Admission and discharge procedures

Admission Procedures

The admission process is the first step in establishing a trusting relationship between the nurse, the child, and the family. The nurse should perform the following tasks during admission:

• Verify the child’s identity and assess his or her clinical status.
• Make the child as comfortable as possible and provide appropriate pain relief if needed.
• Introduce the child and family to the staff, roommates, and environment.
• Orient the child and family to the unit policies, routines, facilities, and resources.
• Provide supplies and special equipment needed for daily care, such as diapers, toys, books, games, etc.
• Review the child’s medical history, medication list, allergies, immunizations, growth charts, developmental milestones, etc.
• Obtain baseline vital signs, height, weight, head circumference (for infants), pain score, etc. Normal ranges for vital signs vary by age group. Table 1 shows some examples of normal ranges for different age groups1.

• Perform a comprehensive physical assessment using a systematic approach. Use developmentally appropriate techniques to elicit cooperation from the child. For example, use distraction, play, or storytelling to reduce anxiety or fear; allow the child to touch or examine equipment before use; explain procedures in simple terms; praise the child for cooperation; etc.
• Collect specimens for laboratory tests as ordered by the physician. Follow standard precautions and infection control measures when handling specimens. Label specimens correctly and transport them to the laboratory promptly.
• Administer medications as ordered by the physician. Follow the six rights of medication administration: right patient, right drug, right dose, right route, right time, right documentation. Use pediatric-specific dosing formulas or charts to calculate drug doses based on the child’s weight or body surface area. Use appropriate devices or techniques to administer medications to children. For example, use oral syringes or droppers for liquid medications; crush tablets or open capsules and mix with food or liquid if allowed; apply topical medications with gloves or cotton swabs; etc.
• Initiate intravenous (IV) therapy as ordered by the physician. Select an appropriate IV site based on the child’s age, condition, and type of infusion. Use an aseptic technique to insert an IV catheter and secure it with tape or dressing. Monitor the IV site for signs of infiltration, phlebitis, infection, or extravasation. Adjust the IV flow rate according to the physician’s order or protocol. Use an infusion pump or controller to deliver accurate and safe IV fluids or medications.
• Implement other interventions as ordered by the physician or indicated by the child’s condition. For example,
  • Apply oxygen therapy if the child has hypoxia or respiratory distress. Use an appropriate device to deliver oxygen at the prescribed concentration. Monitor the child’s oxygen saturation level using a pulse oximeter. Assess the child’s respiratory rate, depth, rhythm, effort, breath sounds, etc.
  • Insert a nasogastric (NG) tube if the child has vomiting, gastric decompression, feeding intolerance, malnutrition, etc. Use a measuring tape to determine the correct length of insertion based on the child’s nose-to-ear-to-xiphoid process distance. Use a syringe to aspirate gastric contents and check pH level to confirm proper placement. Secure the NG tube with tape or dressing. Monitor the NG tube function, output, patency, etc.
  • Insert a urinary catheter if the child has urinary retention, obstruction, infection, incontinence, etc. Use an appropriate size and type of catheter based on the child’s age, gender, and condition. Use an aseptic technique to insert the catheter and collect urine. Secure the catheter with tape or dressing. Monitor the catheter function, output, patency, etc.
• Document all admission data and interventions in the child’s medical record. Use clear, concise, accurate, and timely language. Follow the SOAP format: subjective data (what the child or family says), objective data (what the nurse observes or measures), assessment (what the nurse concludes or diagnoses), and plan (what the nurse plans to do or has done).

Discharge Procedures

The discharge process is the final step in ensuring a smooth transition from hospital to home for the child and family. The nurse should perform the following tasks during discharge:

• Review the child’s progress and readiness for discharge with the healthcare team. Ensure that the child has met the discharge criteria, such as stable vital signs, adequate pain control, improved symptoms, normal laboratory values, etc.
• Obtain a discharge order from the physician. The order should include the date and time of discharge, the mode of transportation, the destination, and any follow-up instructions or referrals.
• Educate the child and family about the discharge plan and home care. Use developmentally appropriate methods to teach the child and family about the diagnosis, treatment, medications, diet, activity, wound care, infection prevention, signs of complications, when to seek medical attention, etc. Use teach-back or return-demonstration techniques to evaluate the child and family’s understanding and ability to perform home care. Provide written instructions and contact information for questions or concerns.
• Arrange for any necessary equipment, supplies, or services for home care. For example,
  • Order a home health nurse or therapist if the child needs skilled care at home.
  • Order a durable medical equipment (DME) company to deliver oxygen tanks, infusion pumps, feeding tubes, etc.
  • Order a pharmacy to deliver medications or supplies for home use.
  • Coordinate with social workers or case managers to arrange for financial assistance, transportation, respite care, etc.
• Reconcile the child’s medications before discharge. Compare the medications that the child was taking before admission with those that he or she will be taking after discharge. Identify any discrepancies or changes and communicate them to the child and family. Provide a complete and accurate list of medications that the child will be taking at home, including names, doses, routes, frequencies, indications, side effects, interactions, etc.
• Perform a final physical assessment and vital signs check on the child. Ensure that the child is stable, comfortable, and ready for discharge. Remove any IV lines, catheters, dressings, etc . that are no longer needed. Apply bandages or ointments as needed. Assist the child with dressing and personal hygiene.
• Collect any valuables or belongings that were stored in the hospital. Return them to the child and family. Check that nothing is left behind in the room.
• Escort the child and family to the exit. Help them with loading their belongings into their vehicle or arranging for transportation. Thank them for choosing your hospital and wish them well.
• Document all discharge data and interventions in the child’s medical record. Use clear, concise, accurate, and timely language. Follow the SOAP format: subjective data (what the child or family says), objective data (what the nurse observes or measures), assessment (what the nurse concludes or diagnoses), and plan (what the nurse plans to do or has done).