The percentage of seriously medically and mentally ill individuals in carceral settings is higher than ever. With less than ample staff, health care professionals work tirelessly to meet those patients' needs and documentation is often neglected. When documentation is missing, incomplete, or inaccurate, patient care suffers and liability risk increases. This refresher will cover basic principles and simple tips to help you write accurate, brief, concise, and complete documentation.

Educational Objectives

• Recite the six principles of documentation and their application in facilitating patient care
• Review examples and case studies that underscore the potential for serious consequences of poor documentation
• Demonstrate three techniques that will ensure documentation is brief, concise, and complete

Level:Intermediate