Hospital admission and discharge
Discharge of patients
Meaning: it is the process of permitting a client to back to his community from a hospital after his diagnosis, initiation of treatment. recovery or death. as per the advice of his physician after fulfilling certain procedures in the hospital
Types of discharges:
A. Planned discharge
1. Short stay discharge- only observation, duration not more than 3 days (can differ acc to hospital policy.)
2. Long stay discharge- after more than 3 days. Discharge is well planned & done during working hours. Eg: after treatment of appendicitis.
B. Referrals or transfers- from one hospital to another (eg: for specialized care)
C. Other types:
· Discharge after death -is unplanned, emergency & should not delay more than one hour after death.
· Inter departmental discharge -ward to ward.
· Leaving Against Medical Advice (LAMA)-here the client leaves the hospital against the physicians orders after signing the LAMA form undertaking self responsibility for any further complications
· Abscond- running away from the hospital without giving any prior information (without payment of bills at times)
a) To prepare the patient, family or other care givers physically or psychologically for transfer to home.
b) Promotes the highest possible level of independence.
c) Provides continuity of care from hospital to community.
d) Ensures the smooth transfer from hospital to community.
Role of a nurse in discharge:
· Assessing and identifying healthcare needs
· Setting goals with the patient
· Providing home health care referrals
· Evaluating discharge plan effectiveness
Assessing and identifying healthcare needs
· The first step in discharge planning involves collecting and organizing data about the patient
· Factors to assess in discharge planning are,
a) Health data
b) Personal data
e) Financial and support resources
Assess patients ability to carry out ADL
Setting goals with the patient
· The expected goals are set mutually and must be realistic involving the patient and the family members.
· Eg: the nurse teaches the patient about a special diet but the patient may not be follow it as it is too expensive or he is not able to go to the grocery store to buy it
I) No patient is discharged without physician's written orders. The physician writes on the patient's chart when the patient is to be discharged
2) Inform relatives, to enable them to clear bills without hurry
3) Teach the nursing procedures which need to be done at home to patient or care giver. Ask them to demonstrate the care independently under close supervision of nurse before discharge.
4) Explain clearly about diet, treatment, exercises, medications etc to be followed at home. Clarify all doubts.
5) Demonstrate diet to be followed by the patient at home.
6) Watch for the reactions of patient & family & help them adjust to the change.
7) Written instructions on further care, medication, treatment & follow up should be given & interpreted properly to client & family.
8) Instruction in home care: Treatment, Medications, Personal hygiene, Activity & rest, Diet & elimination. Avoidance of infections, Mental health.
9) Provide medications or direct to purchase
10) Patients personal belongings kept in the safe must be returned & a receipt should be obtained from the patient.
11) Any hospital property used by the patient should be received back after checking before he leaves. Articles in the patient's unit must be checked including hospital linen.
12) Confirm if the client has paid all bills before he leaves.
13) Ensure that client is bathed, groomed & dressed in clean clothes.
14) If client is not able to walk arrange for wheel chair or stretcher & ensure safe transfer & that a hospital attendant accompanies the patient up to the front door, if possible.
15) Inform dietary department about client's discharge.
16) If client leaves against medical advice then get the patient's sign on the release form & filed along with the patient's record.
17) The nurse should see that charts are completed & sent to the office or 10 record section to be filled.
18) Discharge from hospital should be planned & arranged by a team which will include or have links with Social Services & Health
Providing home healthcare referrals
Health care provider
· Home health nurse
Provides assessment, directs care, client teaching & supports coordinating services, evaluates outcomes
· Home health aid
Provides hygienic care, cooking, supervision & companionship
· Social worker
Finds & connects with community resources or financial resources, provides counseling & support
· Physical therapists
Assists in restoring mobility, strengthens muscle groups, teaches ambulation with new devices.
· Occupational therapists
Helps clients adjust to limitations by teaching new vocational skills & improves methods of ADL( Activities of Daily Living)
Teaches meal planning, diet restrictions, Works with clients with swallowing problems.
· Respiratory therapists
Provides follow-up for clients with respiratory problems including assessment, oxygen administration & home ventilator care
Evaluating discharge plan effectively
· Evaluation is crucial to ensure that the discharge planning works
· Evaluation is ongoing
· Maybe done by a telephone call or questionnaire or a home visit.