Admission, Transfer, and Discharge of the Patient

1
Admission, Transfer, and Discharge of the Patient

• HST 2

2
Rationale

• There are many things to consider when admitting
  or discharging a patient in a health care
  facility.

3
Student Expectations

• Recognize and demonstrate established procedures
  for admitting, transferring, and discharging a
  patient.
• Assess the importance of observing the patients
  general physical condition and appearance.
• Communicate what information must be documented.

4

• During this lesson, you will be learning the
  established procedures and rationale for the
  following scenario concerning patient James
  Willmark.

5
Helping Patients Adjust

• Every patient being admitted is nervous, even if
  its not their first admission.
• Strange surroundings
• Busy nursing staff
• Sight of other patients
• May not know what to expect

6
Admissions

• Temporary for surgery or treatment of an acute
  illness.
• Permanent no longer able to care for
  themselves.
• They feel no control, powerless, dependent on
  others, lonely.

7
Prepare the patients room

• Before the patients arrival, make sure their
  room is ready.
• Admission checklist ready
• Pen / pencil
• Gown or pajamas
• Portable scale
• Thermometer

8

• Sphygmomanometer / stethoscope
• Envelope for patients valuables
• Make sure there is adequate light and
  ventilation.
• Open the bed by fan-folding the covers back
  attach signal cord within reach.
• Washbasin
• Drinking cup / pitcher if allowed

9

• Emesis basin
• Soap / towels / lotion
• Bedpan and/or urinal
• IV pole if needed
• Make sure the room is clean, neat and orderly.

10
Greeting the patient

• Greet each patient in a friendly, cheerful
  manner.
• Introduce yourself / take pt to room
• Invite friend or relative, if allowed.
• Introduce patient to other caregivers as they
  enter the room.

11
Admission Procedure

• Explain facilitys policy on visitors, telephone
  use, how to use the TV remote.
• Show how to use the call light and operate the
  bed controls.
• Tell patient when meal times are.
• Answer any questions.

12

• Have the patient put personal articles and other
  small belongings in the drawer in the bedside
  stand.
• Clothes may be kept in room or sent home with
  family member.
• Make a list of the clothing and items the patient
  is keeping.

13

• Valuables should be sent home with a family
  member.
• If not, they should be inventoried and placed in
  the valuables envelope with name, date, room
  number, and description of items.
• Give to supervisor or take to safe.
• Assist patient into gown or pajamas.

14
Assessment of Patient

• Assess the patients general physical condition,
  appearance and behavior.
• Observe for
• Cuts, bruises, scars
• Loss of function
• Signs of weakness
• Any prosthesis
• Physical complaints the patient has

15

• Record vital signs.
• Ask about previous hospitalizations, allergies,
  diseases.
• Record all information and observations on the
  admission checklist.
• Be very thorough.
• Collect any urine samples needed.

16

• Make the patient comfortable in their bed or in a
  chair.
• If put to bed, raise side rails if needed.
• Give water if it is allowed.
• Make sure the patient can reach the signal cord
  and other needed items.
• If patient is unable to answer have family member
  help w/ information.

17
Recording the Data

• Complete the admission checklist.
• Fill in the date and time of admission.
• Method of admission the way the patient came
  into the room
• wheelchair
• ambulatory
• stretcher

18

• Observations or unusual conditions noted.
• Chief complaint of the patient.
• Be brief but complete, and write legibly.

19
Transferring the Patient

• Patients may be transferred from one room to
  another for several reasons.
• Sometimes it is at the patients request for a
  different type of room or a more compatible
  roommate.
• Medical staff may request it change in level of
  care, i.e. ICU to Med-Surg or vice versa.

20

• Sometimes the staff will transfer a patient
  closer to the nursing station where the patient
  can be observed more closely.
• Make sure the patients belongings are
  transferred with them.
• Collect belongings and any equipment.
• Check all areas of the room for articles that
  might be forgotten.

21

• The nurse will collect the patients chart and
  medicines.
• Document date / time of transfer reason for
  transfer patients attitude toward the move.
• Introduce the patient to the personnel caring for
  him/her in the new room.
• Orient patient to new room comfort.

22
Discharging the patient

• The patient may have concerns regarding managing
  own care at home.
• Provisions such as home health care may be
  needed, as ordered.
• Assessment needs to be done as to what help the
  patient will need at home.
• Discharge planning involves the entire healthcare
  team.

23

• The patient, the family, medical staff, nursing
  staff, social worker, dietician all work together
  to coordinate the discharge.
• The doctor plans the discharge with the patient
  and leaves a written order on the patients chart.

24

• The nurse will then make necessary arrangements
  with other departments to prepare for the
  discharge.
• Written orders for discharge (by the doctor) need
  to be specific and need to include

25

• Taking medications.
• Exercise programs.
• Physical therapy
• Changing dressings / bandages.
• Injections or respiratory treatments.
• Any home health care.
• When to follow up with the doctor.

26

• Any discharge instructions reviewed with the
  patient must also be put in a written form for
  the patient to take home.
• They need to be specific, written in terms the
  patient can understand, thorough, and legible.
• Make sure family members are notified of pending
  discharge / for transportation.

27

• The patient who is not yet ready to care for
  him/herself may be discharged to an extended care
  facility.
• If the patients condition indicates the need for
  long-term care, they may be discharged directly
  to a long-term care facility or rehabilitation
  facility.

28

• When getting a patient ready for discharge, allow
  periods of rest.
• Answer any questions the patient has.
• Ask family member to check with the business
  office. Financial matters need to be taken care
  of before the patient leaves.

29

• Assist the patient into a wheelchair and take
  them to the entrance have the family member
  drive to the entrance.
• Assist the patient into the car.
• Make sure all patient belongings are put into the
  car make sure valuables have been retrieved from
  the safe.

30
Documentation of discharge

• Chart the date and time of discharge.
• How patient left the facility.
• Any special instructions given to the patient.
• Make a notation that the patients personal
  belongings were sent with the patient.