Admission Transfer and Discharge of the Patient HST

Admission, Transfer, and Discharge of the Patient HST 2

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

Student Expectations: n Recognize and demonstrate established procedures for admitting, transferring, and discharging a patient. n Assess the importance of observing the patient’s general physical condition and appearance. n Communicate what information must be documented.

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

Helping Patients Adjust n Every patient being admitted is nervous, even if it’s not their first admission. n Strange surroundings n Busy nursing staff n Sight of other patients n May not know what to expect

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

Prepare the patient’s room: n Before the patient’s arrival, make sure their room is ready. n Admission checklist ready n Pen / pencil n Gown or pajamas n Portable scale n Thermometer

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

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

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

Admission Procedure n Explain facility’s policy on visitors, telephone use, how to use the TV remote. n Show to use the call light and operate the bed controls. n Tell patient when meal times are. n Answer any questions.

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

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

Assessment of Patient n Assess the patient’s general physical condition, appearance and behavior. n Observe for: n Cuts, bruises, scars n Loss of function n Signs of weakness n Any prosthesis n Physical complaints the patient has

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

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

Recording the Data n Complete the admission checklist. n Fill in the date and time of admission. n Method of admission – the way the patient came into the room: n wheelchair n ambulatory n stretcher

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

Transferring the Patient n Patients may be transferred from one room to another for several reasons. n Sometimes it is at the patient’s request for a different type of room or a more compatible roommate. n 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.

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

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

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

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

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

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

n The patient who is not yet ready to care for him/herself may be discharged to an extended care facility. n 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.

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

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

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