ADMISSION

• Admission


  Allowing a patient to stay in hospital for observation, investigation, treatment and care
• Standards on Patients Admission

  • To discuss standard ways of ensuring the patient and significant others a courteous welcome into the hospital
  • To familiarize nurses in the admission process and be able to orient the patient and family to the hospital set-up thereby making the patient an integral part of the unit
  • Appreciate the role of nurses in providing for an immediate care of the patients upon arrival at the Nursing units
  • To promote quality care while handling patients in the most efficient, safest, and effective way possible
  • To serve as a tool for Nurses, providing them knowledge in ensuring a safe, well organized and timely discharge of patients from the hospital
• Emergency / Unplanned Admission

  Patients are admitted in acute conditions requiring immediate treatment
• Emergency Admission


  • Patient with RTA Poisoning, burns and cardiac or respiratory emergency
• Routine / Planned Admission


  Patients are admitted for investigation, diagnostic and medical or surgical treatment. Treatment is given according to patients problem.
• Routine Admission


  • Patient with hypertension, diabetes mellitus
• Care needs identified and prioritized for admitted patients

  • Preventative services
  • Diagnostics services
  • Curative or treatment services
  • Rehabilitative services
  • Palliative services
• Points of Entry for Admission

  • Emergency Medical Service (EMS)
  • Operating Room (OR) / Delivery Room (DR)
  • Outpatient Department (OPD)
  • Doctor's clinic
  • Pre-admission Unit (PAU) / Admission Office
• Pre-Admission to the Nursing Unit

  1. Receive report from admission point of entry

  2. Receive patient details including demographic profile, diagnosis, pre-admission report and other pertinent information

  3. Verify if patient has signed hospital admission consent, patient bill of rights

  4. Ensuring Availability of Necessary Resources (e.g., Sheets, Bed, Equipment, Supplies)

  5. Prepare patient room, equipment needed and special needs (e.g. cardiac monitor, IV pump)
• Admission to the Nursing Unit

  1. Introduction – of self and other personnel, introduce other client if present in the same room

  2. Verification of Patient Information (ID wrist band)

  3. Completion of Admission Forms and Consent Documents

  4. Take patient height, weight and ask for allergies (food, medications)

  5. Nursing Assessment (Head-to-foot), Nursing notes

  6. Patient orientation to the unit (mealtimes, visiting hours, use of phones recreational use, physician's visits, other schedules)

  7. Coordination with Support Services (e.g., Dietary, Laboratory, Radiology)
• Advance Directives


  A written document that tells your health care providers who should speak for you and what medical decisions they should make if you become unable to speak for yourself
• Living Will


  An advance directive, sometimes called a "living will," is a written document that tells your health care providers who should speak for you and what medical decisions they should make if you become unable to speak for yourself
• Articles Needed in Admitting Patient

  • Prepare bed
  • Vital signs equipment
  • Weighing scale
  • Admission kit
  • Patient gown, bath towel, wash cloth
  • Other equipment like cardiac monitor for ICU patients, IV pole
  • Forms like Nurses's Notes, PA sheet, Doctor's Progress Sheet, Doctor's order sheet, Pre-op Sheet, TPR Sheet, Other sheets like I & O, Lab sheet, etc.
• Special Considerations in Admission

  • Admission cause undue stress (emotional factors as well as financial capability must given utmost importance)
  • Be observant consider the individual patient needs
  • Provide an individual admission procedure
  • Show efficiency and concerns
• Admission Procedure


  1. Meet and receive the patient

  2. Verify the patient data, by checking the record sheet, chart

  3. Introduce immediate personnel, other caregiver if present

  4. Assist patient to the treatment area

  5. Ask the patient to change clothes into hospital gown if necessary
• Orientation to the Patient and Relatives

  1. The equipments/ instruments

  2. Use of call system and telephone

  3. Treatment schedule

  4. Visiting hours

  5. Other health care team members

  6. Policy and rules and regulations

  7. Care of patients valuable etc.
• Perform Examination and Evaluation Procedure

  1. Perform examination and evaluation procedure establish base line values like vital signs. Do history taking, physical examination etc.

  2. Coordinate with the physician and carry out initial orders

  3. Give the treatment and instruction as needed
• Record & Report


  1. Admission Book

  2. Preparation of Paper

  3. Drug Book

  4. Diet Book

  5. Directory Board

  6. HMIS (Health Management Information System) Entry List

  7. Cot List
• Medico-Legal Cases (MLC)


  Any case of injury or ailment where, the attending doctor after history taking and clinical examination, considers that investigations by law enforcement agencies (and also superior military authorities) are warranted to ascertain circumstances and fix responsibilities regarding the said injury or ailment according to the law
• Internal Transfer


  Moving a patient within the same hospital to a different unit that provides special care or care suited to his needs, e.g. from general ward to ICU
• External Transfer


  Moving a patient from one hospital to another hospital for the purpose of special care, e.g. from general hospital to specialized hospital – cancer centre
• Procedure in Transfer to Other Hospital

  1. Written order from attending physician

  2. Informs the patient and family of the need to transfer

  3. Encourage family to choose facility or hospital of preference where to transfer

  4. Coordination with the facility where patient will be transferred

  5. Make a copy of the medical records and provide a copy of transfer summary

  6. Collect all patient's belonging

  7. Assist in the transport of patient

  8. Provide transfer personnel with a copy of the medical record and transfer summary

  9. Complete the patient's chart and do documentation

  10. Notify all department regarding he transfer
• Discharge from the Hospital


  Relieving a person from hospital setting, who admitted as an inpatient in that hospital
• Types of Discharge


  • Planned Discharge
  • DAMA/LAMA: Discharge/Leave Against Medical Advice
  • Transfer: Transfer to other unit or hospital
  • Abscond: Abscond from Hospital
  • Referral: Referred for further management
• Consent for DAMA (Discharge Against Medical Advice)
• Essentials of Planned Discharge

  • Written order by doctor
  • Discharge card
  • Informing other departments
  • Check payment of the bills
  • Hospital glossaries taken back
  • Returning of personal belongings
  • Arrangement for transport
  • Documentation
• Steps involved in the Discharge Planning

  1. Evaluation of the patient by a qualified personnel

  2. Discussion with the patient or his relatives

  3. Planning for homecoming or transfer to another place

  4. Determining if caregiver training is needed for appropriate support

  5. Referrals to home care agency or appropriate support

  6. Arranging for follow-up appointments or test
• Nurses Responsibility in Discharge - Preparation for Discharge

  1. Planning in the beginning

  2. Plan for rehabilitation and follow - up need

  3. Teach nursing procedures to be continued at home, get it's practice done

  4. Arrangement for transport
• Nurses Responsibility in Discharge - During Discharge Procedure

  1. See doctor's written order

  2. Explanations

  3. Hand over personal belongings

  4. Check and receive any hospital property

  5. Confirm bill paid

  6. Inform other departments regarding discharge

  7. Arrange transport

  8. DAMA: - check consent
• Discharge Checklist


  • Medication
  • Environment
  • Treatment
  • Health Teaching
• Discharge Planning


  1. Evaluation of the patient by a qualified personnel

  2. Discussion with the patient or his relatives

  3. Planning for homecoming or transfer to another place

  4. Determining if caregiver training is needed for appropriate support

  5. Referrals to home care agency or appropriate support

  6. Arranging for follow-up appointments or test
• Nurses Responsibility in Discharge

  • Planning in the beginning
  • Plan for rehabilitation and follow-up need
  • Teach nursing procedures to be continued at home, get its practice done
  • Arrangement for transport
• Checklist


  • MEDICATION
  • ENVIRONMENT
  • TREATMENT
  • HEALTH TEACHING
  • OUT PATIENT REFERRAL
  • DIET
• Articles needed in discharging patient

  • Wheelchair or stretcher
  • Discharge booklet
  • Prescription order
  • Clinic appointment
• Nurses Responsibility in Discharge - After Discharge


  1. Documentation

  2. Care of patient's room and articles
• Nurses responsibility in MLC Discharge

  • Check for medico legal history
  • Notify medical officer in charge
  • Abscond cases immediately contact medical officer in charge
  • Maintain all documents in proper manner
  • Take in written handing over and taking of articles
  • Never discharge patient without written order by physician
• Chart the date and time of discharge, how patient left the facility, any special instructions given to the patient, and make a notation that the patient's personal belongings were sent with the patient
• Documentation is a vital aspect of nursing
• Nursing documentation systems


  • Should reflect current standards of nursing practice and minimize the risk of errors
  • Need to be flexible enough to allow members of the health care team to efficiently document and retrieve clinical data, track patient outcomes, and facilitate continuity of care
• Purposes of the health care record

  • Facilitates interprofessional communication among health care providers
  • Legal record of care provided
  • Justification for financial billing and reimbursement of care
  • Auditing, monitoring, and evaluation of care provided
  • Education and research