ADMISSION PROCEDURES

People being admitted to hospital feel anxious and unsure of a lot of things. The nurse being the
first health worker to meet the patient should put the patient at ease. Greet the patient, introduce
yourself. It is important for the nurse to appear pleasant and friendly as this will reassure the
patient. It is also the beginning of the nurse/patient relationship.

TYPES OF ADMISSION

i) PLANNED: This is usually for surgical and gynecological patients. The patient is attended to
in the outpatient department then booked/given a date to come for operation and admission. The
patient is aware of being admitted and operated upon.

ii) UNPLANNED OR EMERGENCY ADMISSION

This refers to patients who come to hospital hoping to be treated as outpatients and end up being
admitted. It includes all patients admitted from accidents or needing emergency surgery.

TYPES OF PATIENTS

i) Ambulant: These are patients who are able to walk.

ii) Stretcher/Wheel chair patients: These are patients who are too weak to walk and are
wheeled in on a wheel chair or stretcher.

ADMISSION PROCEDURE

The patient is seen in the out patient department (OPD) by the Doctor who decides to admit. The
patient is then accompanied to the ward by a nurse together with admission forms and case notes.

Admission Form: This is a form that carries identification data of the patient. It should include
the following information: Name, Age, Sex, Occupation, and residential Address, next of kin,
religion, tribe, village, chief and a hospital number.

This data is important for follow up of the patient.

On the Ward:

1) Welcome the patient by name on the ward. Introduce yourself and other health workers if
present.

2) Decide whether the patient needs to be placed in bed right away or not.

3) Ambulant patients give a chair at the admission desk.

4) Prepare patients admission notes and case notes by opening a file and entering information in
admission book.
5) Take observations on the following: Temperature, Pulse, Respirations, blood pressure and
weight if ambulant. Record on patient’s chart. This data is for comparison with subsequent
observations.

- Collect a specimen of urine and carry out urinalysis to rule out abnormalities in urine.

6) Allocate the pt a bed depending on the condition.

7) Ambulant patients orient them to the ward showing them bathroom, toilet, kitchen, day room
e.t.c. Show them how to use toilets and taps if necessary.

8) Surgical patients obtain consent for operation either from the pt or relatives.

9) Finally explain the ward routine; and let pt to rest. Provide pyjamas or night dress.

10) Some patients might require a bath before being given a bed.

11) During the admission procedure interact with the patient; make pertinent observations, listen
to pts complaints or comments to allay pts anxiety.

Observe the following:

a) General reaction to the admission, anxious or resigned.

b) Patients health and hygiene –

- color of skin; cyanosis (bluish discoloration in the nails or mucus membranes),

Jaundiced; yellow discoloration of skin and eyes,

- look out for visible scars, signs of dehydration such as sunken eyes.

- enquire about passage of urine and stool, ask about menses in the woman of child bearing age.

Patients Valuables

The patient’s clothes and valuables are kitted. Money should be taken to accounts department for
safe keeping.

Taking Specimens

Take specimens as ordered by MO. Give prescribed drugs. Inform the kitchen of new
admissions.

EMERGENCY ADMISSION

From casualty or OPD; ring the ward informing them about the name and condition of patient.
On the Ward:

Prepare admission bed, bed elevators, suction machine, emergency trolley, oxygen cylinder and
catheters, extra linen, dressing trolley.

These will depend on the pts needs. Once pt is admitted put on the bed; carry out any urgent
procedures. Other procedures of admission are routine.

TRANSFER OF PATIENT

Transfer can be:

a) Hospital to hospital

b) Ward to ward

c) health centre to hospital

d) hospital to nursing home.

PROCEDURE

A) HOSPITAL/HEALTH CENTRE TO HOSPITAL

- Inform the patient and the relatives about the transfer and reason for transfer.

- Pack patients belongings

- Letter of transfer/referral and all relevant documents placed together in readiness for
Transfer.

- If there are any drugs to be collected for the pt, do so.

- Ensure pt is clean and dry; wounds should be dressed before transfer.

- Long journeys make arrangements for food a little pocket money and transport.

- If possible inform the receiving hospital about the patient.

B) WARD TO WARD

Inform receiving ward; Inform patient; Prepare the patients charts, belongings and take patient to
the ward including all the relevant documents.

DISCHARGING OF A PATIENT
The Doctor authorizes the patients discharge. Discharge planning should begin 1-2 days before
discharge so that pt and relatives are ready.

- the pt is given written instructions of how to take drugs and when to come for review.

- make sure that the patient is given enough drugs or dressings.

- give advice on where to get new supplies before they finish.

- make arrangements for the public health nurse to visit him necessary.

- ensure that a relative is around to accompany the patient home.

- accompany pt to door of the ward or hospital and bid him farewell.

AFTER DISCHARGE

1) Remove bed linen and send to the laundry.

2. Carbolise the bed and mattress.

3) Clean lockers and other furniture in the unit.

4) The pts case notes are completed by the medical staff and sent to the medical records for
filing.

5) Left over drugs are sent to the pharmacy.

DISINFECTION OF A BED UNIT

This is also known as carbolisation or terminal disinfection. It is a procedure carried out after
discharge or death of a patient.

Requirements:

Trolley with the following requirements:

- bowl with a disinfectant

- bowl with plain water

- receiver with a duster

- clean bed linen

PROCEDURE

1) Bring the equipment to the bed side,

3) Remove everything from locker.

4) Clean bed with disinfectant, pay special attention to grooves where dust gathers.

5) Start with the head of the bed and dry it after using a wet duster.

6) Clean lockers and polish the top of the locker.

7) Make an empty bed.

8) Clean the equipment used and store away.

DISCHARGE AGAINST MEDICAL ADVICE

This refers to the patient who prefers to go home in spite of the advice given by the staff. You
request the patient or relative to sign in the file indicating that the patient is living against
medical advice. No drugs or discharge slip are given; but you write in the chart of file.

ABSCONDING

This refers to the patient running away or sleeping out of the ward without the nurses knowledge.
Search for the patient in the ward before informing the ward in charge and security. Write in the
file that pt has absconded indicating date and time. In some institutions the policy involves
informing the police as well.