ADMISSION AND DISCHARGE OF PATIENTS.

Patients are admitted to the hospital because they are ill or have some discomfort for which they
want a cure or to get some relief. Hospitalization or admission is usually not experienced by the
patients, which is full of anxieties and uncertainties regardless of age, nationality or educational
background. These may include worries’ about:-

1. Painful diagnosis or therapeutic procedures.

2. Their family
3. Their job/business
4. Missing studies
5. Terminal illness e.g. cancer, HIV.
6. Loss of vacancy
7. The unknown
8. Hospital expenses.

The impression that the patients get on admission has significant effect on the success of the
subsequent treatment. The first health worker whom the patient meets on arrival to the hospital
can do much to dispel the patients’ fears and anxieties by being friendly, understanding kind and
helpful. Likewise admission routines that are impersonal increase a patient’s anxiety, hinder their
responses to their treatment, and may even aggravate symptoms.

Considering the above, therefore, a positive therapeutic relationship between a nurse and a
patient should be maintained from admission and throughout the patients stay in the hospital.

TYPES OF HOSPITAL ADMISSIONS

1. Planned admission.

Preparation before the arrival of the patient on the ward starts when the ward is informed of the
incoming patient; all the necessary preparations for receptions on the ward are made according to
the patient’s condition and needs.

An admission bed is made up for a serious ill patient as he /she will need a bed bath.

An occupied bed for an ambulatory patient since they will be able to go the bathroom.

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Requirements.

 Patients chart
 Nursing care plan
 Observations chart
 Admission book
 Patients belongings noted in the record book
 Patients’ lockers
 Patients’ gown
 Special equipments if required on admission e.g. oxygen apparatus, suction apparatus
prepared and ready for use.

On arrival to the ward

Refer to the general principles of nursing procedures.

 The health worker should speak slowly and clearly

 The case sheet is read carefully and the following particulars are filled in the admission
book.
 Full name of the patient.
 Age
 In patient no/hospital number
 Sex
 Address of the patient
 Tribe
 Nationality of the patient.
 Name and address of the next of Kin
 Provisional diagnosis
 Date and time of admission
 Condition of the patient on admission e.g. confused, in shock, delirious, semiconscious,
and unconscious.

Procedure.

 The patient weight is taken and recorded

 The patient is taken to the bed.
 The patient is introduced to other patients if not in a great distress
 Privacy is provided.
 Wash hands and help the patient change into the hospital gown
 The patient belongings are recorded.
 The patient is encouraged to store values e.g. money, jewelry to the hospital custody or to
have them sent home along with any medication that may have come with.

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Observations

 Vital observations are taken and recorded on the patients chart any abnormalities are
noted and action is taken accordingly.
 An informed consent is obtained from the patient/relatives.

The followings are noted on the patients nursing information form.

 Clinical features e.g. Dyspnoae, pain, vomiting.

 Past history including details of previous medical, surgical, obstetrical/ gynecological
histories.
 Social history
 Marital history
 Family size
 Occupation
 Social habits e.g. smoking, alcohol consumption
 Presenting complains
 Hypertension, blood disorders or other circulatory problems.
 Any known allergies are noted. A physical examination is carried out and results
recorded.
 Any treatment that has been prescribed is administered and recorded.
 A patient is shown how to use the equipment in the room e.g. telephones, bed adjustable
lights etc.
 The ambulatory patient is shown where the bathroom is located.
 The hospital routines are explained to the patients.
 The patients is encouraged to make any inquires when in doubt and should be precise and
clear.
 The patients comfort is ensured before leaving the room.

2. Emergency admission.

This is when a patient who is admitted through the causality department and routine procedures
are postponed until the patient is out of danger.

 After emergency treatment, the patient arrives at the ward with a temporary identification
band and admission chart.
 The emergency casualty department nurse should give full report concerning the patient
and what has been done in the emergency department.
 The nurse should ensure continuity of the care plan for the patient and gain insight into
the general condition of the patient.
 On-going treatment e.g. IV fluids is recorded in the nurses notes. The patients’ vital signs
are recorded.

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  The Doctor’s orders are followed.
 If patient is conscious and not in great distress, any treatment orders are explained
otherwise is delayed until the patient is fully conscious.
 If some relatives are with the patient, they are offered a seat and asked to wait until
assessment of the patient is complete and initial treatment given.
 The relative will be asked to visit the patient after he has settled in the bed when the
condition allows.
 When the patient’s condition stabilizes the routine admission procedures are carried out.
 Daily nursing care is continued, nutrition, hygiene etc.

TRANSFER/REFERRAL.

 State the indications and transfer of the patients

Patients can be transferred either within the hospital or to another care facility therefore it
requires thorough preparation and careful documentation.

A patient may be transferred to another unit because of better facilities e.g.

 Intensive care unit

 Specialized treatment
 For convenience or better management

PREPARATION FOR TRANSFER OF THE PATIENT.

1. The patient should be told clearly the reason for the move.
2. The reason for transfer if is not on request.
3. Whatever has been done on the patient from the referring unit should be properly
documented e.g. the referral form.
4. First aid treatment or care given
5. Observations of vital signs
6. Drugs treatment
7. Special care given/investigations carried out.
8. Patient’s diagnosis.
 A transfer form should be signed by the referring Doctor/staff.
 A copy of the transfer form should be retained by the referring unit for statistical
purpose and possible legal implications.
 If the patient requires an ambulance for transfer to the next unit, this should be
arranged.
 While in transits, reassurance and comfort should be given.
 A qualified staff should accompany the patient and hand over the patient to the staff at
the receiving unit.
 An oral report about the patient and the transfer form must be handed over.

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  Referral of the patient must be recorded in the admission book.
9. Name of the patient
10. Date and time of transfer
11. Patients condition during transfer
12. Reason for transfer
13. Name or the receiving unit
14. Means of transport to receiving unit.

DISCHARGE.

Discharge of the patient from the hospital is usual considered when the patient’s condition has
improved to the maximum, although in some instances it may be deemed necessary to discharge
a patient whose condition is likely to improve with time e.g. (paralyzed Patient or patients
suffering from terminal illness).

Besides, the patients and relatives may decide to request for discharge against medical advice.

The following should be considered on discharge.

1. Teach the patient about the illness, its cause and its effect on the patient’s life and how it
can be controlled or be prevented.
2. Care at home
3. Diet
4. Drugs on discharge
5. Counsel the patient on drug compliance
6. The importance of follow-up clinics e.g. orthopedics clinic, radiotherapy, physiotherapy
etc.
7. Period of leave from work.

The property kept for the patients should be returned and signed by the doctor indicating the
diagnosis, care, treatment, given during his her stay in the hospital. The dosage, frequency and
rate of drugs to be continued with at home are clearly explained to the patient and the relatives.
This prevents improper administration and equally promotes patients compliance.