COURSE TITLE: FOUNDATION OF NURSING II

COURSE CODE : NUR 121

HOSPITAL ADMISSION,
TRANSFER AND DISCHARGE

BY
ADETUNMIBI, JULIANAH BOSEDE
 OBJECTIVES
• At the end of the lecture, the students should be able to :
• describe the procedures for reception, admission, transfer
and discharge of patients.
• explain nurses roles in admission, referral/transfer and
discharge of patients.
 ADMISSION OF PATIENT
DEFINITION
• Patient admission is the acceptance of a patient into a healthcare facility
for series of activities which aimed at promoting health and integrating
patient into the therapeutic ward environment.
• Admission is the entry of a patient into a hospital/ward for
therapeutic/diagnostic purposes.
 Purpose of admission procedure

1. To alleviate patient's fear and worry about

hospitalization.
2. To make patient feel welcome, comfortable and at ease.
3. To acquire vital information regarding the patient
4. To assess the patient from which a nursing care plan can
be initiated and implemented
5. To meet the health needs of the patient.
6. To facilitate recovery of patient.
 Principles
• Sudden change or strangeness on the environment
produces fear and anxiety
• Entering the hospital is a threat to personal identity
• People have diverse habits and behavior
• Illness can be novel experience for the patient and brings
stress on his physical and mental health.
 Types of Admission
• Emergency Admission: Patient are admitted for
immediate treatment. E.g RTA, food poisonings , burns
and scalds, heart attacks etc.
• Routine Admission: Patients are admitted for
investigations, medical or surgical treatment. Treatment is
given according to patients problem such as
Hypertension, diabetes, Malaria etc
 Preparation of the unit
• Prepare the treatment table
• Ensure all equipment are completed
• Check ventilation
• Ensure Privacy
• The admitting department or ER notifies the unit/ward
prior to the patient’s arrival so that room/bed can be
prepared.
 Admission Procedure Requirements
• Make admission bed • Nursing process booklet
• TPR tray • Admission and discharge
• Thermometer
• Stethoscope and Sphygmomanometer
book
• Watch with a second hands • Bed state booklet
• Portable scale • 2 Visitors card
• Urinalysis kits •Meal ticket and meal book
• Patient's chart •Hospital wear
 Admission Procedure
• Greet and welcome patient and relatives/caregiver
• Checks case note to see the admission or transfer notice
• Confirm patient's name,
• Check record and receipt of money paid by patient before to ensure that the
appropriate amount was paid for admission
• Assess patient's condition and attend to patient's immediate needs accordingly
• Makes patient comfortable in bed, provides chair if necessary and make the
relatives comfortable too.
• Assembles and fills the patient's details in the following records: admission &
discharge register, bed state booklet, meal book and others according to
hospital's policy.
 Admission Procedure
• Use the nursing process booklet to obtain relevant data as indicated. Invite and
involve informant to give or support patient's information-Inform and explain the
nursing assessment procedure to the patient
• Washes hands and dry
• Provide privacy
• Observes general condition of patient as patient moves and positions on the bed
and note it
• Perform a complete head-to-toe assessment of client, also use tools stated in the
nursing process booklet
• Check Vital signs, Temperature, Pulse, Respiration, Blood Pressure
• Document patient's assessment findings in the appropriate charts and the
nursing process booklet
 Admission Procedure
• Measure and chart patient's weight appropriately
• Take patient's urine specimen, test and record findings, note abnormality (ies)
• Formulate the nursing care plan using relevant nursing diagnoses derived from
nursing assessment in order of priority
•Encourage and assist the patient to have his/her bath if necessary and change to a
patient's hospital wear or simpler clothing of choice
•Introduce patient to other patients if on a general ward and familiarize the patient
with his new environment, informs patients and relatives about ward routine,
visiting time, things to bring and not to bring for patient's optimal care
•Document procedure, noting the general condition of patient, where patient is
coming from (A&E...), the consulting doctor, the medical diagnosis, actions
performed on patient, and outcome.
Nurses roles and responsibilities
in admission procedure
• Nurses should be friendly and courteous with the patient and relatives
• Make proper observation of patient condition and document
• Orient patient and relatives to the ward /unit
• Deal carefully with patients suffering from communicable diseases or
illness (Isolate if necessary).
• Ensure proper handing over of patients’ valuables to the relatives and
record.
• Explain hospital procedures, policies, rules and regulations to the
clients and relatives.
 Transfer
• Transfer is defined as preparing patient, completing
records and shifting to another department within the
hospital or to another hospital.
PURPOSE
• To obtain necessary diagnostic test and procedure
• To provide treatment and nursing care
• To provide specialized care
• To ensure most appropriate utilization or available
personnel and services.
 Types of Transfer
1. Internal Transfer : To transfer the patient in a unit to
provide special care according to patient needs.
2. External Transfer: To transfer the patient from one
hospital to another for the purpose of special care or
expert management.
 Preliminary Assessment
• Assess the method for transport, inform the receiving nurse.
• Maintain patient physical well being during transport to new
nursing unit.
• Check the Doctor’s order for transfer
• Inform patient and relatives the purpose of transfer.
• Be sure all documentation including care plan is completed.
• Make arrangement to settle the due bills if going to another
hospital.
 Transfer Procedure

• Transfer to another hospital/department.

• Collect patients’ medicine, X rays and other belongings
• Cancel the hospital diet on transfer.
• Record time, mode of transfer and general condition of the patient
• Assist in transferring patient to wheel chair/stretcher and
accompany patient to new area
• Handover patient, belongings and documents to the receiving
nurse.
• Collect the ward articles.
• Inform the concern person/department regarding transfer of the
patient.
• Tidy room and keep ready for next patient.
 Discharge of Patient

Discharge planning is the incorporation of series of activities

leading to the patient's departure from the hospital.
Objectives
1. To teach patients special skills on personal health maintenance.
2. To reduce anxiety.
3. To prevent unnecessary delay.
4. To prevent nosocomial infection.
5. To incorporate patient back into the community
 Discharge of Patient
Indications:
1. Patient that is medically fit to go home
2. On patient's request (DOR)
3. Discharge against medical advice (DAMA)
4. Referral
5. Death

Requirements:
• All record books under admission
• Assessment form
 Discharge procedure
Confirm patient's discharge on case note
Inform patient about discharge
Perform hand hygiene, wear gloves if necessary
Assess the general condition of patient, take vital signs and assess
fitness to be discharged.
Give assessment form to relatives/significant other
Collect discharge clearance certificate
Review necessary health teaching with the patient and the family
and evaluate feedback.
 Discharge procedure
✔ Ensure to gather the patient's take-home medications both on the ward and
from the pharmacy (if need be) and instruct patient and relative on how to use
them, using clearly verbalized and written instructions.
✔ Dressing should be done if necessary, before discharge.
✔ An appointment card should be given for follow-up care
✔ Give written summary of instruction if necessary.
✔ Assist patient in getting dressed and render any other assistance needed.
✔ If patient is unable to walk, provide a wheel chair or stretcher as the case may
be.
 Discharge procedure

When the patient is ready to leave the ward, write it on the discharge book, bed
state and nursing process booklet discharge summary
Arrange the charts in the correct order, including the nursing process booklet and
the final hospital bill in the patient's case note, and keep for the medical record
officer.
Escort patient to the source of transportation and assist into the vehicle.
Wash hands and dry, put on gloves, and gather requirements for stripping of bed.
Strip the bed, put away all items appropriately and ensure that the mattress,
pillow and other apparatus used for patient are decontaminated.
•THANKS FOR
LISTENING AND FOR
YOUR ACTIVE
PARTICIPATION