Question

1. Imogene King is a strong advocate of documenting patient transactions. Discuss whether documenting goals on the chart is feasible and appropriate, what advantages are obtained from this documentation process, how the patient’s privacy can be maintained (e.g., if the patient’s spouse is abusive and intrusive, is it appropriate to document the patient’s goal of filing for divorce where the spouse can see it?)

Answer 1

Documentation is the major important factor in healthcare delivery system.It is a critical component to the delivery of healthcare. It is a tool to:

• Ensure continuity of care as it serves as a communication tool among healthcare providers
• Plan and evaluate a patient’s treatment
• Create a permanent record for the patient’s future care
• Create a database to evaluate effectiveness of treatment
• Facilitate research
• Substantiate billing
• Recollect a memory and/or justify/defend care provided.
• Documentation is also have legal value. It should be done with date time, document the details at the time off it happens , should include all the completed tasks at proper time. Also documentation should have another property of Securing patient informations . It has the responsibility if maintain privacy off the patient and should not disclose it to anything