ADMISSION OF PATIENTS TO THE HOSPITAL.

ADMISSION OF PATIENTS TO THE HOSPITAL.

ADMISSION: it is the entry and acceptance of a patient to stay in a health facility for the purpose of observation , investigation and treatment . Clients coming in for admission may walk-in (ambulant ) or not.

TYPES OF ADMISSIONS1. ELECTIVE/ PLANNED/ROUTINE 2. EMERGENCY

Elective /Planned Admission: with this type of admission the medical officer or the health care provider arranges with the patient on a convenient date for admission. Patient is informed well ahead of time to enable him prepare for the admission.

Patient is taken through the admission process from the OPD.

ADMISSION OF PATIENTS TO THE HOSPITAL

Emergency Admission- with this type of admission patient reports to the hospital in a critical condition; he/her is usually brought in by people (relatives, friends or a good Samaritan).

The patient is transported to the ward in a wheel chair or stretcher. This type of patients needs immediate treatment.

REASONS FOR ADMISSION

For diagnostic investigations to be done

For treatments which may be medical or surgical

For observation

ADMISSION PROCEDURE (PLANNED/AMBULANT PATIENT)

1. Welcomed Patient/ relatives to the ward/unit and introduce yourself and any other nurse present to the patients

2. Collect the necessary documents i.e. admission papers and other information from the accompanying nurse

ADMISSION OF PATIENTS CONT’D

1. Identify and confirm patient by name particulars

2. Provided seats for patient and the relatives to make them comfortable

3. Gather information from patient and if necessary the relatives to fill the admission papers.

4. Depending on the condition provide an admission bed.

5. Assist patient to change into pyjamas or hospital gown and give identification bracelets if applicable

ADMISSION OF PATIENTS CONT’D6. Provide privacy and do baseline assessment

of patient and document (observation, vitals etc.), collect specimen if ordered.

7. Serve prescribed urgent medication if applicable.

8. Take care of patient’s valuables if necessary.

9. Ensure patients sign consent form for treatment.

ADMISSION OF PATIENTS CONT’D

10. National health insurance scheme is explained to the patient and relatives.

11. Patients relatives are informed about the visiting hours, thing the patient needed on admission. Patient is allowed to see relatives and bid them goodbye.

12. Patient is oriented to ward and its environment.

13. The nursing process is used to nurse the patient

ADMISSION OF PATIENTS CONT’D

14. Patient’s name and particulars are

entered into the admission and

discharge book as well as the ward

state. Admission is documented in the

nurses note.

ADMISSION PROCEDURE (EMERGENCY;

PATIENT IN A WHEEL CHAIR OR STRETCHER)

Advance PreparingWash hands and assemble the following depending on the condition Temperature tray Resuscitation/emergency tray Oxygen apparatus

Patient is received into an already prepared bed- type of bed may depend on the condition of the patient i.e cardiac bed for for respiratory distress

ADMISSION OF PATIENTS CONT’D

Tray for venipuncture

Suction apparatus

Blood pressure apparatus

Bed to suit patient’s condition.

ADMISSION PROCEDURE…

1. Welcome patient/ relatives to the ward/unit and introduce your self and any other nurse present to the patients

2. Collect the necessary documents i.e. admission papers and other information from the accompanying nurse

3. Identify and confirm patient by name , particulars

ADMISSION PROCEDURE…

4. Quickly assess the patient’s general

condition

5. Receive patient into an already

prepared bed – depending on the

condition.

6. Patient is changed into bed clothing if

possible

ADMISSION PROCEDURE...

7. privacy provided and patient is assessed i.e. checking of vital signs, observation and examination- general appearance, skin for abnormalities, pain, breathing pattern, complaints, general reaction of the patient, level of consciousness, etc.

8. Relevant history is taken from patient or relatives

ADMISSION PROCEDURE...

9. Ensure consent form is signed.

10. Patients valuables are taken care of if

necessary

11. National health insurance scheme is

explained to the patient and relatives.

12. Patients relatives are informed about the

visiting hours, thing the patient needed on

admission. Patient is allowed see relatives

and bid them goodbye.

ADMISSION PROCESS…13. Depending on the condition specimen

collected and tested.

14. Nurse patient using the nursing process.

15. Administer prescribed medications

16. Patient’s name and particulars are entered into the admission and discharge book as well as the ward state. Admission is documented in the nurses note

ADMISSION PROCESS...The Role of the Nurse in the Admission Process meeting the immediate needs of the

patient- physical and emotional Thorough assessment of the patient-

nursing process Ensure patient is assigned to the

appropriate room. Write admission report- day and night

report Ensuring comfort and reducing anxiety of

patients and relatives

TRANSFER OF PATIENTSTransfer of patient within a healthcare facility/hospitalIt is the movement of a patient within the same health facility

Types Transfer in/Trans –in: when patient is

moved from one unit or ward of first admission to a new unit or ward. E.g. Medical to Surgical Ward, Emergency Ward to the Medical or Surgical Ward for update treatment. The receiving ward must be informed about trans in before it is done.

ROLES…

Steps prepare a suitable bed to receive

patientAssemble the necessary equipment

depending on the patients condition i.e. oxygen apparatus, suction machine, vital signs tray.

Receive incoming patient, relatives and accompanying nurse warmly.

ROLES…

TRANS IN (CONT…) Take over the transfer notes and personal

belonging of the patient from accompanying nurse.

confirm patient’s identity with accompanying

nurse

Ask for clarification on vital issues pertaining

to the patient’s condition from the

accompanying nurse.

Introduce self and other nurses around to

patient and relatives

TRANS IN (CONT…)

Do a quick assessment of the patient’s

condition and needs and act accordingly

Admit patient using the nursing process

Orientate patient and relatives to ward and its

environment, routine of the unit if necessary

Document time of patient’s arrival in the

nurses note, admission and discharge book

and ward state.

TRANSFER OF PATIENTS

TRANSFER OUT/ TRANS OUT(CONT…)

Transfer out/ trans out: it could be from unit to unit or facility to facility

StepsConfirm with receiving unitAssess patients conditionArrange for accompanying nurse Arrange for appropriate vehicle-

where applicable.

TRANSFER OUT/ TRANS OUT(CONT…)

Collect all necessary data Explain reason of transfer to patient and

relatives and reassure them to reduce anxiety

Obtain written consent for transfer Pack patients belonging Collect patients medications ,

investigations results and transfer notes Assist patient to dress up Assist patient into wheel chair, stretcher,

ambulance where applicable

TRANSFER OUT/ TRANS OUT(CONT…)

hand over patient’s notes and belongings to the accompanying nurse.

Enter patient’s name in the A&D book, ward state and nurse note.

DISCHARGE OF A PATIENT FROM THE HOSPITAL

Discharge occurs when a patient leaves the hospital after a period of treatment to his or her home; it normally done at the discretion of the medical team when patient is fit or his condition is stable or upon patient's own request.

It is important that patients and relative have a prior knowledge of the intended discharge.

DISCHARGE PLANNINGIt is a process that facilitate the

transition of the client from the health care institution to the most independent level of care, home or another health facility.

The over all goal of discharge planning is to provide the most appropriate level and quality of care throughout all stages of the client illness. To ensure adequate continuity of care.

DISCHARGE OF A PATIENT FROM THE HOSPITAL

The role of the nurse in discharge planning Include all caregivers involved in the care of the

patient i.e. physiotherapist ( multidisciplinary) Adequate assessment of patient during all the

stages of care to identify discharge needs. Assess health teaching needs of client and

family and provide family members with the knowledge and skills to care for the client in the home setting e.g. wound care, range of motion exercises.

Assess home situation i.e. bathroom facilities, doorway, steps , home arrangement etc.

DISCHARGE OF A PATIENT FROM THE HOSPITAL...

STEPS

Ensure discharge is ordered by a medical officer or signed letter from patient

Patient and relatives are informed about discharge

They are educated on the need for continuing treatment and follow up care

DISCHARGE…

Ensure patient’s hospital bills are worked out and submitted to the health insurance officer or paid at the revenue office by patients who are not members of the scheme.

Receipt number is entered into the A&D book and the receipt handed over to the patient.

Relatives are directed to collect prescribed drugs from the pharmacy if applicable.

DISCHARGE… Drug administration is well explained to

patient and relatives as well as education on home and follow up care

Patient is helped to pack belongings.

Any patient valuable in the nurses custody is handed over to patient and relatives, it is recorded, witnessed and signed.

DISCHARGE…

Patient and relatives are once again reminded of the review date and exactly where to report on the said date.

Bed linen is removed, bed and lockers are decontaminated.

Discharge is documented in the nurses note, A&D book and ward state.