The TJC focus on the discharge process continues in 2014. During surveys, surveyors will frequently request a sample of closed records. In the past, the focus for closed records was on determining if the discharge summary had been completed on time. More recently, however, surveyor focus has been on evaluating whether the patient/client was given appropriate instructions about their medications at discharge. Two issues are getting close scrutiny:

Issue #1: Were the medication instructions provided to the client/family in a way that they could easily understand?

There is a standard in both the Hospital and Behavioral Health manuals that speaks directly to this issue:

Hospital Manual: PC.04.01.05 EP 8:“The hospital provides written discharge instructions in a manner that the paaptienand/or the patient’s family or caregiver can understand.”

BH Manual:CTS.06.02.03 EP 9:“The organization provides the individual served and his/her family, if applicable, discharge instructions in a form the individual can understand.”

Several organizations have been cited for the fact that their discharge instructions related to medication were written in medical terminology that could not be easily understood by the client/family. Surveyors have specifically cited terms such as “BID, QHS, PO and QAM” as not being in consumer friendly language. Thus, it’s important to ensure that whoever is preparing the discharge instructions writes the medication instructions in “everyday” language such as “twice a day,” “by mouth,” etc.

Issue # 2: Was the client educated about the medications he/she should be taking after discharge?

The Medication Reconciliation standard addresses the requirement for educating the patient/client about their medications at discharge:

Hospital Manual: NPSG.03.06.01 EP 5: “Explain the importance of managing medication information to the patient when he or she is discharged from the hospital or at the end of an outpatient encounter.”

BH Manual:NPSG.03.06.01 EP 5: “Explain the importance of managing medication information to the individual served.”

Several organizations have been cited for not educating patients/clients about their medications at discharge. The typical scenario is that the surveyor reviews a copy of the discharge instructions and there is no documentation (either on the discharge instruction form or in a progress note) that the patient received education about their medications at discharge. So, we recommend that you build into your discharge instructions form a place to document the medication education that was provided. This can be as simple as a check-off box that indicates the education was provided. For more information on how surveyors are evaluating the discharge process, see our March 2012 article Increased Focus on Discharge Planning in Psychiatric Hospital Surveys.