Public Health Organisations - The Health Care Records Policy - Health Assignment Help

Assignment Task :

Summary The Health Care Records Policy defines the requirements for the documentation and management of health care records across public health organisations in the NSW public health system. The Policy ensures that high standards for documentation and management of health care records are maintained consistent with common law, legislation, ethical and current best practice requirements.

PURPOSE  

The purpose of this policy is to:  

• Define the requirements for the documentation and management of health care records  across public health organisations (PHOs) in the NSW public health system.  
• Ensure that high standards for documentation and management of health care records are  maintained consistent with common law, legislative, ethical and current best practice  requirements.  

Clinical audits of documentation in health care records should involve a team based approach  with the clinical team consisting of medical practitioners, nurses, midwives, allied health  practitioners and other health care personnel, as appropriate.  

Health care record audit results should be:  

a) Provided to relevant clinical areas and health care personnel.  

b) Included in PHO performance reports.  

c) Referred to PHO quality committees to facilitate quality improvement. 

1.5 Education  

PHOs must establish a framework for the development and delivery of suitable education on  documentation and management of health care records. All health care personnel who document  or manage health care records must be provided with appropriate orientation and ongoing  education on the documentation and management of health care records.  

The content and delivery of education programs should be informed by health care record audits.  The results of such audits should be used to target problem areas relating to particular health  care personnel groups or facets of documentation and management.  

Specific education must be conducted for the introduction of any new complex health care record  forms and for changes in documentation models. 

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