ADMISSION & DISCHARGE

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This PPT describes about Admission & Discharge procedure which is coming under the Unit III of Nursing Foundation, B.Sc. Nursing I Year under INC Syllabus

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Unit III: ADMISSIONS/DISCHARGE/TRANSFER:

Unit III: ADMISSIONS/DISCHARGE/TRANSFER 1 Mrs. P. Vadivukkarasi Ramanadin, Professor, Dept. Of OBG (N), Shri Vinoba Bhave College of Nursing, Shri Vinoba Bhave Civil Hospital, Silvassa, DNH.

UNIT: III Hospital admission and discharge 4 HRS:

UNIT: III Hospital admission and discharge 4 HRS Admission to the hospital o Unit and its preparation admission bed o Admission procedure o Special considerations o Medico-legal issues o Roles and Responsibilities of the nurse Discharge from the hospital o Types: Planned discharge, LAMA and abscond, Referrals and transfers o Discharge Planning o Special considerations o Medico-legal issues o Roles and Responsibilities of the nurse o Care of the unit after discharge 2 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Definition of admission :

Definition of admission It is defined as allowing a patient or client to stay in the hospital for their wellbeing or to provide health care services by observation, investigation, treatment & care. Admission is the entry of a patient / client into a hospital / ward for diagnostic or therapeutic purpose 3 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

ADMISSION:

ADMISSION (ENTERING A HEALTH CARE AGENCY FOR NURSING CARE AND MEDICAL/SURGICAL TREATMENT) INVOLVES: A. AUTHORIZATION FROM A PHYSICIAN B. COLLECTION OF BILLING INFO FROM THE ADMITTING DEPARTMENT C. COMPLETION OF THE ADMISSION PROCESS BY NURSING D. DOCUMENTING PT’S MED HX & PHYSICAL EXAM E. INITIAL MED ORDERS FOR TREATMENT 4 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Purpose:

Purpose Receiving the client Provide comfort & safety Provide immediate, comprehensive & emergency care Advocacy the client to utilise the government facilities / scheme Help the client to adjust with hospital environment Collect the necessary information to aid for care Maintain therapeutic relationship 5 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Principles :

Principles New environment may produce fear & anxiety. So provide fearless environment , simplify the admission process Hospital admission may be an threads to personal identity, hence counsel them People have diversity of habits & behavior, so treat them equally Illness may result stress to the client so support the client & theirfamily 6 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

TYPES OF ADMISSION:

TYPES OF ADMISSION INPATIENT OUTPATIENT 7 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

INPATIENT STAY:

INPATIENT STAY LONGER THAN 24HRS PLANNED : NO IMMEDIATE THREAT PLANNED ELECTIVE SURGERY, TESTS PT IS PREPARED EMERGENCY : UNPLANNED STABILIZE IN EMERGENCY ROOM (CHEST PAIN, TRAUMA) DIRECT ADMISSION: UNPLANNED BYPASS EMERGENCY (VOMITING, DIARRHEA) 8 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

OUTPATIENT STAY:

OUTPATIENT STAY LESS THAN 24 HRS OBSERVATIONAL: HEAD INJURY PREMATURE LABOR UNSTABLE VITAL SIGNS FOLLW UP 9 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

OTHER TYPES :

OTHER TYPES EMERGENCY ROUTINE 10 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

RESPONSIBILITIES OF THE ADMITTING DEPARTMENT:

RESPONSIBILITIES OF THE ADMITTING DEPARTMENT GATHER INFO FOR BILLING INITIATE MEDICAL RECORD CONSENT FORMS ARE SIGNED, INITIAL ORDERS OBTAINED VERBAL REPORT GIVEN TO FLOOR RN PATIENT IS ESCORTED 11 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

NURSING RESPONSIBILITES:

NURSING RESPONSIBILITES PREPARE ROOM IDENTIFY SELF ORIENT PATIENT GATHER INFO 12 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

PREPARE ROOM:

PREPARE ROOM PROVIDE PERSONAL CARE ITEMS SUCTION OXYGEN IV POLE BED IN HIGH POSITION IF ARRIVING BY EMERGENCY BED IN LOW POSITION IF ARRIVING BY BLOOD LOSS FOLLOW THE ASEPTIC TECHNIQUE 13 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

IDENTIFY SELF:

IDENTIFY SELF MAKES PT FEEL SECURE MAKES PT FEEL WELCOME ALLEVIATES ANXIETY/FEAR 14 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

ORIENT PATIENT:

ORIENT PATIENT LOCATION OF NURSE’S STATION CLOTHES STORAGE CALL LIGHT BED CONTROLS LIGHT SWITCHES TELEPHONE POLICY TV CONTROLS MEALTIMES SAFETY MEASURES SUCH AS BEDRAILS VISITING HOURS WHAT TESTS ARE SCHEDULED DIET ROOM BOUNDARIES SCHEDULED SURGERY TIME TIMES FOR DR VISITS 15 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

GATHER INFORMATION:

GATHER INFORMATION THE NURSE WILL GATHER INFO ABOUT: MEDICAL ORDERS TX’S LABS TESTS DIET ACTIVITY PHYSICAL ASSESSMENT WITHIN 24HRS. 16 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

UNIT PREPARATION :

UNIT PREPARATION BED POSITION EQUIPMENTS & SUPPLY 17 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

VALUABLES:

VALUABLES WHEN DOCUMENTING VALUABLES, MAKE SURE TO USE WORDS LIKE: WHITE/YELLOW METAL NOT GOLD CLEAR STONE NOT DIAMONDS, RUBIES, ETC. HAVE A WITNESS HAVE NURSE & PT SIGN VALUABLES LIST DON’T FORGET DENTURES, GLASSES, ETC. WHEN TRANSFERRING PT, SIGN-OFF WITH NURSE KNOW YOUR FACILITY’S VALUABLES POLICY 18 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

PATIENT COMFORT:

PATIENT COMFORT PROVIDE PRIVACY. (SHUT DOOR & PULL CURTAIN.) ASSIST IF NEEDED TO REMOVE CLOTHING AND PUT GOWN ON. PROVIDE EXTRA BLANKETS IF REQUESTED. COLLECT INFO FOR DATABASE. PERFORM INITIAL ADMISSION ASSESSMENT IF APPROPRIATE. (SOME FACILITIES REQUIRE AN RN TO DO INITIAL ASSESSMENTS). OBTAIN PHYSICIAN ORDERS FOR TX’S, LABS, TESTS, MEDS, ACTIVITY, ETC. WITHIN 24HRS. 19 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

COMPONENTS OF A MEDICAL HISTORY:

COMPONENTS OF A MEDICAL HISTORY IDENTIFYING DATA CHIEF COMPLAINT PERSONAL HX PAST HEALTH HX HX OF PRESENT ILLNESS FAMILY HX REVIEW OF BODY SYSTEMS CONCLUSION 20 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

WHAT TO WATCH FOR IN NEWLY ADMITTED PATIENTS:

WHAT TO WATCH FOR IN NEWLY ADMITTED PATIENTS ANXIETY LONELINESS DECREASED PRIVACY LOSS OF IDENTITY 21 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

ANXIETY:

ANXIETY APPEARANCE Exhibits Separation Anxiety. Sad. Worried. Restless. Reduced Appetite. Insomnia. HOW TO HELP Acknowledge feelings. Provide explanations and instructions before performing procedures. Inquire about stress due to children/pets/spouse at home. Reassure. Separation Anxiety can cause the elderly to be confused and disoriented. 22 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Alleviating anxiety and fear:

Alleviating anxiety and fear Admission can cause anxiety and fear for many pts and their families Even a transfer from one room to another can cause anxiety because the individual will have to adjust to another environment Essential for health care provider to create a positive first impression Assistant can do much to alleviate fear by being courteous, supportive, and kind. 23 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Slide24:

Alleviating anxiety and fear Help patient become familiar with the unit Provide clear instructions on how to operate equipment Explain the type of routine to expect, such as times for meals Do not hurry or rush Allow the pt to ask questions and to express concerns If you do not know the answers to specific questions, refer to your immediate supervisor 24 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

LONELINESS:

LONELINESS Make frequent contact with your patient. Orient your client. Allow liberal visitation. 25 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

DECREASED PRIVACY:

DECREASED PRIVACY Pull curtain and close door. Knock. Identify room boundaries, esp. if sharing room. Be careful of exposing patient. Patient feels uncomfortable because of unkempt appearance, so announce visitors. 26 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

LOSS OF IDENTITY:

LOSS OF IDENTITY Call patient by name they prefer. Allow patient to wear own gown. Display pictures. Give them some choices. (bathing, eating, etc.) 27 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

ADMISSION FORMS:

ADMISSION FORMS Forms list the procedures that must be performed Will vary slightly from facility to facility Important for health care worker to become familiar with required information on the form Much of the information on the admission form is used as a basis for the nursing care plan Must be complete and accurate! It the pt is unable to answer the questions, a relative or the person responsible for the pt is usually able to provide the information 28 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

PROCEDURES PERFORMED UPON ADMISSION:

PROCEDURES PERFORMED UPON ADMISSION Vital signs Height and weight measurements Collection of a routine urine specimen Protect patient’s possessions Make a list of clothing, valuables, and personal items In a hospital a family member will frequently take clothing home Any personal items left in a room should be noted on a list, and the list should be signed by the pt and the assistant At the time of transfer or discharge, the list of items is checked to make sure all of the belongings are returned If the family member does not take items home, the items should be placed in a safe FOLLOW CORRECT TECHNIQUE WHILE PERFORMING THESE PROCEDURES!! 29 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

PROCEDURES PERFORMED UPON ADMISSION:

PROCEDURES PERFORMED UPON ADMISSION Orient patient to facility Provide instructions on how to operate the bed, call light, remote control for TV, etc. Explain visiting hours, location of lounges, smoking regulations, availability of services, times for meals, and other rules and regulations Many facilities have a pamphlet or paper listing this information, which is given to the patient and family members. FOLLOW CORRECT TECHNIQUE WHILE PERFORMING THESE PROCEDURES!! 30 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

TRANSFER:

TRANSFER DISCHARGING A PATIENT FROM ONE UNIT OR AGENCY AND ADMITTING THEM TO ANOTHER UNIT INFORMS PATIENT/FAMILY COMPLETE TRANSFER SUMMARY SPEAKS WITH NURSE ON TRANSFER UNIT TRANSPORTS PATIENT/BELONGINGS/SUPPLIES & CHART CHECKS ORDERS/MAKES NEW ADDRESSOGRAPH CARD W/NEW ROOM # 31 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

TRANSFERS:

TRANSFERS Done for a variety of reasons Change in the patient’s condition Per patient request Agency policy must be followed during any transfer Reason for transfer should be explained to patient and family by the appropriate personnel New room or unit must be ready to receive the patient All personal items must be moved with patient Organized and efficient transfer will help prevent fear and anxiety for the patient 32 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Discharge:

Discharge Terminating the hospital stay & sending the client to home is termed as discharge “Discharge of patient from the hospital means, reliving a person from hospital setting, who admitted as an inpatient in that hospital” 33 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Discharge preparation :

Discharge preparation Physical consideration Psycho – Cognitive consideration Family Consideration Ethical consideration Home care 34 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Types :

Types Planned Patient completes the initial, actual management in the hospital and now he or she need not to be under direct supervision of that hospital Cured & Discharge DOR (Discharge on Request) Transfer to other Hospital Relieved Death Other LAMA (Leave Against Medical Advice) Absconded 35 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

DISCHARGE PROCEDURE:

DISCHARGE PROCEDURE Doctor’s order/ written consent / Instruction & follow up description is usually required If an individual plans to leave a facility without permission, report this immediately to supervisor Facilities have special policies that must be followed when a patient leaves against medical advice (LAMA) When an order for discharge is received, assistant must check and pack the patient’s belongings Check the unit, including any drawers, closets, and storage areas carefully to find all items 36 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

DISCHARGE:

DISCHARGE Most agencies require a staff member to accompany the individual to the car If a patient is transferred by ambulance, the ambulance attendants will bring a stretcher to the room Most agencies have forms or checklists that are used during a discharge to ensure that all procedures have been followed. Client & Family members should clear about their treatment diet & follow up 37 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Slide38:

Assist the client to dress up, check & pack the belongings Collect discharge slip & discharge summary & give it to client Any of the hospital property given to client must be taken it back & send it to concern department for cleaning Confirm whether client cleared his dues Make sure that client is well groomed & assist him / her for that 38 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Slide39:

Other department collaborated with client treatment must be informed (eg. Dietary, pharmacy, physiotherapy etc.) Concern forms must be signed by the client Make sure all the forms are filled (I/O Chart, Medicine Chart, Vital signs etc.) 39 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

DISCHARGING:

DISCHARGING Return to the unit, strip the bed, remove any equipment and follow agency policy for cleaning the room Record all required information on the patient’s chart 40 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

STEPS OF PLANNED DISCHARGE:

STEPS OF PLANNED DISCHARGE Written order by doctor Discharge card Informing other departments Check payment of the bills Hospital glossaries taken back Returning of the personal belongings Arrangement for transport Documentation. 41 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

NURSES RESPONSIBILITY FOR DISCHARGING A PATIENT:

NURSES RESPONSIBILITY FOR DISCHARGING A PATIENT GATHER BELONGINGS/CHECK INVENTORY ARRANGE TRANSPORTATION INFORM PT OF CHECKOUT TIME TO AVOID BEING BILLED FOR AN EXTRA DAY ESCORT UNTIL PT SAFELY INSIDE VEHICLE WRITE DISCHARGE SUMMARY TERMINAL CLEANING. BED STRIPPED AND DISINFECTANT USED. BEDSIDE CABINET RESTOCKED/CLEANED. 42 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

ACRONYM OF DISCHARGE:

ACRONYM OF DISCHARGE METHOD M=MEDICATION E=ENVIRONMENT T=TREATEMENT H=HEALTH TEACHING O=OUT PATIENT REFFERAL D=DIET 43 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Medico – legal cases :

Medico – legal cases It can be defined as a case of injury or ailment, etc., in which investigations by the law-enforcing agencies are essential to fix the responsibility regarding the causation of the said injury or ailment. In simple language it is a medical case with legal implications for the attending doctor where the attending doctor, after eliciting history and examining the patient, thinks that some investigation by law enforcement agencies is essential . Or a legal case requiring medical expertise when brought by the police for examination. 44 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Cases that are to be treated as medico-legal :

Cases that are to be treated as medico-legal The following cases should be considered as medico-legal and as such the medical officer is "duty-bound" to intimate to the police regarding such cases: 1. All cases of injuries and burns -the circumstances of which suggest commission of an offence by somebody. (irrespective of suspicion of foul play) 2. All vehicular, factory or other unnatural accident cases specially when there is a likelihood of patient's death or grievous hurt. 3. Cases of suspected or evident sexual assault. 4. Cases of suspected or evident criminal abortion. 5. Cases of unconsciousness where its cause is not natural or not clear. 6. All cases of suspected or evident poisoning or intoxication. 7. Cases referred from court or otherwise for age estimation. 8. Cases brought dead with improper history creating suspicion of an offence. 9. Cases of suspected self-infliction of injuries or attempted suicide. 10. Any other case not falling under the above categories but has legal implications. 45 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Medico –legal issues :

Medico –legal issues A medicolegal case should be registered as soon as a doctor suspects foul play and the same is applicable on later stage of admission or even if it is brought after several days of the incident. Issuance of the discharge certificate is the mandatory duty of the treating doctor; failure to do so renders the doctor liable for "negligence" and "deficiency of service 46 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Slide47:

If non identified at the initial time MLC but later on after admission of the patient the case required to be converted as MLC and the police was informed. This duty should also be extended in cases of discharged patient.  The nearest police station must be informed at the earliest whenever there is an admission, death or discharge of a medicolegal case and a medicolegal register should be maintained with necessary entries of patient details.  While discharging or referring the patient, care should be taken to see that he receives the Discharge Card/Referral Letter, complete with the summary of admission, the treatment given in the hospital and the instructions to the patient to be followed after discharge. 47 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Slide48:

If the patient is not serious and can take care of himself, he may be discharged on his own request; after taking in writing from him that he has been explained the possible outcome of such a discharge and that he is going on his own against medical advice. Police have to be informed before the said patient leaves the hospital. Sometimes the patient, registered as a medico–legal case, may abscond from the hospital. The police should be informed immediately, the moment such an instance comes to the notice of the doctor/ hospital staff. 48 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Precautions to be taken :

Precautions to be taken a. Consent b. Confidentiality c. Collection and preservation of samples 49 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

RECEIVING A MLC :

RECEIVING A MLC A doctor can receive a medico-legal case in any of the four situations:– 1. A case is brought by the police for examination and reporting, or order of the court for medical examination 2. The person in question was already attended to by a doctor and a medico-legal case was registered in the previous hospital, and the person is now referred for expert management/ advice. 3. When patient himself expressing his intention to register a case against the alleged accused. 4. After eliciting history and examining the patient, the attending doctor feels that some investigation by law enforcement agencies is essential to establish and fix responsibility for the case in accordance with the law of the land. In the last situation it is the attending doctor has to utilize his medical knowledge and judgment to decide whether the case should be treated as MLC or not, specially when the history is not completely revealed, either by the patient or his relatives/ friends, due to some motive. 50 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

PROCEDURE OF REGISTERING A MLC :

PROCEDURE OF REGISTERING A MLC The responsibility to label any case as an MLC rests solely with the attending medical practitioner. In the casualty, while attending to an emergency, the doctor should understand that his first priority is to save the life of the patient. He should do everything possible to resuscitate the patient and ensure that he is out of danger. All legal formalities to be suspended till the patient is resuscitated. This has been clearly ordered by the Hon’ble Supreme Court of India 51 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

REGISTRATION AND REPORTING :

REGISTRATION AND REPORTING The attending doctor is duty bound to inform the police about the Case Provides for prosecution of the doctor for the failure to inform, informed again when patient dies or is discharged from hospital Reports must be prepared in duplicate on proper pro-forma giving all necessary details Avoid abbreviations, over writings. Correction if any, should be initialed with date and time. Reports must be submitted to the authorities promptly. Medico-legal documents should be stored under safe custody for 10 years Age, sex, father’s name, complete address, date and time of reporting, time of incident, brought by whom. Identification marks and finger impressions All MLC to be informed to the police for taking legal evidence If the patient is dying, inform the magistrate to record ‘dying declaration’. 52 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

ADMISSION AND DISCHARGE :

ADMISSION AND DISCHARGE Whenever a medico-legal case is admitted or discharged, the same should be intimated to the nearest police station at the earliest. It is always better to inform the police through the casualty of the hospital where the medico-legal register is usually maintained and necessary entries can be made in it. While discharging or referring the patient, care should be taken to see that he receives the Discharge Card/Referral Letter, complete with the summary of admission, the treatment given in the hospital and the instructions to the patient to be followed after discharge. Failure to do so renders the doctor liable for “negligence” and “deficiency of service”. 53 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

EXAMINATION OF MLC PATIENT :

EXAMINATION OF MLC PATIENT Consent: Under medical ethics all cases should be examined after obtaining a consent. Consent to be taken for a particular purpose or procedure in writing. Consent to be taken before starting the procedure and after clearly explaining the patient/ relative what exactly to be done. If the patient is a minor or less than 18 yrs of age consent of the guardian be obtained for private part examination. Consent of relative required for unconscious patient requiring surgery If an unconscious patient brought by police from road and operation essential to save life 2 or 3 doctors to give consent by signing on consent form. A conscious adult has the right to refuse 54 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Examination of MLC cases: :

Examination of MLC cases: It is preferable that a lady doctor should examine a lady, or, wherever this is not possible, a female attendant (nurse, etc) should be present during the examination.  If a case is referred from other hospital where medico legal case sheet has been prepared, the findings be attached to the same without making fresh MLC If the date of incidence is delayed and patient brought late, the present findings are to be entered in MLC 55 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

TREATMENT OF MEDICO-LEGAL CASES :

TREATMENT OF MEDICO-LEGAL CASES The patient should immediately be given treatment without waiting for the medico legal formalities of reporting. Treatment to be started after examination and recording findings. First Aid to be given immediately without waiting for completion of MLC sheet If specialist consultation is required, patient to be referred to concern specialist for further treatment All cases requiring constant observation and treatment to be admitted into the hospital 56 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

TRANSFER OF MLC s :

TRANSFER OF MLC s The transferring hospital provides medical treatment within its capacity that minimizes the risks to the patient The receiving hospital (a) has available space and qualified personnel for the treatment; and (b) has agreed to accept transfer and to provide appropriate treatment The transferring hospital sends all medical records (history, examination findings, results of diagnostic tests, provisional diagnosis, and treatment provided ) that are available at that time. The informed written consent or certification as required by EMTALA. The transfer is effected through qualified personnel and transportation equipment to provide life support measures during the transfer. The Emergency Medical Treatment and Active Labor Act 1986 (EMTALA) 57 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

ABSCOND/DEATH OF MEDICO-LEGAL CASE :

ABSCOND/DEATH OF MEDICO-LEGAL CASE In case a person admitted as a medico-legal case expires or absconds. Inform the police immediately Send the body to the hospital mortuary for preservation, till the legal formalities are completed and the police releases the body to the lawful heirs. Request a medico-legal postmortem examination, providing a copy of death summary. Do not issue a death certificate before postmortem even if the patient was admitted. The dead body should never be released to the relatives; it should only be handed over to the police 58 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

PROCEDURE OF DYING DECLARATION :

PROCEDURE OF DYING DECLARATION In a critically ill medico legal case that is not expected to survive, medical officer treating the case should inform the police to arrange for recording evidence so that the magistrate should come and record the dying declaration. Provided it has been made by the deceased while in a fit mental condition as certified by the attending doctor. In all the cases where there is immediate likelihood of death and it is not possible to contact a magistrate, the dying declaration must be recorded by the doctor of the unit concerned in the presence of another gazetted officer or two responsible persons, either two fellow doctors or two persons from qualified nursing staff . Statement of the witness shall be recorded, preferably in the vernacular of the patient in which he/ she speaks. In all such cases medical officer should obtain either signatures or thumb impression of the patient. The original dying declaration shall be sent to the SDM concerned in a sealed cover through the Medical Record Department. Doctor should not attest the dying declaration or act as a witness in case when police or magistrate records the dying declaration. 59 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Medico-legal Reports :

Medico-legal Reports a) Pre-amble-includes the date, time and place of examination, name of the patient, his residential address, occupation; name of the person(s)/police official accompanying, DDR/FIR No., informed consent of the person being examined, two marks of identification, etc, wherever applicable. b) Body (Findings/Observations)-includes a complete description of the injuries/any other findings present; any investigations/referrals, etc, asked for. c) Post-amble (Opinion)-includes the Nature of the injury-whether simple or grievous. Weapon/Force used-whether blunt or sharp or fire-arms or burns, etc. Duration of the injuries-based on the characteristics of the external injuries. 60 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

NURSE’S RESPONSIBILITY IN MEDICO-LEGAL DISCHARGE PROCEDURE:

NURSE’S RESPONSIBILITY IN MEDICO-LEGAL DISCHARGE PROCEDURE CHECK FOR MEDICO LEGAL HISTORY NOTIFY MEDICAL OFFICER INCHARGE ABSCOND CASES IMMEDIATELY CONTACT MEDICAL OFFICER INCHARGE MAINTAIN ALL DOCUMENTS IN A PROPER MANNER TAKE IN WRITTEN HANDING OVER ANDTAKING OF ARTICLES NEVER DISCHRGE PATIENT WITHOUT WRITTEN ORER BY PHYSICIAN 61 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Care of unit after discharge:

Care of unit after discharge The room must be cleaned Ensure the good ventilation in the room Change all the bed linen & send the soiled one to the linen department The doors, windows & furniture's are washed & cleaned All articles used by the client should be taken to utility room, washed, cleaned, sterilized if necessary or disinfected by chemicals 62 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Slide63:

Used tubings, cotton balls & gauze pieces must be discarded Rearrange the rooms for receiving the next client Mattress, pillows, blankets etc should be dusted & exposed to the sunlight Bed should be covered with new linen If the client had communicable disease the room must be fumigated 63 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

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