*PR: Standards Revisions for Psychiatric Hospitals with Deemed Status[®] [REF: 2015, AT, CMS, IM, MD, SW] Perspectives, January 2015, Vol 35, #1, Pg 8 JCp1501_B01
In concert with its in-progress reapplication for psychiatric hospital deeming authority, TJC has revised nine requirements and developed one new requirement to help ensure its alignment with CMS Conditions of Participation. The following changes for hospitals using TJC for deemed status purposes become effective on 2/1/15:
- LD.04.03.01, EP1: Agreement(s) and/or transfer mechanisms in place to ensure timely surgical services if not available in-house {B145}
- LD.04.03.01, EP14: Therapeutic activities must be appropriate to patient needs/interest and focused on restoration/maintenance of functioning both physical and psychological. {B157}
- PC.01.02.13, EP2: Assessments include documentation of illness onset {B114} and patient strengths/disabilities in descriptive (vs. interpretive) manner {B117}.
- PC.01.02.13, EP5: Assessments include a social history and reports of interviews with patient and significant others {B108}.
- PC.01.02.13, EP6: When indicated, a complete neurological exam is conducted at the time of the admission physical exam {B109}.
- PC.01.03.01, EP1: Treatment planning also referenced to PC.01.02.13, EP2
- PC.01.03.01, EP6: Treatment plans include a substantiated diagnosis [Key Def] {B120}, justification of the diagnosis and “all active therapeutic efforts” {B125}.
- RC.02.01.01, EP2: Medical record diagnosis include intercurrent diseases [Key Def] {B106}.
- RC.02.01.01, EP10: When indicated, progress notes include recommendations for treatment plan revision as well as “precise assessment” of patient progress {B132}.
- RC.02.04.01, EP3: All discharged patients must have a discharge summary that at minimum addresses 6 specified points (see details in comments section) {B133-5}.
Tip: Review the CMS Interpretive Guidelines (e.g., {B106}) related to the B-Tags (Appendix AA) upon which these changes are based. See also Key Definitions in the comments section of this article and Prepublication Standards – Standards Revisions for Psychiatric Hospitals
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2 responses to “RTN1501_B01_2015 Psych Hosp Standard Revisions”
Key Definition: A Substantiated Diagnosis
• The substantiated diagnosis is the diagnosis identified by the treatment team to be the primary focus upon which treatment planning will be based. It evolves from the synthesis of data from various disciplines. The substantiated diagnosis may be the same as the initial diagnosis or it may differ.
Key Definition: Intercurrent Diseases
• Diseases that may occur during the course of another disease; for example, a patient with AIDS may develop an intercurrent bout of pneumonia (or a patient with schizophrenia may develop a urinary tract infection).
Requirements for Discharge Summaries
As per TJC RC.02.04.01, EP3
• The reason for hospitalization
• The procedures performed
• The care, treatment, and services provided
• The patient’s condition and disposition at discharge
• Information provided to the patient and family
• Provisions for follow-up care
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As per B133
“The discharge summary should contain a recapitulation of the patient’s hospitalization, which is a summary of the circumstances and rationale for admission, and a synopsis of accomplishments achieved as reflected through the treatment plan. This summary includes the reasons for admission, treatment achieved during hospitalization, a baseline of the psychiatric, physical and social functioning of the patient at the time of discharge, and evidence of the patient/family response to the treatment interventions.”
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As per B144
“The patient’s discharge summary should describe the services and supports that are appropriate to the patient’s needs and that will be effective on the day of discharge.”
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As per B135
The patient’s discharge planning process should address anticipated problems after discharge and suggested means for intervention, i.e., accessibility and availability of community resources and support systems including transportation, special problems related to the patient’s functional ability to participate in aftercare planning.
The discharge summary and/or plan should contain information about the status of the patient on the day of discharge, including psychiatric, physical and functional condition.