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Hospital admission and discharge.pptx
This document discusses hospital admission and discharge procedures. It covers the admission process including indications for admission, unit preparation, and admission procedures. It then discusses the purpose of admission, preliminary observations, and nurses' responsibilities during admission. The document also covers discharge planning, types of discharge, discharge procedures, and nurses' responsibilities during discharge. It provides examples of medico-legal cases and guidelines for admission, discharge, and transfer of medico-legal patients. Finally, it discusses terminal cleaning of patient units after discharge.
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Hospital admission and discharge.pptx
- 1. HOSPITAL ADMISSION ANDDISCHARGE Anjana Thomas
- 2. ADMISSION • Giving permissionto a patient for staying in hospital • Hospitalized for observation, investigation, and treatment of disease • Reception of an individual patient to a hospital ward for therapeutic or diagnostic purposes
- 3. PURPOSE OF ADMISSION •To provide immediate care, safety and comfort • Observe and report signs and symptoms of a disease condition • Manage and improve the general condition of patient • To facilitate follow up pf the patient • To reduce anxiety and fear of patient
- 4. INDICATIONS OF ADMISSION •Therapeutic aspect for treatment • Diagnostic purposes • Surgical interventions • Conditions requiring expert care
- 5. UNIT AND PREPARATION •Unit • Private room • Semi private room • Ward
- 6. COMPONENTS OF THEBASIC PATIENT UNIT • Furniture • Linens • Toilet equipment • Other articles
- 7. PREPARATION OF UNIT •Admission bed
- 8. ADMISSION PROCEDURE • Datarequired • Name of the patient • Age • Sex • Marital status • Occupation • Income • Telephone number
- 9. • ARTICLES REQUIRED •Admission bed • Temperature tray • BP apparatus and stethoscope • Weighing machine • Articles for physical examination • Kidney tray • Documentation sheet
- 10. PROCEDURE • Routine admission •OPD – Doctor’s office – Admission office – Ward • Emergency admission • Admitted in ER or casualty • Emergency equipment's to be ready near by bed • Investigations will be in the ER • When patient is out of danger then shift to ward / ICU
- 11. PRELIMINARY OBSERVATION • Checkall vital sign of the patient • General facial expressions will denote not only emotions but also pain, fatigue etc • Skin assessment – cyanosis, jaundice, malnutrition • Head to food assessment
- 12. SPECIAL CONSIDERATION • Isolatethe patient if presence of communicable disease • Make proper observation- record and report • Orient the patient and relative • Avoid physical and psychological trauma • Be cautious and kind to the patient and relatives • Observe policies in dealing with medico legal cases • Collect necessary information about the patient from relative and patient • Never leave the patient in causality
- 13. NURSES RESPONSIBILITY • Inout patient department • Receive with courtesy, offer chair, stretcher accordingly • Fill the particular data • Check vitals and examinations • Get the admission slip • Medical record from MRD • Inform concerned ward nurse • Fill the case sheet • Carry out the stat orders • Shift patient to ward
- 14. • In ward •Take case sheet and receive in admission bed • Inform doctor incharge • Complete the admission register and other records • Orientation • General observation / nursing assessment • Routine care • History collection • Assist physician and carry out orders • Diet plan • Psychological support accordingly • Hand over
- 15. MEDICO LEGAL CASES •Any case of injury or ailment where, the attending doctor after history taking and clinical examination considers that investigations by low enforcement agencies are warranted to ascertain circumstances and fix responsibility regarding the said injury or ailment according to the law
- 16. LABELLING A CASEAS MLC • Person who attending the case, medical officer, DMO • Should be based on sound professional judgement, after history collection
- 17. EXAMPLES OF MLC •Assault and battery, including domestic violence and child abuse • Road traffic accident , industrial accidents • Cases of trauma with suspicion of foul play • Electrical injuries • Poisoning, alcohol intoxication • Chemical injuries • Burns and scalds • Sexual offences • Criminal abortions • Attempted suicide
- 18. LEGAL IMPLICATION INADMISSION • Immediately inform the physician • Opd record, admission cards should be kept under lock and key • Do not show record to any one • All the belongingness should be kept under custody • Accurate record of the body discharge • Do not discard any evidence • Take the consent from relatives.
- 19. DISCHARGING THE PATIENT •Permitting the patient to let go from the hospital to his home • Is the preparation of patient to leave the hospital.
- 20. OBJECTIVES • To completeobligation to hospital • Ensure proper medical care after discharge • Motivate patient and relative • Promote independence and self reliance throughout illness • Promote good public relations
- 21. TYPES OF DISCHARGE •Cured and discharged/ planned discharge • Discharge to another hospital/ another unit within the hospital • Discharge against medical advice (DAMA) • Absconded • Discharge on request • Death
- 22. DISCHARGE PLANNING • I: Include the patient and family members as partner in discharge process • D : Discuss with the patient and family five key areas to prevent problems • Management of disease at home • Warning signs and problems • Explain the test results • Medications • Follow up • E : educate the patient and family about the discharge process to reduce anxiety • A : Assess whether patient is able to understand the process • L : Listen to patient and family members respect their preferences
- 23. POINTS TO BEREMEMBER • Ensure that no dues certificates is taken before handing over the discharge slip • Inform the relatives well in advance about discharge • Change the dressings when the patient is ready for discharge • Provide clear discharge instructions – follow up • Keep the record in safe custody and hand over to MRD • Inform hospital authority about discharge of MLC patient
- 24. DISCHARGE PROCEDURE • Thephysician write – patient to be discharged • Patient and family members are instructed – treatment, medication, follow up • Hand over the personal belongings • Articles in the patient unit to be checked • Check payment of bill • Arrange wheel chair or stretcher • If patient go LAMA, take consent and inform the authority • Complete all records
- 25. NURSES RESPONSIBILITY • Informthe patient and relative a day before the discharge • Get the discharge slip prepared • Patient's personal hygiene is maintained • Hand over the patient’s belongings and valuables • Complete the admission and discharge register, case sheet and record • Hand over the case sheet • Inform the authority • Billing clearance • Hand over the discharge slip to the patient, discharge summary • Provide wheel chair for transporting • Immediately after the patient leaves, clean the room and make nessary arrangements for the new patient
- 26. LEAVE AGAINST MEDICALADVICE • Patient express the desire to leave a hospital against medical advice and without physicians permission
- 27. MEDICO LEGAL CASES •On discharge • Should clearly entered • No record to be handed over to the relatives and police • Name address of relative to be mentioned • Physician must inform the CMO regarding discharge • Discharge notes must be kept under lock and key
- 28. • In caseof death • Physician must inform MO/CMO/DMO • Send the body for post mortem examination • Nurse must provide written instructions for handling the body • List of all articles of the patient should be maintained
- 29. DISCHARGE IN LAMA •Follow the instructional policies for patient discharge • Explain about the critical condition of patient • Inform the medical officer • Signature of the relatives • Hospital bill and clearance of bill • Record should be kept safe
- 30. DISCHARGE - ABSCONDING •If the patient runs from the ward/hospital, to avoid this problem nurse must; • Check the number of patients admitted, discharged while changing of the shift • Inform immediately the CMO in writing and get it signed • Record of the patient should be maintained
- 31. TRANSFERRING A PATIENT •Shifting patient to a different unit of a hospital • Eg; ward to ICU
- 32. PROCEDURE • Check theorder of transfer to another unit • Assess the readiness of new unit – to prevent inconvenience and waiting time • Explain the procedure of transfer • Review the check list of patient belongings • Assess and gather any other equipment to be transferred • Transfer the patient in wheel chair or stretcher • Document the time and date, condition of patient
- 33. TRANSFER TO ANEXTENDED CARE FACILITY • Make sure that physician has written the transfer order • Complete the nursing summary • Attach one copy transfer order and nurses not/ summary
- 34. CARE OF THEUNIT AFTER DISCHARGE • After the patient is discharged and before admitting another patient, the room is cleaned. • Windows and rooms are opened • All articles used by the patient are washed and sterilized or disinfected by chemicals • Disposable things are discarded and linens send to laundry • Mattress, pillows, blankets are posed to the sunlight
- 35. CARE OF THEUNIT AFTER DISCHARGE • In case of communicable disease, fumigation of room and articles should be done • Care is taken of the sanitation of bed, bed side cabinet and general area of the patient care unit with a germicidal agent • These activities are carried out and performed at every patient care unit before the area is prepared for the next patient
- 36. PURPOSE OF TERMINALCLEANING • Prevention of the spread of microorganisms. • Removal of encrusted secretions from framework or bedside rails • Removal of residue of body wastes from mattress • Deodorizing of the bed frame, mattress and pillow
- 37. GUIDELINES • Review wardpolicies for specific procedure. • Use only authorized disinfectants/ germicidal • Check to ensure, the bedside cabinet is cleaned of any valuable belonging to the patient • Check bed linens for personal items. (dentures, contact lenses, money) • Prevent spread of microorganisms by carefully removing linen from the bed • Use caution when cleaning under frame and bedspring • Replace any torn mattress or pillow cover • Allow the mattress and pillow to air dry thoroughly before remaking the bed
- 38.