Hospital Admission And Discharge con...

Hospital admission and discharge  con….

Medico legal issues related to admission and discharge:

Meaning: Medico legal case any case of injury or ailment where criminality is involved. It is judged by history furnished by the patient & the examination findings.

Medico legal cases:

·         Suspicious cases of injuries & burns

·         Suspected or evident poisoning or intoxication

·         Vehicular, factory or unnatural accidents.

·         Suspected or evident sexual assault

·         Suspected or evident criminal abortion

·         Unconscious cases where cause IS not natural or clear

·         Cases brought dead with improper history creating suspicion of offence.

·         Cases referred from court.

Admission of MLC:

·         Any case among the above list even if brought after several days must be registered as an MLC & an opinion regarding the case given as per patient's present condition.

·         Request of patient or family member for not registering the case as MLC should not be agreed to.

·         A fresh medico legal report must not be prepared if the case was already registered in any other hospital.

·         Treatment of MLCs take precedence over medico legal formalities especially if patient is in serious condition.

·         All MLCs are supposed to be registered and informed to the police . The medico legal report must be filled in appropriately with all the identification data, date & time of arrival, date & time of examination, name & address of the attendant of the patient etc.

·         Specimens relevant to the case must be properly sealed ,labeled & sent for investigations

E.g.: tablets, vaginal swab

·         All admission documents, investigation reports and patient file should have the MLC seal.

·         Patients thumb impression should be present on the MLC record and details of the person bringing the patient for admission

Discharge of medico legal patients:

·         Inform the police department before discharge.

·         Discharge against medical advice must be documented in the file & signature taken from the patient or responsible others.

·         Patient's records should not be handed over to the police or legal authority without a written permission of the treating physician.

·         On discharge patient has the full right to seek his medical records, including his investigation reports

      Medico-legal issues related to the discharge of mentally ill patient:

·         As per the Indian Mental Health Act 1987, after 24 hrs a board should decide regarding continuation of treatment or discharge of the patient.

·         Admission can be made under special conditions where patient is brought by relatives, friends etc.

·         Application form for admission is accompanied by report of 2 medical officers out of which one should be in government service.

·         But a patient admitted on involuntary basis cannot be discharged with patient's wish but requires a due approval from psychiatrist and order of court.

      Medico legal issues related to discharge of body after death

·         As per institutional policy keep in mortuary for postmortem.

·         A signature for release should be obtained by the nurse while releasing the body to the relatives or police

·         Dead bodies which expire in the hospital should be sent to mortuary & from there handed over to the police or to the sub division magistrate. Inform relatives & police about death & transfer of body.

·         Unclaimed dead body.

   Nurses responsibilities:

·         Informed consent

·         Providing privacy

·         Maintaining confidentiality

·         Identifying MLCs

·         Safe keeping of MLC records under lock & key

·         Collecting complete data of patient

Transfer of patients:

When a patient is transferred to another unit, the nurse in the original area gives a verbal report about the patient to the nurse in the new area. The report should include the patient's name, age, admitting diagnosis, surgical procedure if done, current conditions and manifestations, allergies, medications and treatments, laboratory data and any special equipment that will be needed to provide care. Accurate, concise and complete verbal communication is essential.