Patient Admission in Hospital – Nursing Procedure

Updated 2024

PATIENT ADMISSION

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. 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.

Definition

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 the
nursing care plan can be initiated and implemented

Principle 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
patient are admitted in acute conditions requiring immediate treatment, e.g. patient
with accidents poisoning, burns and heart attacks
Routine admission: the patients are
admitted for investigation and medical or surgical treatment is given
accordingly, e.g. patients with hypertension, 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, addessography plate)
Initial nursing plan for care
Medical admission responsibilities

General Instructions

Nurses should make every effort to
the 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
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, 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

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 examination
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 his 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 are 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 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
admitted 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 from 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

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
healthcare 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

NURSES ROLE IN ADMISSION

Admission to
an acute hospital may be planned (elective) or may be required as a matter of
urgency (emergency). Elective admissions are those which occur as a consequence
of referral to hospital by a general practitioner, medical consultant, a visit
to the hospital outpatient department or a planned transfer from another
hospital. Some patients may confound these definitions, e.g. patients requiring
chemotherapy who may be both urgent and planned. A number of principles should
underpin the development of an effective emergency and elective admissions and
discharge planning function. These include:

The provision of patient centered
services, which are accessible to the population without compromising safety,
quality and clinical standards, to the right people in the right location and
at the right time
Patients should be consulted and
included in all decisions about their care
Clinical practice and care should be
based on the most up to date evidence
Cooperation and clinical networking
between hospitals and between care groups are essential to optimize outcomes,
particularly where complex care issues are involved
A service based on good clinical
governance (i.e. founded on continuous quality improvement, staff development,
risk management and audit)
Acute hospital services should be
organized into three parallel streams of care interdependent of each other.
This involves a division of acute hospital services into emergency, elective
and out patients department/day care
The pivotal role of the Primary Care
Teams should be emphasized
Early induction training of
healthcare professionals in relation to the principles set out above

The
effective management of hospital beds and associated resources is vital if the
growing demand placed on hospital resources is to be met. Recognized
impediments to patient “flow” in hospitals include:

Difficulties in gaining access to
inpatient beds (i.e. insufficient bed capacity)
The resulting congestion within
Emergency Departments
Inappropriate retention of patients
in hospital beds

To ensure
that all patients admitted to hospital receive the high quality and safe
service to which they are entitled, resources must be efficiently and
effectively utilized. Services are organized so that patients, depending on
their needs, can move smoothly between emergency care and the best and most
appropriate inpatient care, primary care and continuing care. Effective quality
assurance and safe care are essential rights of all users of the health
services. Achieving the standards set by the Irish Health Services
Accreditation Board will ensure that all hospitals are providing such care

EMERGENCY ADMISSIONS

An emergency
hospital admission is defined as one that is not planned and which results from
trauma (injury) or acute illness which cannot be treated on an outpatient
basis. In order to manage the balance between elective and emergency
admissions, the factors below have been identified as effective in improving
the management of admissions and general patient flow in the Emergency
Department

Managing
emergency admissions: for the patient admitted through the emergency department
(ED), immediate treatment take priority over routine admission procedures.
After ED treatment, the patient arrives on the nursing unit with a temporary
identification bracelet, a physician’s order sheet, and a record of
treatment. Read this record and talk to
the nurse who cared for the patient in the ED to ensure continuity of care and
to gain insight into the patient’s condition and behavior. Next, record any
ongoing treatment, such as an IV infusion, in your notes. Take and record the
patient’s vital signs, and follow the physician’s orders for treatment. if
family members accompany the patient, ask them to wait in the lounge while you
assess the patient and begin treatment. Permit them to visit the patient after
he’s settled in his room. When the patient’s conditions allows, precede with
routine admission procedures.

ELECTIVE ADMISSIONS

Achieving
the correct balance the competing demands for hospital beds by elective and
emergency cases of varying complexity is likely to remain a considerable challenge
for the future. In order to improve the experience of patients waiting for
elective admission, the following priorities have been identified:

Local clinical consensus on the ratio
of emergency admissions to planned elective procedures
Measures to review and monitor
criteria for hospital admission and for lengths of stay
Greater emphasis on ensuring that in
admitting elective patients, consideration is given to the length of time they
have been waiting since the decision to admit was taken – taking account of
their clinical needs
Greater standardization of waiting
list administration with consistent monitoring of cancellations, suspensions
and removal from lists without treatment.
Emphasis on planning discharge from
day of admission
The adoption of a whole systems
approach to bed management
The appointment of a manager or
clinician with sufficient authority and support to balance and monitor the
competing demands of emergency and elective pressures ensuring all bed and
theatre resources are fully utilized

A patient’s
episode of care should be planned before his/her admission and should take
account of the entire “journey” up to and after discharge from hospital.
Patients and their care taker should be partners in the planning. Bed management
should be overseen by a Hospital Bed Manager who has the authority to implement
the bed management policy and to coordinate the bed management team. The bed
management service should operate on a permanent basis, i.e. for 24 hours on
everyday of the year. The bed manager reports to a senior member of management.
Part of their role would include continuous analysis and the provision of
reports and forecasts. The function of allocating beds to patients should be
centralized and the Hospital Bed Manager should have authority over the access
to all hospital beds. There should be an awareness of the bed designation ratio
as set out by the Department of Health and Children. The Hospital Bed Manager
should work within the notional allocation of beds to each specialty to ensure
that patients are accommodated in the most appropriate bed available at the
time of their admission, and to ensure that patients are cared for by staff
with the appropriate expertise

The
following key requirements have been identified to facilitate effective
elective admission practices:

Centralized waiting list management
and agreement on the parameters for scheduling theatre lists with clinicians
Pre-admission assessment should be
standard requirement for all elective admissions to ensure appropriate planning
of the entire patient journey
The anticipated length of stay (this
should be indicated as early as possible to facilitate scheduling) for elective
admissions should be indicated as early as possible to facilitate scheduling
Increased day surgery can also the
supported by before admission assessment to ensure appropriate scheduling and
to minimize transfer to in-patient beds

PATIENT TRANSFER – NURSING PROCEDURE

PATIENT DISCHARGE – NURSING PROCEDURE

PATIENT ADMISSION - NURSING PROCEDURE
Definition, General Instructions, Equipment, Nurses role in Admission Procedure, Types of Admission — PATIENT ADMISSION – NURSING PROCEDURE
Definition, General Instructions, Equipment, Nurses role in Admission Procedure, Types of Admission

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NURSE FUNDAMENTAL PROCEDURES

MEDICAL SURGICAL NURSING

KEY POINTS IN HOSPITAL ADMISSION

The hospital admission procedure involves several steps to ensure that patients receive appropriate care and that the necessary information is collected. Here is a general overview of the hospital admission process:

Pre-Admission Coordination:
- In some cases, pre-admission coordination may take place. This involves scheduling the admission, verifying insurance information, and obtaining necessary pre-authorizations.
Arrival at the Hospital:
- Upon arrival, the patient or accompanying family member should check in at the hospital’s admission or registration desk. This is typically located in the main lobby or near the emergency department.
Completion of Admission Forms:
- The patient will be asked to fill out admission forms, which include personal information, medical history, insurance details, and consent forms. In emergency situations, a family member or healthcare proxy may assist in completing these forms.
Identification and Insurance Verification:
- The hospital staff will verify the patient’s identification and insurance information. This step ensures that the hospital has accurate details for billing and other administrative purposes.
Medical Assessment:
- A nurse or healthcare provider will conduct a medical assessment to gather information about the patient’s current health status, symptoms, and medical history. Vital signs such as blood pressure, heart rate, and temperature may be measured.
Initial Treatment and Stabilization:
- If the patient requires immediate medical attention, they may receive initial treatment and stabilization in the emergency department before being admitted to a specific unit or ward.
Assignment of Room or Bed:
- Once the admission process is complete, the patient is assigned a room or bed in the appropriate unit or department, depending on their medical condition and the type of care needed.
Introduction to Care Team:
- The patient will be introduced to the healthcare team responsible for their care. This team may include doctors, nurses, technicians, and other healthcare professionals.
Patient Education:
- The healthcare team provides information about the hospital routine, safety measures, and the patient’s plan of care. This includes details about medications, tests, and procedures.
Consent for Treatment:
- Patients or their legal representatives will be asked to provide informed consent for specific treatments, procedures, and interventions. This ensures that the patient is fully aware of and agrees to the proposed medical interventions.
Financial Arrangements:
- Hospital staff may discuss financial arrangements, including insurance coverage, copayments, and any potential out-of-pocket expenses. Financial counselors may be available to assist with financial-related queries.
Medication Reconciliation:
- A thorough review of the patient’s current medications is conducted to ensure accurate and safe administration during the hospital stay.
Personal Belongings and Valuables:
- Patients are advised on the hospital’s policy regarding personal belongings and valuables. It’s common for hospitals to provide a safe place for items like jewelry, wallets, and other valuables.
Communication Plan:
- A communication plan is established, including how family members will be informed about the patient’s progress and any important updates. This may involve providing contact information and discussing visiting hours.
Discharge Planning (if applicable):
- If the admission is for a planned procedure or treatment, initial discussions about discharge planning may take place, outlining post-discharge care, follow-up appointments, and medications.