Admission, Transfer, and Discharge Procedures

Admission, Transfer, and Discharge Procedures

Dr. Ali D. Abbas/ Instructor, Fundamentals of Nursing Department, College of Nursing, University of Baghdad, [email protected]

Admission:
Admission to the nursing unit prepares the patient for his stay in the health
care facility. Whether the admission is scheduled or follows emergency
treatment.
Effective admission procedures should accomplish the following goals:
1. Verify the patient's identity and assess his clinical status,
2. Make him as comfortable as possible,
3. Introduce him to his roommates and the staff,
4. Orient him to the environment and routine,
5. Provide supplies and special equipment needed for daily care.
Admission routines that are efficient and show appropriate concern for the
patient can ease his anxiety and promote cooperation and receptivity to
treatment.
Conversely, admission routines that the patient perceives as careless or
excessively impersonal can lead to:
1. Heighten anxiety,
2. Reduce cooperation,
3. Impair his response to treatment,
4. Perhaps aggravate symptoms.
Equipment:
Gown , personal property form , valuables envelope , admission form , nursing
assessment form, , thermometer , emesis basin , bedpan or urinal , bath basin ,
water pitcher, cup, and tray , urine specimen container, if needed.
An admission pack usually contains soap, comb, toothbrush, toothpaste,
mouthwash, water pitcher, cup, tray, lotion, facial tissues, and thermometer. An
admission pack helps prevent cross-contamination and increases nursing
efficiency.

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Admission, Transfer, and Discharge Procedures

Preparation of equipment:
1. Obtain a gown and an admission pack.
2. Position the bed as the patient's condition requires. If the patient is
ambulatory, place the bed in the low position; if he's arriving on a stretcher,
place the bed in the high position.
3. Fold down the top linens.
4. Prepare any emergency or special equipment, such as oxygen or suction, as
needed.
Implementation:
1. Adjust the room lights, temperature, and ventilation.
2. Make sure all equipment is in working order prior to the patient's admission.
3. Admitting the adult patient.
4. Speak slowly and clearly, greet the patient by his proper name, and introduce
yourself and any staff present.
5. Compare the name and number on the patient's identification bracelet with
that listed on the admission form. Verify the name and its spelling with the
patient. Notify the admission office of any corrections.
6. Quickly review the admission form and the physician's orders. Note the
reason for admission, any restrictions on activity or diet, and any orders for
diagnostic tests requiring specimen collection.
7. Escort the patient to his room and, if he isn't in great distress, introduce him
to his roommate. Then wash your hands, and help him change into a gown or
pajamas; if the patient is sharing a room, provide privacy.
8. Take and record the patient's vital signs, and collect specimens if ordered.
Measure his height and weight if possible. If he can't stand, use a chair or bed
scale and ask him his height. Knowing the patient's height and weight is
important for planning treatment and diet and for calculating medication
and anesthetic dosages.
9. Show the patient how to use the equipment in his room. Be sure to include the
call system, bed controls, TV controls, telephone, and lights.
10. Explain the routine at your health care facility. Mention when to expect
meals, vital sign checks, and medications. Review visiting hours and any
restrictions.

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Admission, Transfer, and Discharge Procedures

11. Take a complete patient history. Include all previous hospitalizations,

illnesses, and surgeries; current drug therapy; and food or drug allergies. Ask
the patient to tell you why he came to the facility. Record the answers (in the
patient's own words) as the chief complaint. Follow up with a physical
assessment, emphasizing complaints. Record any wounds, marks, bruises, or
discoloration on the nursing assessment form.
12. After assessing the patient, inform him of any tests that have been ordered
and when they're scheduled. Describe what he should expect.
13. Before leaving the patient's room, make sure he's comfortable and safe.
Adjust his bed, and place the call button and other equipment (such as water
pitcher and cup, emesis basin, and facial tissues) within easy reach. Raise the
side rails.
USING PATIENT CARE REMINDERS
When placed at the head of the patient's bed, care reminders call attention
to the patient's special needs and help ensure consistent care by communicating
these needs to the hospital staff, the patient's family, and other visitors.
You can use a specially designed card or a plain piece of paper to post
important information about the patient, such as:
1. Allergies
2. Dietary restrictions
3. Fluid restrictions
4. Specimen collection
5. Patient deaf or hearing-impaired in right ear
6. Foreign-language speaker.
You can also use care reminders to post special instructions, such as:
7. Complete bed rest
8. No blood pressure on right arm
9. Turn every 1 hour
10. Nothing by mouth.
Admitting the pediatric patient:
1. Your initial goal will be to establish a friendly, trusting relationship with the
child and his parents to help relieve fears and anxiety.
2. Speak directly to the child, and allow him to answer questions before
obtaining more information from his parents.

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3. While orienting the parents and child to the unit, describes the layout of the
room and bathroom, and tells them the location of the playroom, television
room, and snack room, if available.
4. Teach the child how to call the nurse.
5. Explain the facility's rooming-in and visiting policies so the parents can take
every opportunity to be with their child.
6. Inquire about the child's usual routine so that favorite foods, bedtime rituals,
toileting, and adequate rest can be incorporated into the routine.
7. Encourage the parents to bring some of their child's favorite toys, blankets, or
other items to make the child feel more at home amid unfamiliar
surroundings.
Special considerations
1. If the patient doesn't speak English and isn't accompanied by a bilingual
family member, contact the appropriate resource .
2. Keep in mind that the patient admitted to the emergency department requires
special procedures.
3. If the patient brings medications from home, take an inventory and record this
information on the nursing assessment form. Instruct the patient not to take
any medication unless authorized by the physician.
4. Find out the patient's normal routine, and ask him if he would like to make
any adjustments to the facility regimen.
Documentation
After leaving the patient's room, complete the nursing assessment form or
your notes, as required. The completed form should include the patient's vital
signs, height, weight, allergies, and drug and health history; a list of his
belongings and those sent home with family members; the results of your
physical assessment; and a record of specimens collected for laboratory tests.

Transfer
Patient transfer either within your facility or to another one requires
thorough preparation and careful documentation.
Preparation includes:
1. An explanation of the transfer to the patient and his family,

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Admission, Transfer, and Discharge Procedures

2. Discussion of the patient's condition and care plan with the staff at the
receiving unit or facility,
3. Arrangements for transportation if necessary.
Equipment:
Admission inventory of belongings , patient's chart, medication record, and
nursing Kardex , medications , bag or suitcase , wheelchair or stretcher, as
necessary.

Implementation:
1. Explain the transfer to the patient and his family. If the patient is anxious
about the transfer or his condition precludes patient teaching, be sure to
explain the reason for the transfer to his family members, especially if the
transfer is the result of a serious change in the patient's condition. Assess his
physical condition to determine the means of transfer, such as a wheelchair or
a stretcher.
2. Using the admissions inventory of belongings as a checklist, collect the
patient's property. Be sure to check the entire room, including the closet,
bedside stand, over bed table, and bathroom.
3. Gather the patient's medications from the cart and the refrigerator. If the
patient is being transferred to another unit, send the medications to the
receiving unit; if he's being transferred to another facility, return them to the
pharmacy.
4. Notify the business office and other appropriate departments of the transfer.
5. Have a staff person notify the dietary department, the pharmacy, and the
facility telephone operator about the transfer (if within the facility).
6. Contact the nursing staff on the receiving unit about the patient's condition
and drug regimen and review the patient's nursing care plan with them to
ensure continuity of care.
Transfer within the facility
1. If the patient is being transferred from or to an intensive care unit, your
facility may require new care orders from the patient's physician.
2. Send the patient's chart, laboratory request slips, Kardex, special equipment,
and other required materials to the receiving unit.

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Admission, Transfer, and Discharge Procedures

3. Use a wheelchair to transport the ambulatory patient to the newly assigned

room.
4. Introduce the patient to the nursing staff at the receiving unit. Then take the
patient to his room and, depending on his condition, place him in the bed or
seat him in a chair. Introduce him to his new roommate, if appropriate, and
tell him about any unfamiliar equipment such as the call bell.
Transfer to an extended-care facility
1. Make sure the patient's physician has written the transfer order on his chart
and has completed the special transfer form. This form should include the
patient's diagnosis, care summary, drug regimen, and special care
instructions, such as diet and physical therapy.
2. Complete the nursing summary, including the patient's assessment, progress,
required nursing treatments, and special needs, to ensure continuity of care.
3. Keep one copy of the transfer form and the nursing summary with the
patient's chart, and forward the other copies to the receiving facility.
Transfer to an acute-care facility
1. Make sure the physician has written the transfer order on the patient's chart
and has completed the transfer form as discussed above. Then complete the
nursing summary.
2. Depending on the physician's instructions, send one copy of the transfer form
and nursing summary and photocopies of pertinent excerpts from the
patient's chart such as laboratory test and X-ray results, patient history and
physical progress notes, and records of vital signs to the receiving facility with
the patient.
Special considerations
If the patient requires an ambulance to take him to another facility, arrange
transportation with the social services department. Ensure that the necessary
equipment is assembled to provide care during transport.
Documentation
Record the time and date of transfer, the patient's condition during
transfer, the name of the receiving unit or facility, and the means of
transportation.

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Admission, Transfer, and Discharge Procedures

Discharge
Effective discharge requires careful planning and continuing assessment of
the patient's needs during his hospitalization. Ideally, discharge planning begins
shortly after admission.
Discharge planning aims to:
1. Teach the patient and his family about his illness and its effect on his lifestyle,
2. Provide instructions for home care,
3. Communicate dietary or activity instructions,
4. Explain the purpose, adverse effects, and scheduling of drug treatment.
5. Arranging for transportation,
6. Follow-up care if necessary,
7. Coordination of outpatient or home health care services.
Equipment
Wheelchair, unless the patient leaves by ambulance , patient's chart , patient
instruction sheet , discharge summary sheet , plastic bag or patient's suitcase for
personal belongings.
Implementation
1. Before the day of discharge, inform the patient's family of the time and date of
discharge.
2. Obtain a written discharge order from the physician. If the patient discharges
himself against medical advice, obtain the appropriate form.
3. If the patient requires home medical care, confirm arrangements with the
appropriate facility department or community agency.
4. On the day of discharge, review the patient's discharge care plan (initiated on
admission and modified during his hospitalization) with the patient and his
family. List prescribed drugs on the patient instruction sheet along with the
dosage, prescribed time schedule, and adverse reactions that he should report
to the physician. Ensure that the drug schedule is consistent with the patient's
lifestyle to prevent improper administration and to promote patient
compliance.
5. Review procedures the patient or his family will perform at home. If
necessary, demonstrate these procedures, provide written instructions, and
check performance with a return demonstration.

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Admission, Transfer, and Discharge Procedures

6. List dietary and activity instructions, if applicable, on the patient instruction

sheet, and review the reasons for them.
7. Check with the physician about the patient's next office appointment; if the
physician hasn't yet done so, inform the patient of the date, time, and location.
8. Retrieve the patient's valuables from the facility's safe and review each item
with him. Then obtain the patient's signature to verify receipt of his valuables.
9. Obtain from the pharmacy any drugs the patient brought with him.
10. If appropriate, take and record the patient's vital signs on the discharge
summary form. Notify the physician if any signs are abnormal such as an
elevated temperature.
11. Help the patient get dressed if necessary.
12. Collect the patient's personal belongings from his room.
13. After checking the room for misplaced belongings, help the patient into the
wheelchair, and escort him to the exit; if the patient is leaving by ambulance,
help him onto the litter.
14. After the patient has left the area, strip the bed linens and notify the
housekeeping staff that the room is ready for terminal cleaning.
Special considerations
1. Whenever possible, involve the patient's family in discharge planning so they
can better understand and perform patient care procedures.
2. Before the patient is discharged, perform a physical assessment. If you detect
abnormal signs or the patient develops new symptoms, notify the physician
and delay discharge until he has seen the patient.
Documentation
1. Record the time and date of discharge,
2. The patient's physical condition,
3. Special dietary or activity instructions,
4. The type and frequency of home care procedures,
5. The patient's drug regimen,
6. The dates of follow-up appointments,
7. The mode of departure and name of the patient's escort,
8. A summary of the patient's hospitalization if necessary.

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MANAGING EMERGENCY ADMISSIONS DEALING WITH A DISCHARGE AGAINST

MEDICAL ADVICE

For the patient admitted through the Occasionally, the patient or his family
emergency department (ED), immediate treatment may demand discharge against medical
takes priority over routine admission procedures.
After ED treatment, the patient arrives on the advice (AMA). If this occurs, notify the
nursing unit with a temporary identification physician immediately. If the physician fails
bracelet, a physician's order sheet, and a record of to convince the patient to remain in the
treatment. Read this record and talk to the nurse facility, he'll ask the patient to sign an AMA
who cared for the patient in the ED to ensure
continuity of care and to gain insight into the form releasing the facility from legal
patient's condition and behavior. responsibility for any medical problems the
Next, record any ongoing treatment, such patient may experience after discharge.
as an I.V. infusion, in your notes. Take and record If the physician isn't available, discuss
the patient's vital signs, and follow the physician's
orders for treatment. If the patient is conscious the discharge form with the patient and obtain
and not in great distress, explain any treatment his signature. If the patient refuses to sign the
orders. If family members accompany the patient, AMA form, don't detain him. This violates his
ask them to wait in the lounge while you assess legal rights. After the patient leaves,
the patient and begin treatment. Permit them to
visit the patient after he's settled in his room. document the incident thoroughly in your
When the patient's condition allows, precede with notes and notify the physician.
routine admission procedures.

References:

Loeb, S., et al.: Nursing Procedures: Student Version, 1993,

Pennsylvania, Springhouse Corporation, P.P.4-8.