Hospital Admission And Discharge

Hospital admission and discharge:

Admission

Meaning:

Allowing a client to stay in the hospital for observation, investigations, & treatment of the disease he is suffering from.

Purposes:

·         A person can be admitted to a healthcare facility with several reasons.

·         For treatment of any acute or chronic disease.

·         For observation of the status of patient.

·         For diagnostic need.

·         For surgical interventions.

·         Emergency basis.

·         For conditions requiring expert care.

Types of admission:

Depending on planning:

1.       Emergency admission: Admission to hospital due to acute conditions requiring immediate treatment. E.g: poisoning, accidents etc.

2.       Routine admission: Admission for investigations or planned treatment or surgeries. E.g: diabetes mellitus, hypertension

Depending on time spent in hospital:

1.       Long term: long term admission is required for clients suffering from pathological conditions having a long term recovery period.

2.       Short term: short term admission is required if clients need less time in health care system.

Depending on purposes of admission:

1.       Diagnostic admission: is usually a short term admission meant to undergo some investigation.

2.       Therapeutic admission: patients suffering from any medical condition requiring continuous medical care are admitted to hospital for better management.

Principles:

1.      Sudden change or strangeness in the environment produces fear and anxiety.

When admitting a client it is important to remember that this may be the first time in the hospital hence it is a new and frightening experience. Much of the anxiety is due to unknown fears. It may be due to:

·         Lack of knowledge about illness.

·         Being in a strange place with strange articles around.

·         Being alone and away from family members.

·         Fear of pain or fear of loss of body parts

·         Fear of being neglected

2.      Entering a hospital is a threat to one's personal identity

Every client admitted to the hospital should be considered as a unique person in terms of personality, needs and extent of illness. Nurses should address the patient by name and proper title and every client should feel that he is being considered and cared for.

3.      People have diversity of habits & modes of behavior.

Every nurse should understand the behavioral patterns of clients according to age, sex, race, caste and socio economic factors. Their needs should be met in appropriate manner.

4.      Illness can be a novel experience for the client & bring stress on his physical & mental health

Hospitalization along with an illness is the cause for stress for the client. Much of this stress can be reduced by proper explanations.

Admission procedure:

·         Initial admitting procedures takes place in admitting office through admitting officers, or secretaries.

·         Identification data including full legal name, age, gender, next of kin, address, birth date, religion, occupation & type of insurance is collected & entered into the computer.

·         The client receives a permanent identification number for the hospital record & an identification bracelet which is worn throughout hospitalization.

·         The signature on the consent form gives the hospital permission to perform routine procedures & selected therapies. In addition the hospital must give clients written information about their rights under state law including right to accept or refuse medical or surgical treatment.

·         The patient is informed on all hospital policies including visiting hours, meal times pastoral care etc.

·         Advance directives: such as a living will or power of attorney, to indicate their treatment preferences about prolonging life.

·         Transportation: After briefing the client he/she is transported to nursing division after the admitting office notifies the nursing division about the client's admission, current status & room assignment. According to client's condition ambulation, wheel chair or stretcher is used to transfer client from emergency room or admitting office along with an escort to the nursing division.

     Admission to nursing division:

·         Preparation of the unit

·         Greeting

·         Immediate needs

·         Introduction and orientation

·         Baseline assessment

·         Care of belongings

·         Record keeping

·         Preparation of the unit

§  Wash hands

§  Prepare room before patient arrives

§  Prepare bed at lowest horizontal level.

§  Assemble all necessary articles & ensure proper working condition.

§  Adequate lighting during day and night

§  Sufficient air movement

§  Provision for disposal of refuse

§  Removal of dust and injurious chemicals

§  A dwelling place free from insects, animal pests, fire hazards, electric shock and poisons

§  hospital gown

·         Greeting: Welcome the patient and family members in a courteous manner, address patient with name.

·         Immediate needs: immediate needs may be either physical or emotional. Eg. If a patient is in acute pain institute nursing measure to relieve pain or follow prescribed orders to reduce pain

·         Introduction and orientation: introduction and orientation according to the condition of the patient. Introduce yourself and other nurses who will be providing care. Introduce the other patients in the unit.

Orientation to the following areas should be provided:

§  Nurses station

§  Location of lounge areas

§  Shower and bathroom facilities

§  Call bell & intercom system

§  Adjusting bed and lights

§  Policies that are applicable to patients- booklet

§  Doctors round timings

§  Visiting hours

§  Canteen

§  Pharmacy

§  Diet pass

§  Prayer service

Baseline assessment

§  Assess vital signs

§  Provide privacy to the client, help wear hospital gowns & give comfortable position.

§  Obtain nursing history: past medical history, present signs & symptoms, history of allergies, medications history, alterations in activities of daily living, family resources & support, client's knowledge etc.

§  Conduct physical examination.

§  Acquire client's sample for the ordered investigations.

Care of belongings

Jewellery, money and any other valuables should be given to the family members. Document

Record keeping

Recording all parts of the admission process is important for legal purposes. Nurses are responsible for keeping all the records pertaining to admission of client which includes the assessments, nursing records, order sheets etc.