N.J. Admin. Code § 8:43G-11.5

Current through Register Vol. 56, No. 21, November 4, 2024

Section 8:43G-11.5 - Discharge planning patient services

(a) Patients who require post-discharge continuity of care shall be linked to needed resources, such as:

1. Placement in a nursing home;

2. Enrollment with a home care program;

3. Transfer to another health care facility;

4. Referral to community resources; or

5. Information regarding availability of Medicare or Medicaid benefits.

(b) The hospital shall make a diligent effort to find and effect an appropriate placement for any patient ready for discharge but requiring further care. Documentation shall be included in the patient's medical record.

(c) Patient care conferences or discharge planning rounds shall be held to discuss planning for patients needing continuity of care.

(d) The patient shall participate in the development of the discharge plan, where possible. The family or significant other shall participate in the development of the plan, where possible, and when the patient is able to agree, and does agree, to their involvement.

(e) Discharge planning shall be initiated within 24 hours of admission in accordance with 8:43G-18.5(d) and 33.2(c). If a patient's needs for post-discharge care change after a discharge plan is developed, the plan shall be modified to meet the patient's needs.

(f) The hospital shall have a mechanism to ensure that each patient receives, upon discharge, written instructions about follow-up care and medications, if relevant, and the telephone number of a contact person to call in case he or she has questions after discharge.

(g) For all patients who receive discharge planning, the patient's medical record shall include on-going documentation and a summary or summaries of the patient's discharge plan prepared by a member of the discharge planning team at the time of discharge, or within 30 days of discharge.

N.J. Admin. Code § 8:43G-11.5

Amended by R.1992 d.72, effective 2/18/1992.
See: 23 New Jersey Register 2590(a), 24 New Jersey Register 590(a).
Documentation requirements added at (b) and (g).
Amended by R.1999 d.436, effective 12/20/1999.
See: 31 New Jersey Register 367(a), 31 New Jersey Register 614(a), 31 New Jersey Register 4293(a).
In (e), substituted "within 24 hours of admission in accordance with N.J.A.C. 8:43G-18.5(d) and 33.2(c)" for "at an early stage of the patient's hospitalization" at the end of the first sentence.