ADMISSION OF PATIENTS TO THE HOSPITAL.

1. ADMISSION OF PATIENTS TO THE HOSPITAL.

2. ADMISSION OF PATIENTS TO THE HOSPITAL. • ADMISSION: it is the entry and acceptance of a patient to stay in a health facility for the purpose of observation , investigation and treatment . Clients coming in for admission may walk-in (ambulant ) or not. • TYPES OF ADMISSIONS • ELECTIVE/ PLANNED/ROUTINE • EMERGENCY

3. Elective /Planned Admission: with this type of admission the medical officer or the health care provider arranges with the patient on a convenient date for admission. Patient is informed well ahead of time to enable him prepare for the admission. • Patient is taken through the admission process from the OPD.

4. ADMISSION OF PATIENTS TO THE HOSPITAL Emergency Admission- with this type of admission patient reports to the hospital in a critical condition; he/her is usually brought in by people (relatives, friends or a good Samaritan). The patient is transported to the ward in a wheel chair or stretcher. This type of patients needs immediate treatment.

6. REASONS FOR ADMISSION • For diagnostic investigations to be done • For treatments which may be medical or surgical • For observation

7. ADMISSION PROCEDURE (PLANNED/AMBULANT PATIENT) • Welcomed Patient/ relatives to the ward/unit and introduce yourself and any other nurse present to the patients • Collect the necessary documents i.e. admission papers and other information from the accompanying nurse

8. ADMISSION OF PATIENTS CONT’d • Identify and confirm patient by name particulars • Provided seats for patient and the relatives to make them comfortable • Gather information from patient and if necessary the relatives to fill the admission papers. • Depending on the condition provide an admission bed. • Assist patient to change into pyjamas or hospital gown and give identification bracelets if applicable

9. ADMISSION OF PATIENTS CONT’d • Provide privacy and do baseline assessment of patient and document (observation, vitals etc.), collect specimen if ordered. • Serve prescribed urgent medication if applicable. • Take care of patient’s valuables if necessary. • Ensure patients sign consent form for treatment.

10. ADMISSION OF PATIENTS CONT’D • National health insurance scheme is explained to the patient and relatives. • Patients relatives are informed about the visiting hours, thing the patient needed on admission. Patient is allowed to see relatives and bid them goodbye. • Patient is orientedto ward and its environment. • The nursing process is used to nurse the patient

11. ADMISSION OF PATIENTS CONT’d • Patient’s name and particulars are entered into the admission and discharge book as well as the ward state. Admission is documented in the nurses note.

12. ADMISSION PROCEDURE (EMERGENCY; PATIENT IN A WHEEL CHAIR or stretcher) Advance Preparing Wash hands and assemble the following depending on the condition • Temperature tray • Resuscitation/emergency tray • Oxygen apparatus • Patient is received into an already prepared bed- type of bed may depend on the condition of the patient i.e cardiac bed for for respiratory distress

13. ADMISSION OF PATIENTS CONT’d • Tray for venipuncture • Suction apparatus • Blood pressure apparatus • Bed to suit patient’s condition.

14. ADMISSION PROCEDURE… • Welcome patient/ relatives to the ward/unit and introduce your self and any other nurse present to the patients • Collect the necessary documents i.e. admission papers and other information from the accompanying nurse • Identify and confirm patient by name , particulars

15. ADMISSION PROCEDURE… • Quickly assess the patient’s general condition • Receive patient into an already prepared bed – depending on the condition. • Patient is changed into bed clothing if possible

16. ADMISSION PROCEDURE... • privacy provided and patient is assessed i.e. checking of vital signs, observation and examination- general appearance, skin for abnormalities, pain, breathing pattern, complaints, general reaction of the patient, level of consciousness, etc. • Relevant history is taken from patient or relatives

17. ADMISSION PROCEDURE... • Ensure consent form is signed. • Patients valuables are taken care of if necessary • National health insurance scheme is explained to the patient and relatives. • Patients relatives are informed about the visiting hours, thing the patient needed on admission. Patient is allowed see relatives and bid them goodbye.

18. Admission process… • Depending on the condition specimen collected and tested. • Nurse patient using the nursing process. • Administer prescribed medications • Patient’s name and particulars are entered into the admission and discharge book as well as the ward state. Admission is documented in the nurses note

19. Admission process... The Role of the Nurse in the Admission Process • meeting the immediate needs of the patient- physical and emotional • Thorough assessment of the patient- nursing process • Ensure patient is assigned to the appropriate room. • Write admission report- day and night report • Ensuring comfort and reducing anxiety of patients and relatives

20. TRANSFER OF PATIENTS Transfer of patient within a healthcare facility/hospital It is the movement of a patient within the same health facility Types • Transfer in/Trans –in: when patient is moved from one unit or ward of first admission to a new unit or ward. E.g. Medical to Surgical Ward, Emergency Ward to the Medical or Surgical Ward for update treatment. The receiving ward must be informed about trans in before it is done.

21. ROLES… Steps • prepare a suitable bed to receive patient • Assemble the necessary equipment depending on the patients condition i.e. oxygen apparatus, suction machine, vital signs tray. • Receive incoming patient, relatives and accompanying nurse warmly.

22. ROLES…

23. TRANS IN (CONT…) • Take over the transfer notes and personal belonging of the patient from accompanying nurse. • confirm patient’s identity with accompanying nurse • Ask for clarification on vital issues pertaining to the patient’s condition from the accompanying nurse. • Introduce self and other nurses around to patient and relatives

24. TRANS IN (CONT…) • Do a quick assessment of the patient’s condition and needs and act accordingly • Admit patient using the nursing process • Orientate patient and relatives to ward and its environment, routine of the unit if necessary • Document time of patient’s arrival in the nurses note, admission and discharge book and ward state.

25. TRANSFER OF PATIENTS

26. Transfer out/ trans out(CONT…) Transfer out/ trans out: it could be from unit to unit or facility to facility Steps • Confirm with receiving unit • Assess patients condition • Arrange for accompanying nurse • Arrange for appropriate vehicle- where applicable.

27. Transfer out/ trans out(CONT…) • Collect all necessary data • Explain reason of transfer to patient and relatives and reassure them to reduce anxiety • Obtain written consent for transfer • Pack patients belonging • Collect patients medications , investigations results and transfer notes • Assist patient to dress up • Assist patient into wheel chair, stretcher, ambulance where applicable

28. Transfer out/ trans out(CONT…) • hand over patient’s notes and belongings to the accompanying nurse. • Enter patient’s name in the A&D book, ward state and nurse note.

29. DISCHARGE OF A PATIENT FROM THE HOSPITAL Discharge occurs when a patient leaves the hospital after a period of treatment to his or her home; it normally done at the discretion of the medical team when patient is fit or his condition is stable or upon patient's own request. It is important that patients and relative have a prior knowledge of the intended discharge.

30. DISCHARGE PLANNING • It is a process that facilitate the transition of the client from the health care institution to the most independent level of care, home or another health facility. • The over all goal of discharge planning is to provide the most appropriate level and quality of care throughout all stages of the client illness. To ensure adequate continuity of care.

31. DISCHARGE OF A PATIENT FROM THE HOSPITAL The role of the nurse in discharge planning • Include all caregivers involved in the care of the patient i.e. physiotherapist ( multidisciplinary) • Adequate assessment of patient during all the stages of care to identify discharge needs. • Assess health teaching needs of client and family and provide family members with the knowledge and skills to care for the client in the home setting e.g. wound care, range of motion exercises. • Assess home situation i.e. bathroom facilities, doorway, steps , home arrangement etc.

32. DISCHARGE OF A PATIENT FROM THE HOSPITAL... STEPS • Ensure discharge is ordered by a medical officer or signed letter from patient • Patient and relatives are informed about discharge • They are educated on the need for continuing treatment and follow up care

33. DISCHARGE… • Ensure patient’s hospital bills are worked out and submitted to the health insurance officer or paid at the revenue office by patients who are not members of the scheme. • Receipt number is entered into the A&D book and the receipt handed over to the patient. • Relatives are directed to collect prescribed drugs from the pharmacy if applicable.

34. DISCHARGE… • Drug administration is well explained to patient and relatives as well as education on home and follow up care • Patient is helped to pack belongings. • Any patient valuable in the nurses custody is handed over to patient and relatives, it is recorded, witnessed and signed.

35. DISCHARGE… • Patient and relatives are once again reminded of the review date and exactly where to report on the said date. • Bed linen is removed, bed and lockers are decontaminated. • Discharge is documented in the nurses note, A&D book and ward state.