University of the East RAMON MAGSAYSAY MEMORIAL MEDICAL CENTER, INC. #64 Aurora Boulevard, Brgy.

Doa Imelda, Quezon City

COLLEGE OF NURSING

The Level of Adherence of Registered Nurses to Admission Protocol in UERM Hospital

SUBMITTED BY: 4 South ALVAREZ, Henderson R. BATLE, Angelo Adrian S. BAUTISTA, Mary Angeline CARUBIO, Ruther Paolo R. CASCO, Gerald S. DELA CRUZ, Jhanalyn H. ESCAREZ, Zarah Jane F. FALCULAN, Joanne Mariz D. GIRAY, Ivy E. GREGORIO, John Paul V. LAPUZ, Karen Aida M. LEONZON, Nathaniel A. MARCOS, Alyssa Marie V. MARQUEZ, Arianne T. OCAMPO, Dane Carlyn S. SALES, Althea Raphaelle S.

SUBMITTED TO: Ma. Luisa T. Uayan, DHSc, MSN, RN

TABLE OF CONTENTS

CHAPTER 1 Introduction 3 A. Statement of the Problem 3 B. Significance of the Study 4 C. Scope and Limitation of the Study 4 D. Hypothesis 5 E. Conceptual Framework 5

CHAPTER 2 Review of Related Literature 6

CHAPTER 3 Methodology 18 A. Method of Research . 18 B. Population 18 C. Sampling Technique 18

D. Data gathering Instrument 18

E. Data gathering Procedure 19 F. Statistical Treatment of Data 19

BIBLIOGRAPHY . 20

APPENDICES 27 Appendix A: Admission Protocol Checklist 27

CHAPTER 1 INTRODUCTION

The UERM Memorial Hospital is a health facility which opened in 1957, located at #64 Aurora Boulevard, Barangay Dona Imelda, Quezon City. It is comprised of a pay and charity wards; it has a 500 bed capacity. It is a teaching hospital wherein students from the UERM Colleges of Medicine, Nursing, and Allied Rehabilitation Sciences have their clinical experience.

The UERM Hospital The institute has an average of 5,426 admissions in the private wards and 4, 104 admissions in the charity wards annually. The average occupancy rate of the hospital is 90%.

In this study, the investigators would like to evaluate the adherence of registered nurses to the admission protocol of UERM Memorial Hospital and the amount of time spent in each action. With that, the investigators can help determine the effectiveness of the existing admission protocol and determine whether nurses are able to follow the protocol effectively and efficiently. Furthermore, the investigators can now give insight on how to follow the protocol more effectively and efficiently.

A. STATEMENT OF THE PROBLEM This research study seeks to answer the following questions: 1. What is the admission practice of registered nurses at UERM hospital? 2. What is the amount of time spent in admitting a client at UERM hospital?

3. How does the registered nurse follow the system to effectively and efficiently admit a patient? 4. How effective and efficient is the admission protocol in the institution?

B. SIGNIFICANCE OF THE STUDY Nursing Education. The study will help the Department of Nursing Service in identifying issues that can be addressed through the in-service training of personnel.

Nursing Practice. The study will help the registered nurses assess if they are able to follow the admission protocol. Also, it will help the institution to evaluate the effectiveness and efficiency of the admission protocol and enable them to make necessary actions.

Nursing Research. The study may serve as a reference for related or further study in the effectiveness of admission protocols.

C. SCOPE AND LIMITATION OF THE STUDY This study will be conducted at the UERM Hospital from February to March 2013. The investigators will observe the admission practice of registered nurses/ personnel from the moment patients enter the Emergency Room, Out-Patient Department, and Admission Area up to the transfer to their designated rooms. They will oversee if the admission protocol of the institution is being followed.

The investigators will not be able to ask the views and opinions of the registered nurses.

D. HYPOTHESIS 1) The registered nurses are able to adhere to the admission protocol. 2) The registered nurses are not able to adhere to the admission protocol.

E. CONCEPTUAL FRAMEWORK
Patient consults at the Emergency Room, Out-Patient Department, and Admission Area

Giving of admission slip with diagnosis to patient

Admitting Area then: 1. 2. 3. 4. Explains policy to patient Completes Patients Information Ensures consent Have clients sign: a. Memorandum of Undertaking (Pay Patients) b. Checklist (Hospital Policy) (Charity Patients)

Admitting Area encodes data

Admission Area selects room according to clients preference

Patient goes to the cashier and pays initial fees

Patient goes back to the Admission Area and presents OR number

Patient is accompanied by appropriate personnel to his/her room

ER personnel (From Emergency room)

Clinical clerk (From direct admission to Charity ward)

Admitting Information Section personnel (From direct admission to Pay ward) 5

CHAPTER 2 REVIEW OF RELATED LITERATURE

The admission process is typically the initial point of contact a patient has with the hospital. Key patient information is collected during admission and used for identification, billing, and care planning purposes. In addition, patients receive a significant amount of information from the hospital, including patient rights documents and relevant hospital policies. As patients and their families interact with staff at the registration desk and complete admission forms and paperwork, the admission phase of the care continuum provides hospitals with the first opportunity to identify and address the unique needs of their patients (Bau et.,al 2010) .Admission to the hospital can happen in various ways. Your family member may be treated in the Emergency Room (ER) and need additional treatment requiring a hospital stay. Other times you may know that your family member will be staying in the hospital for at least one night. This planned admission could be for elective (non-emergency) surgery, tests, or special procedures. Whether it starts as an emergency or as a planned admission, a hospital stay is often the first stage in a series of transitions, or moves to different health care settings. You and your family member will feel more prepared and perhaps less anxious when you know. (United Hospital Fund, 2008). There are several different types of hospital admissions, depending on the nature of tests or treatment required. These are: 1. Outpatient- If a patient is referred to see a hospital consultant for their specialist opinion, they will receive an outpatient appointment. The patient will not need to stay in hospital. People usually get referred to Outpatients by Casualty, their GP or they get referred from Aberdeen Hospitals. 2. Day patient- A patient may need a hospital bed for tests or surgery, but do not need to stay overnight, in this case they will have a day patient

appointment. This is also known as a day case.3. Inpatient- Should a patient need a hospital bed because they have to stay in hospital for tests or in-patient treatment or surgery, they will have an inpatient appointment. An admitted patient is defined as a patient whose entire care is not provided within a designated emergency department or urgent care centre and who meets at least one of the Criteria for Admission. Admission can occur in a traditional hospital setting, or in other settings under specified programs such as Hospital In The Home. Non-admitted

(emergency or outpatient) services provided to a patient who is subsequently classified as an admitted patient shall be regarded as part of the admitted episode. (Laurenson, 2010) When a patient is transferred from the Emergency Department to a ward (including short stay units), the Admission Time is the time treatment was started in the Emergency Department rather than the time it was decided to transfer the patient. Any intervention provided after treatment commences should be recorded and identified as part of the admitted patients episode of care (Victorian Hospital Policy, 2012) . The aim of this guidance document is to support hospitals, Primary Care Trusts (PCTs), local authorities and the voluntary sector, working in partnership, to develop an effective admission and discharge protocol for people who are homeless or living in temporary or insecure accommodation. Due to the complex needs of some homeless people, a hospital admission and discharge protocol will be most effective when it is developed in partnership by the hospital, local PCTs and primary care providers, the voluntary sector and the local authority. Steps to consider in developing a protocol: 1.Step one Identify relevant organisations 2. Step two Set up a steering group 3. Step three Review existing systems 4. Step four Identify training and resource requirements 5. Step five Develop a protocol building on existing systems 6. Step six Ensure protocol is fit for purpose 7. Step seven Test and monitor protocol 8. Step eight Set up audit arrangements 9. Step nine Review and refine

protocol 10. Ensuring the protocol remains up to date. (London Network for nurses and midwifes, December 2006) The Criteria for Admission reflect the intended level of treatment that the patient is to receive. The criterion under which each patient is admitted does not have an impact on casemix funding. (Victorian Hospital Admission Policy, 2012) Checklist to Improve Effective Communication, Cultural Competence, and Patient- and Family-Centered Care During Admission: Inform patients of their rights., Identify the patients preferred language for

discussing health care., Identify whether the patient has a sensory or communication need.,Determine whether the patient needs assistance completing admission forms, Collect patient race and ethnicity data in the medical record, Identify if the patient uses any assistive devices, Ask the patient if there are any additional needs that may affect his or her care, Communicate information about unique patient needs to the care team.

Hospitals are responsible for ensuring that appropriate procedures and records are maintained to facilitate accurate reporting, and to justify the admission. The list of criteria for admission in the definition is complete there are no other criteria for admission. Under these criteria, the fact that a procedure is undertaken in a procedure room does not, in itself, justify admission. The Criterion for Admission is determined at the point of admission and does not change even if the patients circumstances change.(Bau et., al, 2010) Improving Hospital Admission and Discharge for People who are Homeless (March 2012) is a joint report from Homeless Link and St Mungos. Commissioned by the Department of Health, the report was produced to inform the National Inclusion Health Board to identify what more must be done to prevent people at risk of rough sleeping being discharged from hospital without accommodation. It draws on the direct experiences of staff and clients and presents recommendations for improving practice. Homeless Link has also produced From Hospital to Home - steps for
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hospital staff, a quick guide outlining key tips for admitting and discharging homeless people. The report indicates that more than 70% of homeless people are being discharged from hospital back onto the streets, damaging their health. But it also cites examples of best practice. It found that NHS staff can improve health outcomes for homeless people and save the NHS money by ensuring all patients have somewhere appropriate to stay when they are discharged from hospital. In 2006 Homeless Link, along with the London Network for Nurses and Midwives, and in partnership with the Department of Health and the Department for Communities and Local Government developed theHospital Admission and Discharge Protocol Guidelines. (Homeless Link and St. Mungos, 2012).The study assessed the appropriateness of admission in the paediatrics departments in the 3 study hospitals did not exceed 2% using the PAEP auditing tool the AEP rates the appropriateness of hospital admission using 17 criteria for the clinical stability of the patient, necessity of medical interventions and planned surgical procedures within 24 hours. An admission is considered appropriate if 1 or more of these criteria are satisfied. The PAEP is a modification of the AEP to be applied in paediatric settings, compared with an average 11%25% in most countries. Formby et al. evaluated the medical records of paediatric patients in Australia and found 24% of admissions were in appropriate. In Canada, Smith et al. examined admissions to acute wards in a tertiary care paediatric facility and found 29% of the admissions unnecessary. This suggests either that there is a lack of standardized case management, with a tendency towards intensive treatments requiring admission even though patients may not be in need of such treatments (e.g. using intravenous rehydration therapy to manage mild/moderate dehydration) or else that the tool itself needs to be modified for Egyptian clinical practice. That Reasons for inappropriate admissions as a proportion of inappropriate admissions by study hospital and department This was considered the most important limitation

in this study. Unless hospitals use standardized case management for the common diseases in paediatrics, application of the PAEP for admissions review will be limited. The 3 study hospitals were general hospitals with similar bed capacities, representing the main hospital provision in Egypt. The highest rate for inappropriate admissions was found in the departments of surgery followed by the department of obstetrics/gynaecology, ranging from 20.7% to 78.8% in hospitals A and B. The main reason for inappropriate admissions to these hospitals was undergoing the necessary diagnostic or preoperative investigations in an inpatient rather than an outpatient setting. This implies that system factors within the hospital are the main contributor to

inappropriate admissions and that patient-related factors such as age or sex were not associated with inappropriate hospitalization. Accordingly, efforts to review and improve the system of admission, possibly through review and related policies, will greatly affect the utilization of hospital bed capacity. The route of admission, whether through the emergency room or outpatient clinic, plays a main contributing factor in the analysis of inappropriate admissions. Navarro et al. mentioned that scheduled admission had an odds ratio of inappropriateness 15 times that of unscheduled admission. A similar result was noted by Angelillo et al., where planned admission was a significant predictor of inappropriate admission Along with confirmed improvement in usage of hospital beds in these studies, the current study showed that the percentage of appropriate admissions in the Alexandria hospital was high as it applied a protocol that specified doing necessary investigations in the surgery and obstetrics departments before the admission in an outpatient setting. With the rapid evolution of third-party payers in most countries, including developing countries, it seems imperative to focus on research that supports decisions and proper interventions for better hospital utilization. (Shehad et. Al, 2009) Nurse educators are increasingly sensitive to the differences in learning needs of adult students in

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comparison to the traditional generic student and to the demand for advanced practice nurses. For these reasons, the number and type of accelerated programs has increased. There is very little in the literature related to RN-MSN programs. To determine the state of RN-MSN education, a descriptive exploratory study was conducted to examine admission and curricular requirements for RN-MSN nursing programs in the mid-Atlantic region. The findings reveal a wide variety of educational practices. Over 74 percent of responding programs indicated that challenge exams are used to accelerate students' progress; 59 percent reported participating in statewide articulation agreements. Credit requirements for core and major courses were found to vary dramatically, as do credits required to earn the BSN-MSN credential; the average number of credits for program completion was 127. GPA requirements for admission ranged from 2.5 to 3.5. Findings from this study can assist existing programs to assess their comparability and help developing programs understand emerging patterns in RN-MSN education. (Streubert, 2002)

The nursing admission process is completed within twenty-four hours of admission or before discharge of the patient if hospitalization is less than 24 hours. An electronic patient care documentation system, provides the admission database for the patient and it consists of an admission history and a past medical-surgical history. The past medical and surgical history will be prepopulated from the previous admission, if available. The nurse is responsible for

reviewing and verifying the accuracy of the prepopulated information. (John Dempsey Hospital, 2000) The Registered Nurse must initiate an individualized plan of care for every patient within 24 hours of admission. The plan will address nursing problems identified and include desired patient outcomes. While a Licensed Practitioner Nurse or LPN may contribute to the plan of care, subject to RN review. On admission, the database should be completed to the best of the admitting nurses ability given the ability of the patient communicate and the availability of the
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family. (University of Connecticut Health Center, 2003) Admissions and transfers should be managed actively to ensure that all in patients receive the optimal care in relation to assessed need and that capacity is maintained to support the whole system. A full assessment of need prior to admission must be collaborated & carefully carried out to ensure that patients can be safely and appropriately managed by the service and provided with appropriate treatment programmes. All patients will have specific, measurable, achievable, realistic and timely (SMART) rehabilitation goals that would have been communicated. In order to enhance patient hospital admission process being implemented each hospital will need to have a named Shift Coordinator who will take responsibility for decisions regarding admission of patients to the hospital. The Shift Coordinator will be aware of each wards capacity for accepting admissions/transfers, and it is his or her responsibility to collect checklist information prior to admission of the patients. (Davis, 2013) With admission the nurse will: Provide the patient and family an orientation to the unit and room environment. Review hospital policies that govern visiting hours, prohibition of smoking, disposition of personal medications and patient valuables. Instruct the patient in the use of the unit call bell, hospital phone system, meal schedules and menu selection, and utilization of the hospital safe for valuables. Educate the patient regarding the hospitals practice of universal precautions and proper disposal of wastes. And lastly, address any specific questions/concerns on the part of the patient. (Shiela, 2012) Gatbonton, (2012) explains that once the patients or patients family agrees to admission, a relative will bring a slip with the patients name, age, sex, physician and working diagnosis to the admitting section. Although most patients are free to select their own rooms, under some special circumstances, assignments will correspond to the level of care the patient requires. If you refuse admission, you will most likely be asked to sign out against medical advice (AMA).
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A number of principles should underpin the development of an effective emergency and elective admissions and discharge planning function. These include: 1. 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. 2. Patients should be consulted and included in all decisions about their care. 3. Clinical practice and care should be based on the most up to date evidence. 4. Co-cooperation and clinical networking between hospitals and between care groups are essential to optimize outcomes, particularly where complex care issues are involved. 5. A service based on good clinical governance (i.e. founded on continuous quality improvement, staff development, risk management and audit). 6. 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. 7. The pivotal role of the Primary Care teams should be emphasized. 8. Early induction training of healthcare professionals in the relation to the principles set out above. (HSIP, 2003) A range of service processes have been identified as effective in managing the flow of patients through acute hospital services which will be outline later. In addition, regular communication, good relations and ad hoc liaison, between all those involve are essential to effective bed management. Opportunities to provide an integrated service delivery system arise at two important service points, before hospital admission and after hospital admission. Before the patient is admitted to hospital: 1. There should be a clearly defined preadmission process, which applies to both emergency and elective admissions. 2. The decision to access a hospital service should be shared between the patient and a member of the primary care team (PCT) where possible. 3. Pre-admission services are integrated into secondary care service
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delivery. 4. Pre-admission assessment is conducted on an outpatient basis wherever possible; some aspects of pre-admission assessment may be undertaken by the Primary Care Team if appropriate. 5. Pre-admission assessment aims to optimize a patients health status before planned admission to hospital. 6. At the pre-admission visit, the patient and his/her careers are properly informed about their medical condition, proposed treatment and likely hospital procedures. 7. The patients General Practitioner and/or the Primary Care Team with which the patient is enrolled should be involved in the pre-admission process, as appropriate. 8. The planning for the patients discharge from hospital should begin at the preadmission visit and co ordination of the patients care for both admission and discharge is commenced at the preadmission visit. 9. Patient information is coordinated and made available to all relevant providers in an efficient and timely manner. 10. Pre-admission planning to facilitate day of surgery admission where appropriate. 11. Pre-admission services may require a dedicated individual e.g. Admissions Manager. (DOHC, 2011) Hospitals, local authority housing teams and voluntary sector organisations should work together to agree a clear process from admission through to discharge to ensure patients are being admitted efficiently as soon as possible and are discharged with somewhere to go and with support in place for their on-going care. This process should start on admission to hospital. (Homeless UK, 2011) In St. Lukes Hospital, Quezon City they have an Admission Department assigned and it serves as the patient's first stop when they enter the medical center. The protocol that they follow is that first, their patients will be requested to present their doctor's admission order sheet. But, in the absence of the doctor's admission order sheet or a doctor known to them, a walk-in patient may be admitted through the Emergency Room. A Patient Information Sheet will be filled out by the patient or either the relative wherein the information being requested will
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be needed by the attending physician and the medical center. Patients might be admitted to their room of choice either: suite, private room, semi-private - 2 patients per room, or ward - 4 to 6 patients per room). Sign consent forms are needed to be signed for hospital care, exclusive supply of medicines, limitation on outside diagnostic reports, release of information to insurance companies and/or patient's employer, and waiver of responsibility on loss of valuables. While admission is being processed and the room is being prepared, the patient & relative will be asked to wait in the Admission Waiting Lounge and as soon as the room is ready, patients will be escorted to the Nursing Unit by the admission aide. All patients are given an ID band to be worn around the wrist for the duration of their stay at the medical center. (St. Lukes Medical Center Quezon City, 2012) In an admission protocol being implemented by the Angeles University Foundation Medical Center located in Angeles, Pampanga they classify their admission as either: Direct Admission or Emergency Room Admission.

Patients with doctors orders for Direct Admission after consultation may proceed directly to the admitting section of the hospital for immediate processing. Upon patients arrival at the Medical Center they will be assessed at the Emergency Department and checked into the hospital at the Admitting Office and their staff will assist the patient in getting a room of their choice or assign a room according to the patients medical need. Patients will be given their admission documents, kit and an identification bracelet (ID) which they must wear until they have been discharged from the hospital. The Staff assigned from the Admitting office will then

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escort the patient to their assigned room and make sure that they feel comfortable. Our resident doctors and nursing staff will then visit the patient soon afterward. On the other hand for Emergency Room Admission and in all pediatric cases the following procedure has been observed: After the need for admission is verified, patients or their authorized representative will be requested to accomplish a registration form. Upon submission of the completed registration form, the admitting officer will provide information about the availability of rooms, hospital policies and procedures, safety and security policies, and other matters pertinent to admission. An admission agreement is printed out by the admitting officer to be signed by the patient or his authorized representative. A nursing assistant will then come by to bring the patient to their room. They have also included special considerations especially for cases of communicable diseases which is an SOP (Standard Operating Procedure) are being admitted at private rooms (AUFMC, 2012) The goal of each health care provider is to provide care which is efficient, low in cost, and as safe as possible. One method of providing safe care is by adherence to the specified protocols for nursing practice. Opponents to protocols feel that adherence is limiting and merely an attempt by physicians to limit nurse practice scope. (Clark & Dunn, 2000) Adherence to protocols and guidelines can be viewed in a positive way to define nursing practice standards. Defined practice standards can aid in guiding care and defining the role of nurse practitioners. Formulation of protocols in a collaborative fashion with physicians or other health maintenance organizations is one positive method of establishing consistent processes and levels of care rendered by all health providers. (Campbell, 2001) Few interventions to increase adherence have been demonstrated through rigorous research to be consistently effective. Because human behavior is complex, there is no single or simple explanation for non-adherent behavior. However, there is growing consensus among
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researchers that the behavior of the health care provider has a significant influence on patient adherence. Specifically, the health care professionals ability to communicate and explain information while expressing warmth and concern for the patient appears to be associated with increasing patient adherence. (Zuffaliger, 2010) According to an article by Biomed Central they defined adherence as the extent to which certain behaviour (for example, following hospital policies & guidelines, physicians orders) is in accordance with the physicians' instructions or health care advice. Adherence can be influenced or controlled by a variety of factors like culture, economic and social factors, self-efficacy, and lack of knowledge or means. Guidelines that guide an individual's behaviour exist in a variety of settings (including health care settings), but people do not always adhere with them. In order to explain and understand the factors that influence an individual's adherence with certain guidelines, which consequently may contribute to the adoption of certain behaviour, a number of conceptual models or theories have been developed. One of the most commonly used models is the Health Belief Model. (Efstathiou, 2011)

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CHAPTER 3 METHODOLOGY

A. METHOD OF RESEARCH The design is a descriptive study. Descriptive research is used to obtain information concerning the current status of the phenomena to describe what exists with respect to variables or conditions in a situation. It is used to provide a systematic description that is as factual and as accurate as possible. The investigators chose this design because they want to determine whether the admission protocol is being followed and the amount of time spent in each step.

B. POPULATION The population in this study will be the patients to be admitted at the UERM Hospital from February to March 2013.

C. SAMPLING TECHNIQUE The type of probability sampling to be used will be purposive sampling. This type of sampling is constructed to serve a very specific need or purpose. The studys sample s ize, 30 individuals, are going to be selected from the patients to be admitted at the UERM Hospital from February to March 2013.

D. DATA GATHERING INSTRUMENT

The tool is a checklist containing the admission protocol with which the actual admission practice will be compared, indicating whether the activity is done or not done and the amount of time spent in doing the activity.
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E. DATA GATHERING PROCEDURE Inform the admitting department of the admission protocol observation

Conduct observation of admission practice and accomplish checklist

Collate data gathered

Draw inferences based on the results of the study

Write conclusion

Write recommendations

F. STATISTICAL TREATMENT OF DATA To derive comprehensive, valid, and reliable source results, the following statistical methods and techniques are going to be utilized: Frequency and Percentage. These tools will be used to determine the distribution of the observation in steps while percentage will be employed to determine the level of adherence of the registered nurses in each admission. Average Weighted Mean. These will determine the average score value in adherence in each step of the admission protocol and the amount of time spent in each step.

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BIBLIOGRAPHY Admission Protocol for Community Hospitals.(2010, August). Retrieved February 19, 2013, from https://docs.google.com/viewer?a=v&q=cache:PP4vL9QUepsJ:www.oxfordshirepct.nhs.uk/abou tus/documents/106AdmissionProtocolforCommunityHospitalsAugust2010.pdf+&hl=fil&gl=ph& pid=bl&srcid=ADGEESioUZHpwPY5VKxCYVbKONnxnfSCtTg7gmAkrnhDUyWePizFD4MuwbpPMb1BwQVgIkrLFP9Iph0EzJcfJRF582iCc_vARHR7tTHr25nxoufTkfM3k94Qc2z8ZtTdGvj6TtYvph&sig=AHIEt bRbrv-kH7D2LkldoQ2YK4NoRBDdpA Al-Tehewy, M. et al. (2009) Appropriateness of hospital admissions in general hospitals in Egypt.La Revue de Sante de la Mediterraneeorientale, Volume 15. Retrieved February 19, 2013 from http://www.ncbi.nlm.nih.gov/pubmed/20214126 Best practice initiative: Admission folder. California ED Diversion Project. Retrieved February 19, 2013 from http://www.caeddiversionproject.com/uploads/tools/CAEDDP_Admission-Folder.pdf Sanchez-Garcia, S. (2008) The hospital appropriateness evaluation protocol in elderly patients: A technique to evaluate admission and hospital stay. Scandinavian Journal of Caring Sciences, Volume 22. Retrieved February 19, 2013 from http://onlinelibrary.wiley.com/doi/10.1111/j.14716712.2007.00528.x/abstract?systemMessage=Wiley+Online+Library+will+be+disrupted+on+23 +February+from+10:00-12:00+BST+(05:00-07:00+EDT)+for+essential+maintenance Rogers, G. et al. (2006) Reconciling medications at admission: Safe patient recommendations and implementation strategies. Journal on Quality and Patient Safety, Volume 32. Retrieved February 19, 2013 from http://stage.wapatientsafety.org/downloads/s6.pdf

Improving Hospital Admission and Discharge for People who are Homeless. (May 2012). Retrieved February 19, 2013 from http://homeless.org.uk/sites/default/files/HOSPITAL_ADMISSION_AND_DISCHARGE._REP ORTdoc.pdf Aguillar, O.M., Dantas, R.A., & Dos Santos, B.C. (2002). Implementation of a nursemonitored protocol in a Brazilian hospital: a pilot study with cardiac surgery patients. Sao Paulo, Brazil: University of So Paulo, So Paulo, Brazil. Hospital Admission and Discharge: People who are homeless or living in temporary or insecure accommodation. (8 December 2006). Retrieved February 19, 2013 from https://www.gov.uk/government/publications/hospital-admission-and-discharge-people-who-arehomeless-or-living-in-temporary-or-insecure-accommodation

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Community Health Oxfordshire Hospital. (2004) Retrieved February 19, 2013 from https://docs.google.com/viewer?a=v&q=cache:PP4vL9QUepsJ:www.oxfordshirepct.nhs.uk/abou t-us/documents/106AdmissionProtocolforCommunityHospitals John Dempsey Hospital. (2000) Retrieved http://homeless.org.uk/sites/default/files/Take-a-step-tips Hospital%20Admission%20and%20Discharge.pdf February 19, 2013 from

University of Connecticut Health Center. (2003). Documentation: Admission (Inpatients). Retrieved February 19, 2013 from https://docs.google.com/viewer?a=v&q=cache:_dhizgPVojEJ:nursing.uchc.edu/nursing_standard s/docs/Documentation%2520%2520Admission%2520(Inpatients).pdf+The+Registered+Nurse+must+initiate+an+individualiz ed+plan+of+care+for+every+patient+within+24+hours+of+admission&hl=fil&gl=ph&pid=bl&s rcid=ADGEESgy6PzZQkmPJuzCKGOX6ENG5avFywgTR9h7i6BvNE2MyIX8G2XvOpdXsbv 9znksbxkCMscQ0pxyNteDRUP7rb7oQmH7OOkXHVX9OSmhLwjeMNBAYzbnXVT2YU9mbBSHfzGvcXz&sig=AHIEtbQmP4VFp7ECdyLT4J4SRDDsZ0YlmQ Manias, E. & Street, A. (2000).Legitimation of nurses knowledge through policies and protocols in clinical practice.Journal of Advanced Nursing, 32(6), 1467-1475 Nelleke van Sluisveld, Marieke Zegers1, Stephanie Natsch, Hub Wollersheim, Medication reconciliation at hospital admission and discharge: insufficient knowledge, unclear task reallocation and lack of collaboration as major barriers to medication safety, Radboud University Nijmegen Medical Centre, PO Box 9101, Nijmegen, the Netherlands Department of Clinical Pharmacy, Radboud University Nijmegen Medical Centre, PO Box 9101, Scientific Centre Quality of Care, Catholic University Leuven, Kapucijnenvoer, B-3000, Leuven, Belgium,(21 June 2012) Anderson, A. J., Micheels, P., Cuoco, L., Byrne, T.,CRITERIA BASED VOLUNTARY & INVOLUNTARY PSYCHIATRIC ADMISSIONS MODELING, Criteria Based Voluntary and Involuntary Psychiatric Admissions Modeling. International Journal of Psychosocial Rehabilitation. 2(2), 176-188. (1998) Sami SalehAlwakeel*, Nasser M. Alotaibi, End-to-end Measurement Based Admission Control VoIP protocol with loss policy, Journal of King Saud University Computer and Information Sciences (2011) 23, 3743, (4 July 2010) JooSangYoun, Sangheon Pack and Yong-Geun Hong, Distributed admission control protocol for end-to-end QoS assurance in ad hoc wireless networks (10, November 2011) MikkelBrabrand, Torben Knudsen, JesperHallasDo acutely admitted medical patients comply with the Appropriateness Evaluation Protocol?Brabrand et al. Scandinavian Journal of Trauma, From Danish Society for Emergency Medicine: Research Symposium 2010
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Resuscitation and Emergency Medicine (2010) Al-Tehewy,1 E. Shehad,1 M. Al Gaafary,1 M. Al-Houssiny,1 D. Nabih1 and B. Salem2, Appropriateness of hospital admissions in general hospitals in Egypt, La Revue de Sante de la Mediterraneeorientale, Vol. 15, N 5,(2009) Service Manager Community Officials, Community Hospitals106- Protocol For Admitting Patients to a Community Hospital in Oxfordshire.Community Health Oxfordshire Policy Group13 (July 2010) The health boards executive, Admissions and Discharge Guidelines Health Strategy Implementation Project.(2003) department of health,Victorian Hospital Admission Policy. Published by the Funding and Information Policy Branch, Victorian Government, Department of Health, Melbourne, Victoria, (1 July 2012) Hazel Sutherland Executive Director Education & Social Care, Shetland Islands Council,Admission Protocol for Hospital Patients in Shetland, NHS Shetland / Shetland Islands Council -Admission Protocol (October 2009) Silmara Elaine Malaguti-Toffano, CludiaBenedita dos Santos, Silvia Rita Marin da Silva Canini, MarliTerezinhaGimenesGalvo, Maria MeimeiBrevidelli, ElucirGirAdherence to standard precautions by nursing professionals in a university hospital, (16/03/2011 and accepted 09/12/2011) J Restuccia, M Shwartz, A Ash and S Payne, Health affairs at the intersection of health, health care policy, High hospital admission rates and inappropriate careHealth Affairs, 15, no.4 (1996):156-163doi: 10.1377/hlthaff.15.4.156 M. Al-Tehewy, E. Shehad, M. Al Gaafary, M. Al-Houssiny, D. Nabih, B. Salem, Appropriateness of hospital admissions in general hospitals in Egypt General Directorate of Quality, Ministry of Health, Cairo, Egypt. La Revue de Sant de la Mditerraneorientale, Vol. 15, N 5, )2009) HELEN J. STREUBERT SPEZIALE (2002) RN-MSN Admission Practices and Curricula in theMid-Atlantic Region. Nursing Education Perspectives, November 2002, Vol. 23, No. 6, pp. 294-299.

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Amarasingham, R. (8 February 2010). PubMed.A rapid admission protocol to reduce emergency department boarding times. Retrieved February 19, 2013 from http://www.ncbi.nlm.nih.gov/pubmed/20142408 Lepaux, D. J. (2001) Improving the quality of the admission process in a French psychiatric hospital: Impact on the expertise of the professional team.International Journal for Quality in Health Care, Volume 13, Number 4. Retrieved February 19, 2013 from http://intqhc.oxfordjournals.org/content/13/4/333.full.pdf Hellstrom, L; Bondesson, A; Hoglund, P; Eriksson, T. (2012) Errors in medication history at hospital admission: Prevalence and predicting factors.BMC Clinical Pharmacology, 12:9. Retrieved February 19, 2013 from http://www.biomedcentral.com/1472-6904/12/9 Ortiga, B. et al. (2012) Standardizing admission and discharge processes to improve patient flow: A cross sectional study. BMC Health Services Research, 12:180. Retrieved February 19, 2013 from http://www.biomedcentral.com/1472-6963/12/180 Best practice guidelines for hospital admission. Private Health Insurance Ombudsman publication. Retrieved February 19, 2013 from http://intqhc.oxfordjournals.org/content/13/4/333.full.pdf Graf, C. (2008) The hospital admission risk assessment profile. The Hartford Institute for Geriatric Nursing, New York University, College of Nursing. Retrieved February 19, 2013 from http://consultgerirn.org/uploads/File/trythis/try_this_24.pdf

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Chaudhry, S. (2011). Examining the drivers of readmissions and reducing unnecessary readmissions for better patient care. Retrieved from http://www.rush.edu/rumc/page1277738436397.html. Jaimovich, G. (2004). admission and discharge guidelines for the pediatric patient requiring intermediate care. 32(5), Eilers, R. (2010). Admissions and medical clearance protocols. (2010). discuss the persons normal medication routine with them and their carepartners. understanding Jackson, J. (2011). Elective admission mrsa screening protocol. Elective Admission MRSA Screening Protocol, 3, 9.

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APPENDICES APPENDIX A: Admission Protocol Checklist

University of the East RAMON MAGSAYSAY MEMORIAL MEDICAL CENTER, INC. #64 Aurora Boulevard, Brgy. Doa Imelda, Quezon City Checklist No. _______ ADMISSION PROTOCOL CHECKLIST Done Not Done Time Started 1. Patient consults at the Emergency Room, Out-Patient Department, and Admission Area 2. Giving of admission slip with diagnosis to patient 3. Admitting Area then: 1. Explains policy to patient 2. Completes Patients Information 3. Ensures consent 4. Have clients sign: Memorandum of Undertaking (Pay Patients) Checklist (Hospital Policy) (Charity Patients) 4. Admitting Area encodes data 5. Admission Area selects room according to clients preference 6. Patient goes to the cashier and pays initial fees 7. Patient goes back to the Admission Area and presents OR number 8. Patient is accompanied by appropriate personnel to his/her room
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Time Ended

Total Amount of Time Spent

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