Purpose:
To ensure thorough evaluation and care coordination upon client discharge from Recover Care services.
Regulation: 144A.4794(3)
Policy: RC-C8
Measurement:
- 100% of discharged clients have a discharge summary with the required items addressed and documented
Process:
- Upon confirmed discharge, RN Case Manager will add a discharge note in the client's chart in ClearCare. This note will be added in the Activity section of the client's chart with the Tag: "Termination of Services: XXX" (Enter in appropriate discharge reason). The discharge summary must include:
- Client diagnosis
- Reason for initiation of services
- Brief summary of service provided
- Client’s condition upon service initiation
- Reason for discharge or transfer
- Client’s condition at discharge or transfer
- Notification activity of discharge or transfer
- Location client was discharged or transferred to
- RN Case Manager will notify individual responsible for staffing via email and Clinical Manager/Administrator
- Staffing will be cancelled within 24 hours of notification from RN Case Manager
- RN Case Manager will deactivate client in ClearCare
- RN Case Manager will obtain any paper chart documentation from client home (MARs, PRN, etc.)
- RN Case Manager will upload returned documentation in client's ClearCare chart under "Files"
- If discharge reason is death, a "Death - Chart Review & Evaluation" must be completed and saved in the client chart audit folder in the S:Drive
- MN ONLY - Clinical Manager/Administrator will enter client in MDH discharge census