Today our topic of discussion is Admission Procedure. Patient admission, hospital stays and discharges follow an established procedure, i.e. planned nursing activities. For patients requiring long-term care and repeated hospitalization, the activities must be coordinated so that the nursing care is continuous.
Admission Procedure
The specific medical treatment prescribed by the doctor, and the nursing regime followed by the nurse, are administered by the nurse in order to meet patient needs. The nurse monitors patient responses throughout the stay.
ADMISSION PROCEDURE
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.
Definitions
- Admission is defined as allowing a patient to stay in hospital for observation, investigation, treatment and care
- Admission is the entry of a patient into a hospital/ward for therapeutic or diagnostic purposes.
Purpose
- To establish guidelines regarding admission of patients
- To make the patient feel welcome, comfortable and at ease
- To acquire vital information regarding the patient
- To assess the patient from which a nursing care plan can be initiated and implemented.
Principles Involved
- Sudden change or strangeness on the environment
- produces fear and anxiety
- Entering the hospital is a threat to one’s personal identity People have diversity of habits and modes of behavior
- Illness can be novel experience for the patient and bring stress on his physical and mental health.
General Instructions
- To receive the patient and help him to adjust to the hospital environment
- To welcome and establish a positive initial relationship with the patient and relatives
- To obtain the needed identifying data concerning the patient
- To provide immediate care, safety and comfort To collaborate with patient in planning and providing comprehensive care
- To observe, report signs and symptoms and general condition of the patient
- To secure safety of the patient and his belongings.
Effective admission procedures should accomplish the following goals:
- Verify the patient’s identity and assess his clinical status Make him as comfortable as possible.
- Introduce him to his roommates and the staff
- Orient him to the environment and routine
- 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:
- Heighten anxiety
- Reduce cooperation
- Impair his response to treatment
- Perhaps aggravate symptoms.
Types of Admission
- Emergency admission: Means the patients are admitted in acute conditions requiring immediate treatment, e.g. patient with accidents poisonings, burns and heart attacks
- Routine admission: The patients are admitted for investigation and medical or surgical treatment is given accordingly, e.g. patients with hypertensions, diabetes and bronchitis.
Admission Involves
- Authorization from a physician that the person requires specialized care and treatment
- Collection of billing information by the admitting department of the health care agency
- Completion of the agency’s admission data base by nursing personnel
- Documentation of the client’s medical history and findings from physical examination
- Development of an initial nursing care plan
- Initial medical orders for treatment Medical authorization
- The admitting department
-Preliminary data collected
-Addressograph plate
- Initial nursing plan for care
- Medical admission responsibilities
General Instructions
- Nurses should make every effort to be friendly and courteous with the patient
- Make proper observations of the patient’s condition, record and report
- Orient the patient and his relatives to hospital and ward policies
- Observe policies in dealing with medicolegal cases
- Deal with the patients belonging very carefully communicable diseases
- Insolate the patient if suffering from communicable diseases (Fig. 7.2)
- The nurse should recognize the various needs of the patient and meet them without delay
- The needs to understand the fears and anxieties of patient and help to overcome
- The nurse should find out the likes and dislikes of the patient and include the patient in his plan of care
- The nurse should address the patients by their name and proper title
- Patient’s valuables and cloths should hand over to the relatives with proper recording.
Equipment
Gown, personal property form, valuables envelope admission form, nursing assessment form, thermomete 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.
Preparation of Equipment
- Obtain a gown and an admission pack
- Position the bed as the patient’s condition requires. If the patient is ambulatory, place the bed in the low position; if he is arriving on a stretcher, place the bed in the high position
- Fold down the top linens
- Prepare any emergency or special equipment, such as oxygen or suction, as needed.
Preparation of the Patient
- Greet the patient and his relatives and introduce yourself to them
- Receive the patient cordially and seat comfortable Introduce him to other person in the ward
- Complete the admission record
- Collect history and carry out simple physical exami- nation
- Carry out the prescribed treatment and keep a record
- Help the patient to maintain personal hygiene and change into hospital clothes
- Orient the patient to the ward-toilet bath room, drinking water supply, nurse’s station and treatment room
- Hand over the patients valuable to his relatives
- Issue visitor pass
- Encourage patient to take hospital diet especially when
- therapeutic diet is ordered
- Obtain local address or telephone number, relatives lodge room and document in admission record.
Procedure
- Adjust the room lights, temperature, and ventilation
- Make sure all equipment is in working order prior to the patient’s admission
- Admitting the adult patient
- Speak slowly and clearly, greet the patient by his proper name, and introduce yourself and any staff present
- 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
- 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
- Escort the patient to his room and, if he is not 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 . Take and record the patient’s vital signs, and collect specimens if ordered. Measure his height and weight if possible. If he cannot stand, use a chair or bed scale and ask him patient’s height. Knowing the patient’s height and weight is important for planning treatment and diet and for calculating medication and anesthetic dosages 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
- Explain the routine at your health care facility. Mention when to expect meals, vital sign checks, and medications. Review visiting hours and any restrictions 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 . After assessing the patient, inform him of any tests that have been ordered and when they’re scheduled. Describe what he should expect
- Before leaving the patient’s room, make sure he is 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:
- Allergies
- Dietary restrictions
- Fluid restrictions
- Specimen collection
- Patient deaf or hearing-impaired in right ear
- Foreign-language speaker.
- You can also use care reminders to post special instructions, such as:
- Complete bed rest
- No blood pressure on right arm
- Turn every 1 hour
- Nothing by mouth.
Admitting the Pediatric Patient
- Your initial goal will be to establish a friendly, trusting relationship with the child and his parents to help relieve fears and anxiety.
- Speak directly to the child, and allow him to answer questions before obtaining more information from his parents
- 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
- Teach the child how to call the nurse • Explain the facility’s rooming-in and visiting policies so the parents can take every opportunity to be with their child
- Inquire about the child’s usual routine so that favorite foods, bedtime rituals, toileting, and adequate rest can be incorporated into the routine
- 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
- If the patient does not speak English and is not accompanied by a bilingual family member, contact the appropriate resource
- Keep in mind that the patient admission to the emergency department requires special procedures
- 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
- 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 (Fig. 7.3).
Legal Aspects of Patient Admission
- Providing information about the patient to family members and to the next of kin is governed by applicable legislation.
- In the case of acutely ill patients who cannot express consent with hospitalization (e.g. unconscious, following strokes, etc.) a detention procedure or the “procedure concerning patient admission and detention by a healthcare facility” is put into place. The health care provider reports the patient admission without their consent to the court.
- Under emergency hospitalization, the court will appoint a guardian to represent the patient during detention.
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