard the unwanted objects or materials and disinfect the mattresses. In case the room is used by the patient suffering from communicable diseases then it should be fumigated. Prepare the unit for next patient as per hospital policy.

51.   CHAPTER FOCUS POINTS Admission is the process of allowing the patient to stay in the hospital for a diagnostics or therapeutic purposes. It can be emergency admission or routine admission. Nurse should be skillful to receive the patient in ICU or in the emergency because every second is important for the patient and should be more careful while receiving the medicolegal case. Discharge of the patient means departure of the patient from hospital environment to another environment. Do not discharge the patient without doctor’s written order.

52. “Textbook of Foundation of Nursing" by Jyoti Kathwal