DISCHARGE OF PATIENT.

DISCHARGE OF PATIENT.

Discharge is an authorized release of a patient from a health care facility. However, a doctor’s order or authorization is required for it. The health team develops a patient’s discharge plan.

Discharge from the hospital is usually considered a routine but an effective discharge requires a careful planning and continuing assessment of the patient’s needs during hospitalization.

PLANNING FOR A NORMAL DISCHARGE.

Normally planning for a discharge begins shortly after admission. Discharge planning aims to…

1.      Teach patient and his family about his illness and its effects on his life-style.

2.      To provide instructions for home care.

3.      To communicate dietary or activity instructions

4.      To explain the purpose adverse effects and scheduling of drug treatment.

5.      Follow-up care if necessary

6.      Arranging for transportation.

REQUIREMENTS TO PREPARE FOR DISCHARGE OF  PATIENT

Telephone if available

Paper and pen for writing referral notes

Envelopes

Appropriate referral forms

PROCEDURE

1.      Before the day of discharge, inform the patient’s family of the time and date of discharge. Always confirm arranged transportation on the day of discharge.

2.      Obtain a written discharge order from the doctor. If the patient discharges himself against medical advice, obtain the appropriate hospital form.

3.      If the patient requires home medical care, confirm arrangement with the public health nurses or a nearby hospital.

4.      On the day of discharge, review the patient’s discharge plan initiated on admission and modified during his hospitalization with the patient and his family. List prescribed drugs, dosage, time schedule and adverse effect.

5.      Review procedures the patient and his family will perform at home. If necessary, demonstrate those procedures, provide written instructions and check performance with a return demonstration.

6.      List dietary and activity instructions if applicable to the patient. If the doctor ordered bed rest, make sure patient’s family will/can provide daily care.

7.      Inform patient of the date, time and location for his or her review.

8.      Retrieve the patient’s valuable from the hospital safe and review each item with him. Obtain patient’s signature to verify receipt of his valuables.

9.      Help patient to get dressed if necessary.

10.  Collect the patient’s belongings from his room and help place them in his plastic bag or suitcase.

11.  Help patient unto a wheelchair, escort him to the hospital exit, if he is leaving by ambulance, and help him unto the litter.

12.  After the patient has left the area, strip the bed linens and decontaminate or carbolize the bed.

DISCHARGE AGAINST MEDICAL ADVICE.

Occasionally, the patient or his family may demand discharge against medical advice. If this occurs, notify the doctor immediately. If the doctor is not successful at convincing the patient to remain in the hospital, he will ask the patient to sign against medical advice (AMA) form or write an official letter requesting for a discharge against medical advice. This releases the hospital from legal responsibilities for any medical problems the patient may experience after discharge.

TRANSFER OF PATIENT.

Transfer occurs when a patient is moved from one unit or ward in a facility to a different unit or ward in the same facility or different facility.

There are two types of transfer of patients they are…

1.      Transfer in(trans-in): this is where a patient is moved from the unit or place of first admission to a new unit or ward in the same facility. This is done mostly for specialty care and for update treatment. For example, this could be done from a medical to surgical unit or ward. This is usually prearranged and informed of the incoming patient’s general condition.

      STEPS INVOLVED IN TRANSFER IN.

1.      Assemble necessary requirements example are oxygen cylinder, suction machine etc.

2.      Assemble documentation and investigation forms

3.      Set tray for checking vital signs

4.      Receive incoming patient, relatives and accompanying nurse warmly.

5.      Take over transfer notes and personal belongings from accompanying nurse.

6.      Confirm identity of patient with the accompanying nurse.

7.      Introduce yourself to the patient and relatives.

8.      Orient patient and relatives to the ward.

9.      Document time of arrival of patient and enter patient’s name into all necessary books.

TRANS OUT.

This is where the patient is moved from a unit or place of admission to a new area for update treatment. This will be done at the discretion of the medical team or patient’s own request. This could be a unit-to-unit basis or one hospital to another.

STEPS INVOLVED IN TRANS OUT.

1.      Explain the transfer to the patient and his family

2.      Make sure the doctor has written a transfer order in the patient’s folder

3.      Confirm with the receiving unit

4.      Assess the patient’s condition

5.      Arrange for an accompanying nurse.

6.      Arrange for an appropriate vehicle where applicable.

7.      Collect all necessary data

8.      Pack patient’s belongings

9.      Let patient pay bills where applicable

10.  Assist patient unto the stretcher, wheelchair etc.

11.  Handover patients notes and belongings to accompanying nurse.

12.  Enter patient’s name in appropriate book such as ward state.

ORIENTATION OF PATIENT.

1.      Establish rapport with patient

2.      Mention the name of the ward to the patient

3.      Introduce patient to the ward stuff around and other patients

4.      Show patient the nurse’s office

5.      Show patient his bed

6.      Show patient the bathroom and toilet

7.      Show patient kitchen and dry room

8.      Show patient his cupboard and bed side locker

9.      Inform patient of ward activities

10.  Inform the patient whom to contact for any information

11.  Encourage patient to ask questions and answer correctly and tactfully

12.  Thank patient and put him to bed.