Elements and Performance Criteria
- Develop care plan for client
- Use standing order/written care protocols to underpin health care plans
- Consult clients about proposed care plan and explain how it relates to their health assessment results
- Develop the care plan with reference to relevant health care team and other health care providers
- Propose treatment in accordance with organisation policies and procedures and as negotiated with the client, their family and/or the community
- Include measures consistent with standing orders/ written protocols, based on health assessment findings
- Refer clients as required to relevant health professionals in line with community, organisation and regulatory requirements
- Clearly establish responsibilities for implementing the care plan and obtain client agreement to plan
- Document health care plan in client's file in line with organisation policies and procedures
- Implement care plan
- Build and maintain a relationship of trust with each client, with active promotion of and strict adherence to confidentiality
- Provide health information to client in appropriate language, supported by visual and other aids as required
- Provide client with information about each aspect of the care plan and the rationale for its inclusion
- Initiate action (including referral) as determined by effective decision-making in line with organisation policies based on results of clinical assessment and in accordance with accepted procedures and protocols
- Conduct treatment in accordance with the care plan, organisation policies and procedures and occupational health and safety requirements
- Use medical equipment correctly and maintain in accordance with manufacturer's specifications and organisation policies
- Provide client with information about promoting and maintaining health in a way they understand
- Maintain current, complete, accurate and relevant records for each client contact
- Support client to take a self-care approach to implementing care plan in line with individual, organisation and community requirements