Reporting and Recording for HCAs (CACC111)

• Discuss the HCA’s role in observing and reporting unmet needs in clients.
• Describe common practices for reporting and recording in various health care settings (complex care, community care, and acute care).
• Describe requirements for recording in a timely fashion.
• Discuss the use of clear, current, factual, objective, and relevant language when reporting or documenting client information.
• Discuss the use of appropriate lines of communication.
• Discuss appropriately communicating information about the client while respecting confidentiality.
• Discuss reporting of safety concerns.

Topics include:

• Observing and reporting unmet needs.
• Lines of communication
• Reporting and recording — when, what, how.
• Legal implications of the written word.
• Use of clear, current, factual, objective, and relevant language when reporting or documenting client information.
• Common practices in different health care settings, including complex care, community care, and acute care settings.
• Paper-based documentation (e.g., flow sheets, records, charts). ◦ Electronic-based documentation.
• Electronic health records (EHRs).
• Tools used for EHRs, including computers, tablets, and mobile devices.
• Common health technology systems in B.C.
• Privacy, confidentiality, and security requirements.
• Reporting safety concerns.

All required resources will be provided within the course.

The primary resource used is Sorrentino’s Canadian Textbook for the Support Worker (5^th Canadian Edition). It is available through the Douglas College Bookstore for anyone wishing to order a copy. It may also be available at public college libraries throughout BC where the Health Care Assistant Program is offered. This textbook is used by HCA programs throughout BC, and most of Canada. It is a good resource for anyone working as an HCA in BC.

Interactive online course delivered through Blackboard.

Due to the nature of an online delivery, the student will be expected be proficient in computer skills including email, adding attachments, navigating the internet etc. Resources for getting started with Blackboard are available online to help get the student comfortable in the Blackboard environment.

The course is graded as Mastery/Non-mastery.

Successful course completion proven with official transcript request.