Transcript Admission, Transfer, and Discharge of the Patient

Admission, Transfer, and
Discharge of the Patient
HST 2
Rationale
 There
are many things to
consider when admitting or
discharging a patient in a health
care facility.
Student Expectations:
 Recognize
and demonstrate established
procedures for admitting, transferring,
and discharging a patient.
 Assess the importance of observing the
patient’s general physical condition and
appearance.
 Communicate what information must be
documented.
 During
this lesson, you will be
learning the established procedures
and rationale for the following
scenario concerning patient James
Willmark.
Helping Patients Adjust
 Every
patient being admitted is nervous,
even if it’s not their first admission.
 Strange surroundings
 Busy nursing staff
 Sight of other patients
 May not know what to expect
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.
Prepare the patient’s room:
 Before
the patient’s arrival, make sure
their room is ready.
 Admission checklist ready
 Pen / pencil
 Gown or pajamas
 Portable scale
 Thermometer
 Sphygmomanometer
/ stethoscope
 Envelope for patient’s 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
 Emesis
basin
 Soap / towels / lotion
 Bedpan and/or urinal
 IV pole if needed
 Make sure the room is clean, neat and
orderly.
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.
Admission Procedure
 Explain
facility’s 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.
 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.
 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.
Assessment of Patient
 Assess
the patient’s general physical
condition, appearance and behavior.
 Observe for:
 Cuts, bruises, scars
 Loss of function
 Signs of weakness
 Any prosthesis
 Physical complaints the patient has
 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.
 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.
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
 Observations
or unusual conditions
noted.
 Chief complaint of the patient.
 Be brief but complete, and write
legibly.
Transferring the Patient
 Patients
may be transferred from one
room to another for several reasons.
 Sometimes it is at the patient’s 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.
Sometimes the staff will transfer a patient
closer to the nursing station where the
patient can be observed more closely.
Make sure the patient’s belongings are
transferred with them.
Collect belongings and any equipment.
Check all areas of the room for articles
that might be forgotten.
 The
nurse will collect the patient’s chart
and medicines.
 Document date / time of transfer;
reason for transfer; patient’s attitude
toward the move.
 Introduce the patient to the personnel
caring for him/her in the new room.
 Orient patient to new room; comfort.
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.
 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
patient’s chart.
 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:
 Taking
medications.
 Exercise programs.
 Physical therapy
 Changing dressings / bandages.
 Injections or respiratory treatments.
 Any home health care.
 When to follow up with the doctor.
 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.
 The
patient who is not yet ready to care
for him/herself may be discharged to an
extended care facility.
 If the patient’s condition indicates the
need for long-term care, they may be
discharged directly to a long-term care
facility or rehabilitation facility.
 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.
 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.
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 patient’s
personal belongings were sent with the
patient.