PATIENT ADMISSION IN HOSPITALS – 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

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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:

1. 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.
2. 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.
3. 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.
4. 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.
5. 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.
6. 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.
7. 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.
8. 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.
9. 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.
10. 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.
11. 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.
12. Medication Reconciliation:
    • A thorough review of the patient’s current medications is conducted to ensure accurate and safe administration during the hospital stay.
13. 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.
14. 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.
15. 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.