Transcription of PRACTICE STANDARD Documentation, Revised 2008
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PRACTICE STANDARD Documentation, Revised 2008
PR ACTICE STANDARD . documentation , Revised 2008. Table of Contents Introduction 3. Why Document? 3. The Inter-relationships that support clients through documentation 5. STANDARD Statements and Indicators 6. communication 6. Accountability 7. Security 8. Appendix A: Supporting documentation Practices 9. Appendix B: Nursing documentation Legislation References 10. Appendix C: Electronic documentation Resources 11. Suggested Reading List 11. VISION. Leading in regulatory excellence MISSION. Regulating nursing in the public interest documentation , Revised 2008 Pub. No. 41001. ISBN 978-1-77116-066-7. Copyright College of Nurses of Ontario, 2017. Commercial or for-profit redistribution of this document in part or in whole is prohibited except with the written consent of CNO. This document may be reproduced in part or in whole for personal or educational use without permission, provided that: Due diligence is exercised in ensuring the accuracy of the materials reproduced.
Communication Nurses ensure that documentation presents an accurate, clear and comprehensive picture of the client’s needs, the nurse’s interventions and the client’s outcomes. Indicators A nurse meets the standard by: a) ensuring that documentation is a complete record of nursing care provided and reflects all aspects
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