Inpatient Nursing Discharge - hmislk/hmis GitHub Wiki

Inpatient — Nursing Discharge

Nursing discharge is stage 4 of the inpatient discharge process. It is performed by nursing staff to formally confirm that the patient has been prepared for departure: all rooms are cleared, discharge medications have been explained, and any pending pharmacy requests have been resolved. Once confirmed, nursing discharge is required before the final bill (or any interim bill settlement) can be processed.

Page: Admission Profile → Clinical Data → Nursing Discharge, or Nursing Workbench → Clinical Data → Nursing Discharge
XHTML: /inward/inward_nursing_discharge.xhtml
Controller: NursingDischargeController
Privilege: InwardNursingDischarge
Fields on PatientEncounter: nursingDischarged (Boolean), nursingDischargeDateTime (Date), nursingDischargedBy (WebUser)

Discharge Flow Overview

The five-stage discharge sequence is:

Stage Who Action
1 — Clinical Discharge Doctor Records that the patient is medically fit to leave
2 — Room Discharge Nurse/Ward Clears the patient from the room; room returns to vacant
3 — Nursing Discharge Nurse Confirms readiness: rooms cleared, meds explained, pharmacy resolved
4 — Administrative Discharge Billing Settles the final bill; closes the admission financially
5 — Physical Discharge Nurse Records the moment the patient physically leaves the hospital

Nursing discharge sits between room clearance and billing. It acts as the authoritative checkpoint before the money side closes.

Prerequisites

Before nursing discharge can be confirmed, the system enforces:

  1. Room discharge completed — the patient must have no active room stay. If any room is still open, nursing discharge is blocked.
  2. No pending pharmacy items — any outstanding BHT pharmacy transaction must be resolved first. Four kinds block discharge:
    • a pharmacy request that has not been fully issued
    • medicines issued by Pharmacy but not yet received by the Ward
    • a ward return not yet accepted by Pharmacy
    • a direct-issue return not yet processed
  3. No pending lab investigations — any investigation ordered for the admission must have been pushed through Send to Lab. An investigation still sitting at Ordered, Barcode Generated, or Sample Collected blocks discharge; once its sample is sent to lab, it no longer blocks (later lab-side statuses such as Accepted or Approved don't matter). An investigation whose bill was cancelled, or whose bill item was returned/refunded, does not count as pending.
  4. No running timed services — any Inward timed service (e.g. oxygen, nebulization, ventilator time) added on this admission or a child encounter that has not yet been stopped (Stopped Time left blank) blocks discharge with "Cannot confirm nursing discharge: N timed service(s) are still running and must be stopped first." Stop each one from Manage Inward Timed Services (its row's Update button) before retrying.

When anything is pending, the page lists the blocking items and the Confirm Nursing Discharge button stays disabled until they are resolved:

Nursing discharge blocked, listing the pharmacy items still pending

Nursing discharge blocked: each pending pharmacy item is listed with its reason, and Confirm Nursing Discharge stays disabled until they are resolved.

Nursing discharge blocked, listing lab investigations not yet sent to lab

Nursing discharge blocked: four investigations (FBC, CRP, Creatinine, Electrolytes) are still "Ordered" and have not been sent to lab, so Confirm Nursing Discharge stays disabled.

Nursing discharge unblocked once all investigations have been sent to lab

Once all four investigations are sent to lab, the warning panel clears and Confirm Nursing Discharge becomes enabled.

Confirming Nursing Discharge

  1. Navigate to the Nursing Discharge page from the Admission Profile or Nursing Workbench.
  2. If prerequisites are not met, the page shows the blocking reason (active room, pending pharmacy items, or pending lab investigations) and the Confirm button is disabled. Each prerequisite has its own Refresh Pending Items button to re-check that one without leaving the page.
  3. If all checks pass, click Confirm Nursing Discharge.

On success:

  • patientEncounter.nursingDischarged = true
  • patientEncounter.nursingDischargeDateTime = current timestamp
  • patientEncounter.nursingDischargedBy = logged-in user
  • A notification is raised (NursingDischarge notification type)

The Admission Profile button for Nursing Discharge turns green, and the page shows a confirmation banner:

Nursing discharge confirmed once all prerequisites — including no running timed services — are met

Cancelling Nursing Discharge

If nursing discharge was confirmed in error it can be reversed — but only if physical discharge has not yet been confirmed. Click Cancel Nursing Discharge on the same page. The three fields are cleared and billing is re-blocked.

Effect on Timed Services

Once nursing discharge is confirmed, the Inward Manage Inward Timed Services page locks all three actions for that admission's timed services — Add, Update (stopping/re-pricing a service), and Remove — with "Cannot change timed services: nursing discharge has been confirmed for this patient." A user holding the InwardAddChargesAfterNursingDischarge privilege can still make changes after nursing discharge, the same override that already applied to Add.

Effect on Billing

From PR #21553, the bill settlement gate (BhtSummeryController.checkDischargeTime()) was changed:

Before After
Checked that all previous rooms were individually discharged Checks isNursingDischarged()
Compared bill time against room discharge time Compares bill time against nursingDischargeDateTime

What this means for staff:

  • Attempting to settle an interim or final bill before nursing discharge is confirmed produces the error: "Nursing discharge must be completed before the bill can be settled."
  • If the bill discharge time is set earlier than the nursing discharge time, the error is: "Discharge time must be on or after the nursing discharge time."
  • Once nursing discharge is confirmed and the time is valid, billing proceeds normally.

This applies to admission types where room charges are enabled. Day-case admissions (no room charges) bypass this check and can be billed without a nursing discharge step.

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