acronyms; the problems
a foreign body or a patient's social media account.
What is FB?
Copy and pasting routine information between patients
What is never do this?
only appropriate when discussing your availability to work an extra shift, as all documentation must be based on fact, observation and/or the consumer's own statements.
What is "being vague"?
A real question posed to an AH MDT by a med intern when he saw #NOF in a patient's file.
what is hashtag NOF?
Also known as above knee amputation.
What is AKA?
this routine ensures typed errors are minimised.
What is check spelling before saving?
is the timeframe when events should be documented, signed and dated.
What is "contemporaneously"?
This needs to be added in addition to the date, time, name and designation for a retrospective entry in a patient's file.
What is clear documentation that this entry is retrospective and why?
Perhaps the most important Allied Health discipline, or a person supporting an NDIS participant.
What is SW?
Include 3 points of ID, patient consent and SW introduction
What is what to include in your initial note? (often asked in auditing)
the circumstances for when emojis can be used in documentation
What is NEVER (seriously, what happened that this needed to be included)
The designated AI chat application endorsed by Peninsula Care Group
What is Microsoft Copilot?
Is when blood can’t get to all parts of your brain for a short time, or is a Gr 1 social worker.
What is TIA?
admission reason and reason for referral
What is things to identify in the initial psychosocial assessment?
When an email can be copied and pasted (without modification) in a progress note (including the date and time it was received and it's author)
What is only clinically relevant correspondence?
What ink is the only acceptable colour for if you find yourself having to write in a patient's paper file as a Social Worker?
What is black ink?
Is how you can avoid problems and utilise any acronym within your documentation.
What is use the expanded version of the acronym first, and include the acronym to be used in brackets?
a reason outside of patient centred care for why clear, objective documentation is important.
What is being subpoenaed?
This must be written in red and in capital letters at the top of entries containing information about Family Violence and Child Protection matters.
What is "FOI SENSITIVE & CONFIDENTIAL INFORMATION"?
Is the Peninsula Care Group policy stance on use of abbreviations
What is avoid using them?